The PANDAS subgroup: recognition and treatment

Area of Science:

• Pediatric Neurology
• Immunology
• Infectious Diseases

Background:

• A distinct subgroup of childhood-onset obsessive-compulsive disorder (OCD) patients exhibit symptom exacerbations linked to Group A beta-hemolytic streptococcal (GABHS) infections.
• This subgroup is termed Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS).
• PANDAS is characterized by specific clinical features including OCD/tic disorders, prepubertal onset, sudden symptom exacerbations, neurological abnormalities, and temporal association with GABHS infections.

Purpose of the Study:

• To investigate the efficacy of immunomodulatory therapies for PANDAS.
• To evaluate the potential of therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG) in treating severe neuropsychiatric symptoms in children with OCD and/or tic disorders.

Main Methods:

• A placebo-controlled trial was conducted.
• Severely ill children diagnosed with OCD and/or tic disorders participated.
• Treatment groups received either IVIG or TPE.

Main Results:

• Both IVIG and TPE demonstrated significant reductions in neuropsychiatric symptom severity.
• Reductions ranged from 40% to 55% in the treated groups.
• The post-streptococcal inflammatory nature of PANDAS symptoms suggests novel treatment avenues.

Conclusions:

• Immunomodulatory therapies, specifically IVIG and TPE, are effective in reducing symptom severity in children with severe PANDAS.
• Further research is needed to elucidate the mechanisms of action for these therapies.
• Additional studies are required to determine the role of antibiotic prophylaxis in preventing symptom exacerbations.