[PANDAS: a possible model for adult OCD pathogenesis]

Area of Science:

• Neuroscience
• Immunology
• Pediatrics

Context:

• Obsessive-compulsive disorder (OCD) and tic disorders are disabling conditions.
• Genetic predisposition plays a role, but specific genes remain unidentified.
• Recent research suggests streptococcal infections can trigger these disorders.

Purpose:

• To explore the potential role of streptococcal infections in the pathogenesis of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS).
• To investigate the proposed mechanism of molecular mimicry involving streptococcal antigens and basal ganglia epitopes.
• To examine evidence supporting an autoimmune component in PANDAS, including neuroimaging and immunological findings.

Summary:

• Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) may arise in genetically predisposed children following streptococcal infections.
• A proposed mechanism involves streptococcal antigens triggering antibodies that cross-react with basal ganglia via molecular mimicry.
• Neuroimaging shows enlarged basal ganglia, and altered cytokine levels (TNF-alpha, IL-6, IL-1) suggest immune system involvement.

Impact:

• Findings support an autoimmune hypothesis for PANDAS, linking streptococcal infections to basal ganglia inflammation.
• Potential therapeutic strategies like plasmapheresis and intravenous immunoglobulin are being explored.
• Further research is crucial to elucidate the precise role of streptococcal infections in PANDAS pathogenesis.