title: A new clinical feature associated with familial early-onset of dystonic-guttural tics: An unusual diagnosis of PANDAS.
abstract: Until today there is a large debate about the existence of PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) or PANS (pediatric acute onset neuropsychiatric syndrome). These children usually have dramatic, "overnight" onset of symptoms, including motor or vocal tics, obsessions, and/or compulsions. In addition to these symptoms, children may also have comorbid features of associated disorders. Herein, we report a family with an early onset of tics, with exclusively dystonic and guttural tics. All patients had a particularly strong excitement trigger. Two of the patients were shown to have signs suggestive of PANDAS and all family members were Group A beta-hemolytic Streptococcus (GABHS) carriers. The PANDAS spectrum is probably a group of disorders. We have described a PANDAS variant, in which the family seems to share common autoimmune pattern and may be viewed in the large spectrum of PANDAS.
authors.affiliation: Department of Pediatric and Pediatric Emergency, AUO OVE-Policlinico, University of Catania, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Vitaliti
authors.affiliation: Department of Pediatrics, Morristown Memorial Hospital, Morristown, New Jersey, USA.
authors.forename: Rosario R
authors.initials: RR
authors.lastname: Trifiletti
authors.affiliation: Department of Pediatric and Pediatric Emergency, AUO OVE-Policlinico, University of Catania, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Falsaperla
authors.affiliation: Department of Pediatrics, Morristown Memorial Hospital, Morristown, New Jersey, USA ; Institute of Neurological Science, The National Research Council of Italy, CNR, Catania, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Parano
authors.affiliation: Department of Paediatrics, Division of Child Neurology, University of Rome La Sapienza, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Spalice
authors.affiliation: Department of Pediatrics, Morristown Memorial Hospital, Morristown, New Jersey, USA.
authors.forename: Piero
authors.initials: P
authors.lastname: Pavone
keywords: Childhood; PANDAS spectrum; familial; tics