Pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS): update.
OBJECTIVE
To review recent developments related to the proposed entity Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococci (so-called 'PANDAS').


RESULTS
The relationship between obsessive-compulsive disorder (OCD) or tics/Tourette's syndrome in childhood to antecedent group A streptococci (GAS) is unclear. One recent prospective cohort study found that more than 85% of clinical exacerbations in OCD/tic behavior in patients who met criteria for PANDAS had no relationship to GAS infection. Another study found no correlation between clinical exacerbations and changes in a variety of markers of brain autoimmunity, the proposed pathogenesis of PANDAS. A third recent study concluded that, compared with specialty clinic diagnoses, patients diagnosed with tics or Tourette's by physicians in the community were significantly more likely to be diagnosed with PANDAS without meeting the proposed criteria, most lacked supporting laboratory evidence of GAS infection, and they were more likely to be treated with unjustified short-term to chronic antibiotic and/or immunomodulatory therapy.


CONCLUSIONS
Despite continued research in the field, the relationship between GAS and specific neuropsychiatric disorders (PANDAS) remains elusive. It is possible that GAS infection may be but one of the many stressors that can exacerbate tic/Tourette's or OCD in a subset of such patients.
Shulman
Stanford T
ST
The Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. sshulman@northwestern.edu
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008959:Models, Neurological; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D017410:Practice Guidelines as Topic; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D013297:Streptococcus pyogenes / Q000276:immunology / Q000302:isolation & purification*; D013981:Tic Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*
D000900:Anti-Bacterial Agents; D001323:Autoantibodies; D015415:Biomarkers; D007155:Immunologic Factors