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PANDAS: current status and directions for research
1Pediatrics & Developmental Neuropsychiatry Branch, Department of Health and Human Services, National Institute of Mental Health, Bethesda, MD 20892, USA. SniderL@intra.nimh.nih.gov
Molecular Psychiatry
|July 9, 2004
Summary
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) are a subgroup of childhood-onset OCD and tic disorders. Research focuses on the autoimmune theory linking streptococcal infections to these conditions.
Area of Science:
- Pediatric autoimmune neuropsychiatric disorders
- Neuroimmunology
- Childhood-onset neuropsychiatric conditions
Background:
- The PANDAS criteria established a distinct subgroup of children with childhood-onset obsessive-compulsive disorder (OCD) and/or tic disorders.
- These disorders are characterized by prepubertal onset, abrupt symptom exacerbations, and association with Group-A beta-hemolytic streptococcal (GAS) infections.
- Understanding PANDAS is crucial for targeted research into phenomenology and therapies.
Purpose of the Study:
- To outline the diagnostic criteria for PANDAS.
- To explore the proposed autoimmune pathophysiology of PANDAS.
- To provide a framework for research on PANDAS.
Main Methods:
- Review of the five established diagnostic criteria for PANDAS.
- Discussion of the theoretical autoimmune mechanism involving GAS infection and cross-reactivity with basal ganglia.
- Synthesis of current understanding regarding PANDAS etiology.
Main Results:
- The five criteria provide a homogenous subgroup for research.
- A working hypothesis suggests post-streptococcal autoimmunity, similar to Sydenham's chorea, underlies PANDAS.
- Antibody cross-reactivity with basal ganglia neurons is postulated as the cause of symptoms.
Conclusions:
- PANDAS represents a specific subgroup of pediatric neuropsychiatric disorders with a proposed autoimmune basis.
- Further research into the autoimmune pathophysiology is warranted.
- The established criteria facilitate systematic investigation of PANDAS.