title: Five youth with pediatric acute-onset neuropsychiatric syndrome of differing etiologies.
abstract: BACKGROUND
  Pediatric acute-onset neuropsychiatric syndrome (PANS) is diagnosed by the abrupt onset of new obsessive compulsive disorder (OCD) or food-restricting symptoms, and at least two of a variety of other neuropsychiatric symptoms. Detailed clinical presentation of youth with this condition has not yet been provided in the literature.
  
  
  METHODS
  We review the clinical charts of five youth meeting criteria for PANS in our PANS Clinic. These five patients were selected for differing underlying causes thought to be driving an inflammatory response that appeared to impact psychiatric symptoms.
  
  
  RESULTS
  Five youth with varying potential etiologies impacting neuropsychiatric symptoms were identified. These youth were from 8 to 18 years old at the onset of their PANS illness, and had bacterial, autoimmune, and unknown etiologies. Treatment directed at presumed etiologies ranged from antibiotics to intravenous gamma globulin (IVIG) to other immunomodulatory regimens, and appeared to improve the psychiatric illness.
  
  
  CONCLUSIONS
  Youth with PANS may present in differing ways, with psychiatric and physical symptoms overlapping with inflammatory or infectious diseases, pain syndromes, and other psychiatric diagnoses. Patients' psychiatric symptoms may respond to treatments targeting the underlying cause of physical illness. Faced with a pediatric patient demonstrating the abrupt onset or exacerbation of psychiatric and physical symptoms, clinicians should consider PANS in their differential diagnosis.
authors.affiliation: Stanford Children's Health, PANS Clinic and Research Program, Stanford University School of Medicine , Stanford, California.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Frankovich
authors.forename: Margo
authors.initials: M
authors.lastname: Thienemann
authors.forename: Sonal
authors.initials: S
authors.lastname: Rana
authors.forename: Kiki
authors.initials: K
authors.lastname: Chang
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001327:Autoimmune Diseases / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000209:etiology* / Q000523:psychology; D013290:Streptococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D013577:Syndrome; D013981:Tic Disorders / Q000175:diagnosis* / Q000209:etiology* / Q000523:psychology