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[Autoimmune neuropsychiatric disorders associated to infection by streptococcus in the paediatric age: PANDAS]
Y M Betancourt1, J C Jiménez-León, C S Jiménez-Betancourt
1Universidad de Carabobo, Valencia, Venezuela. neurojcj@telcel.net.ve
Insights
Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus (PANDAS) involves neuropsychiatric issues in children. This study found only 5.2% of analyzed cases were linked to a prior streptococcus infection.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Psychiatry
Context:
- PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus) describes neuropsychiatric disorders in children following streptococcal infections.
- This study investigated the clinical presentation and potential association with Group A beta-hemolytic streptococcus (GABHS) in pediatric patients.
Purpose:
- To clinically analyze 38 patients under 16 with tics, Tourette Syndrome (TS), or Obsessive Compulsive Disorder (OCD).
- To explore the association between these conditions and GABHS infections.
Summary:
- The study reviewed 38 patients (86.8% male) diagnosed with tics, TS, or OCD, with symptom onset most common in schoolchildren.
- Comorbidities included learning difficulties (78.9%), ADHD (71.1%), and OCD (36.8%). Abnormal EEG patterns were observed in 72.4% of patients.
- A link to streptococcus infection was identified in only 5.2% of the cases, aligning with existing literature.
Impact:
- Provides clinical insights into PANDAS spectrum disorders in a pediatric cohort.
- Highlights the prevalence of comorbidities like learning difficulties and ADHD in affected children.
- Suggests a low direct association with streptococcal infection in this specific patient group, warranting further research into underlying mechanisms.
Introduction:
The acronym PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus) describes the neuropsychiatric disorders resulting from an autoimmune response to an infection by streptococcus in children.
Aims:
The aim of this study was to clinically analyse 38 patients under the age of 16 with tics, Tourette syndrome (TS) or obsessive compulsive disorder (OCD) and their possible association to an infection caused by group A beta-haemolytic streptococcus (GABHS).
Method:
We reviewed the medical records at the Instituto Neurológico in Valencia (Venezuela) over a 12 year period (1988-2000). All the patients met the inclusion criteria set out by the National Institute of Mental Health in Bethesda (1997) and the DSM-IV.
Results:
Onset of the symptoms was higher in the group of schoolchildren (n=24), followed by the group of preschool children (n=8) and adolescents (n=6). Males were predominant (n=33) (86.8%). 17 patients presented chronic tics (44.7%), 13 had transitory tics (34.2%) and there were eight cases of TS (21.1%). The most frequently related comorbid disorders were: difficulties in learning (n=30) (78.9%), ADHD (n=27) (71.1%), OCD 14 (36.8%), sleep disorders (n=14) (36.8%), behavioural disorders (n=12) (31.6%), language disorders (n=11) (28.9%), psychomotor disorders (n=10) (26.3%) and nocturnal enuresis (n=7) (18.4%). Electroencephalogram patterns were abnormal in 72.4% (n=12), and the disorganised pattern was the most frequently observed (n=12) (41.4%), followed by a slow diffuse pattern (n= 7) (24.1%) and the left centro-parieto-temporal focal paroxysmal specific pattern (n=7) (24.1%). Less frequently we found unspecific generalised paroxysmal patterns, in four cases (13.8%), and asymmetrical patterns (n=1) (3.4%). The association with an infection by streptococcus was shown in two cases, which amounted to 5.2% of the sample.
Conclusions:
The obtained are similar to those reported in the literature. Only 5.2% of the cases were linked to a prior streptococcus infection.