PANS and PANDAS: Case series of patients in a Danish pediatric clinical cohort

Objectives: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) have been suggested to be a result of a disordered immune response after an infection causing neuropsychiatric symptoms. Although the diagnosis has been controversial, more focus has come on the diagnosis, pathophysiology, and treatment during the recent years.
Methods: We reviewed patient charts of 15 pediatric patients with suspected PANS/PANDAS from the Danish national Tourette syndrome clinic; charts were reviewed for demographics, symptoms, examinations, treatment, and outcome.
Results: 11 patients met either full criterion for PANDAS or PANS. Four patients did not fulfill all diagnostic criteria due to age at onset, absence of GAS infection and/or sub-acute onset of symptoms. Most reported symptoms were tics (86.7%), sleep disturbance (66.7%), behavioral disturbances (60.0%), anxiety (53.3%), motoric control abnormalities (53.3%) and Obsessive Compulsive Disorder (40.0%). Streptolysin-O antibody and streptococcus throat culture were
positive in respectively 61.5% and 38.4%. Anti-neuronal antibody titers were taken; Calmodulindependent kinase II and anti-beta-tubulin antibodies were most often positive. Acute antibiotic treatment was given to all patients and had an effect in 73.3%. Prophylactic antibiotic was given to 53.3% of patients and had an effect in all patients. Some patients were treated with standard psychiatric treatment, intravenous immunoglobulin or steroid, and non-steroidal antiinflammatory drugs.
Conclusion: This study has shown a positive effect of acute and prophylactic antibiotic-, psychiatric- and immunomodulating treatment, according to parental reports. Until further evidence regarding diagnostic tests and treatments exists, current literature and clinical experience must guide clinicians.