PANS/PANDAS

Pediatric acute-onset neuropsychiatric syndrome (PANS) is a phenomenon characterized by a child exhibiting an abrupt and dramatic onset of OCD symptoms that is accompanied by a the presence of additional neuropsychiatric symptoms, with similarly severe and acute onset, from at least 2 of the following 7 categories:

(a) anxiety
(b) emotional liability and/or depression
(c) irritability, aggression, and/or severely oppositional behaviors 
(d) behavioral (developmental) regression
(e) sudden deterioration in school performance
(f) sensory or motor abnormalities 
(g) somatic/physical signs and symptoms, including sleep disturbances, enuresis or urinary frequency. 

Additionally, symptoms are not better explained by a known neurologic or medical disorder.

Pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS)
A possible association has also been shown in which patients develop OCD after experiencing a group A b -hemolytic streptococcal infection. This subgroup of pediatric patients with OCD or tic disorders has been classified as pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS). In PANDAS, children show a rapid onset of significant behavioral changes and OCD symptoms temporally associated with a strep infection.

All five criteria must be met for PANDAS:
1) Presence of obsessive-compulsive disorder (OCD) or a tic disorder
2) Prepubertal symptom onset
3) Acute symptom onset and episodic (relapsing-remitting) course
4) Temporal association between Group A streptococcal infection and symptom onset/exacerbations
5) Associated with neurological abnormalities, (particularly motoric hyperactivity and choreiform movements)


Preliminary research indicates that cognitive-behavioral therapy (CBT) may be an appropriate treatment option for youth with PANDAS-related OCD (Storch et al., 2006).

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PANS/PANDAS References:

Clinical Evaluation of Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Recommendations from the 2013 PANS Consensus Conference.
Chang K*, Frankovich J*, Cooperstock M, Cunningham M, Latimer E, Murphy T, Pasternack M, Thienemann M, Williams K, Walter J, Swedo S.  Journal of Child and Adolescent Psychopharmacology, Vol. 25, No. 1, February 2015: 3-13. PMID: 25325534

Clinical Management of Pediatric Acute-onset Neuropsychiatric Syndrome: Part I - Psychiatric and Behavioral Interventions. 
Thienemann, M., Murphy, T. K. Leckman, J. Shaw, R., Williams, K; Kapphahn, C. et al. (2017). Journal of Child and Adolescent Psychopharmacology, 27, 566-573.DOI: 10.1089/cap.2016.0145
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Clinical Management of Pediatric Acute-onset Neuropsychiatric Syndrome: Part II - Use of Immunomodulatory Therapies.
Frankovich, J., Swedo, S., Murphy, T., Dale, R. C., Agalliu, D., Williams, K., and PANS/PANDAS Consortium. (2017). Journal of Child and Adolescent Psychopharmacology, 27, 574-593. DOI: 10.1089/cap.2016.0148

Clinical Management of Pediatric Acute-onset Neuropsychiatric Syndrome: Part III - Treatment and Prevention of Infections. 
Cooperstock ,M., Swedo S., Pasternack, M., Murphy, T. and the PANS/PANDAS Consortium. (2017). Journal of Child and Adolescent Psychopharmacology, 27, DOI: 10.1089/cap.2016.0151

The immunobiology of Tourette’s disorder, pediatric autoimmune neuropsychiatric disorders associated with Streptococcus, and related disorders: A way forward. Special Issue on Obsessive-Compulsive Disorder and Tourette’s Disorder: 
Murphy, T. K., Kurlan, R., & Leckman, J. (2010). Journal of Child and Adolescent Psychopharmacology, 20, 317–331. doi: 10.1089/cap.2010.0043.

A pilot trial of cognitive-behavioral therapy augmentation of antibiotic treatment in youth with pediatric acute-onset neuropsychiatric syndrome-related obsessive-compulsive disorder. 
Nadeau, J.M.; Jordan, C., Selles, R.R., Wu, M.S., King, M.A.., Patel, P.D. (2015).Journal of Child and Adolescent Psychopharmacology, 25, 337-343. 

Behavioral Treatment of a Child with PANDAS.
Storch, E.A..,  Gerdes, A.C., Adkins, J.W., Geffken, G.R., Star, J., Murphy, T. (2004).  Journal of the American Academy of Child & Adolescent Psychiatry, 43, 510-511. 

Cognitive-behavioral therapy for PANDAS-related obsessive-compulsive disorder: Findings from a preliminary waitlist controlled open trial. 
Storch, E. A., Murphy, T. K., Geffken, G. R., Mann, G., Adkins, J., Merlo,L.J., Duke, D., Munson, M., Swaine, Z., & Goodman, W. K. (2006). Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1171–1178. doi:10.1097/01.chi.0000231973.43966.a0

From research subgroup to clinical syndrome: Modifying the PANDAS criteria to describe PANS (pediatric acute-onset neuropsychiatric syndrome). 
Swedo, S. E., Leckman, J. F., & Rose, N. R. (2012). Pediatrics and Therapeutics, 2, 1–8. doi:10.4172/2161-0665.1000113   Link to Article

Overview of Treatment of Pediatric Acute-onset Neuropsychiatric Syndrome.
Swedo, S.E., Frankovich, J., & Murphy, T. K. (2017).  Journal of Child and Adolescent Psychopharmacology, 27, 562-565. http://doi.org/10.1089/cap.2017.0042



PANS/PANDAS Resources

http://pandasnetwork.org/diagnosis/
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