[Autoimmune neuropsychiatric disorders associated to infection by streptococcus in the paediatric age: PANDAS].
BACKGROUND
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.


OBJECTIVE
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).


METHODS
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.
Betancourt
Y M
YM
Universidad de Carabobo, Valencia, Venezuela. neurojcj@telcel.net.ve
Jiménez-León
J C
JC
Jiménez-Betancourt
C S
CS
Castillo
V E
VE
D000293:Adolescent; D001327:Autoimmune Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013290:Streptococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000628:therapy