The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) etiology for tics and obsessive-compulsive symptoms: hypothesis or entity? Practical considerations for the clinician.
Clinicians have been faced with much publicity and contradictory scientific evidence regarding a recently described condition termed pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS). It has been proposed that children with PANDAS experience tics, obsessive-compulsive behavior, and perhaps other neuropsychiatric symptoms as an autoimmune response to streptococcal infection. We review current scientific information and conclude that PANDAS remains a yet-unproven hypothesis. Until more definitive scientific proof is forthcoming, there seems to be insufficient evidence to support 1) routine microbiologic or serologic testing for group A streptococcus in children who present with neuropsychiatric symptoms or 2) the clinical use of antibiotic or immune-modifying therapies in such patients. The optimum diagnostic and therapeutic approach awaits the results of additional research studies.
Kurlan
Roger
R
Cognitive and Behavioral Neurology Unit, Department of Neurology, University of Rochester School of Medicine, Rochester, New York 14642-8673, USA. roger_kurlan@urmc.rochester.edu
Kaplan
Edward L
EL
D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000293:Adolescent; D017668:Age of Onset; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy / Q000209:etiology / Q000276:immunology*; D013290:Streptococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000517:prevention & control; D013297:Streptococcus pyogenes / Q000302:isolation & purification; D013981:Tic Disorders / Q000188:drug therapy / Q000209:etiology / Q000276:immunology*
D000276:Adjuvants, Immunologic; D000900:Anti-Bacterial Agents