Pediatric acute-onset neuropsychiatric syndrome (PANS)

Pediatric acute-onset neuropsychiatric syndrome (PANS) is a neuropsychiatric syndrome still under research, leading to rapid onset Obsessive-compulsive disorder (OCD) and/or tics in children and adolescents.[1][2][3] It may be either connected to Group A streptococcal infections (PANDAS sub-group)[4][5] or caused by immunologic reactions[6] to other pathogens (PITANDS sub-group)[7][7][8] affecting the basal ganglia.[9][10] This portion of the brain is responsible for mediating cognition, emotion, and movement. Research into the etiology of obsessive-compulsive disorder has identified dysfunctions of the basal ganglia as a key factor for the onset of OCD.[11] A similar syndrome in adults is known as Post-inflammatory Brain Syndrome (PIBS).[12]

Differential diagnostics

As there are other conditions that may have similar presentation, diagnostic workup of individuals suspected of PANS should exclude Sydenham's chorea, lupus erythematosus, acute disseminated encephalomyelitis, and Tourette syndrome.

Treatment

Treatment of OCD or Tourette possibly caused by PANS is generally the same as the standard therapies for OCD and Tourettes (symptomatic treatment).[13] It has, however, been observed that children with PANS appear to be unusually sensitive to the side-effects of SSRIs.[5][14] Treatment with antibiotics,[15][16] and immune-based therapeutic approaches are still considered as experimental.[5][17] Early and consequent treatment appears to be of importance to avoid chronification and lifelong persistence.[3][4][18]

References

  1. ↑ Clinical trial number NCT01617083 for "Antibiotic Treatment Trial for the PANDAS/PANS Phenotype (AZT)" at ClinicalTrials.gov
  2. ↑ "Univetsity of Buffalo School of Public Health". Sphhp.buffalo.edu. Retrieved 2012-11-13.
  3. 1 2 Jeff Szymanski (February 27, 2012). "Can an infection suddenly cause OCD?". Harvard Health Publications.
  4. 1 2 Moretti, Germana; Pasquini, Massimo; Mandarelli, Gabriele; Tarsitani, Lorenzo; Biondi, Massimo (2008). "What every psychiatrist should know about PANDAS: A review". Clinical Practice and Epidemiology in Mental Health. 4: 13. doi:10.1186/1745-0179-4-13. PMC 2413218Freely accessible. PMID 18495013.
  5. 1 2 3 http://intramural.nimh.nih.gov/pdn/web.htm
  6. ↑ Katherine E. Muir, et al.: "A Case Report of Obsessive-Compulsive Disorder Following Acute Disseminated Encephalomyelitis". Published online August 5, 2013 (doi: 10.1542/peds.2012-2876)
  7. 1 2 Rhee, Hanna; Cameron, Daniel (2012). "Lyme disease and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): An overview". International Journal of General Medicine. 5: 163–74. doi:10.2147/IJGM.S24212. PMC 3292400Freely accessible. PMID 22393303.
  8. ↑ Hurley, R. A.; Taber, K. H. (2008). "Acute and Chronic Lyme Disease: Controversies for Neuropsychiatry". Journal of Neuropsychiatry. 20 (1): iv–6. doi:10.1176/appi.neuropsych.20.1.iv. PMID 18305280.
  9. ↑ N. Müller et al.: Mycoplasma pneumoniae infection and Tourette’s syndrome. In: Psychiatry Res., 2004 Dec 15, 129(2)
  10. ↑ Souhel Najjar, Daniel M Pearlman, Kenneth Alper, et al.: "Neuroinflammation and psychiatric illness". Journal of Neuroinflammation 2013, 10:43 doi:10.1186/1742-2094-10-43
  11. ↑ Nestadt, Gerald; Grados, Marco; Samuels, Jack F. (2010). "Genetics of Obsessive-Compulsive Disorder". Psychiatric Clinics of North America. 33 (1): 141–58. doi:10.1016/j.psc.2009.11.001. PMC 2824902Freely accessible. PMID 20159344.
  12. ↑ Alasdair Timothy Llewelyn Rathbone et al.: A review of the neuro- and systemic inflammatory responses in post concussion symptoms: Introduction of the ‘‘post-inflammatory brain syndrome’’ PIBS. In: Brain, Behavior, and Immunity 46 (2015) 1–16
  13. ↑ Danielle Ung, Chelsea M Ale, Eric A Storch: "Optimal management of pediatric obsessive-compulsive disorder". In: Pediatric Health, Medicine and Therapeutics 2012:3 9–18.
  14. ↑ Storch, Eric A.; Murphy, Tanya K.; Geffken, Gary R.; Mann, Giselle; Adkins, Jennifer; J. Merlo, Lisa; Duke, Danny; Munson, Melissa; et al. (2006). "Cognitive-Behavioral Therapy for PANDAS-Related Obsessive-Compulsive Disorder: Findings from a Preliminary Waitlist Controlled Open Trial". Journal of the American Academy of Child & Adolescent Psychiatry. 45 (10): 1171–8. doi:10.1097/01.chi.0000231973.43966.a0. PMID 17003662.
  15. ↑ Lisa A Snider, Lorraine Lougee, Marcia Slattery, Paul Grant, Susan Swedo: Antibiotic Prophylaxis with Azithromycin or Penicillin for Childhood-Onset Neurospychiatric Disorders. In: Biol Psychiatry, 2005, 57, S. 788–792
  16. ↑ Demian Obregon, Ellisa Carla Parker-Athill, Jun Tan, and Tanya Murphy: "Psychotropic effects of antimicrobials and immune modulation by psychotropics: implications for neuroimmune disorders". Neuropsychiatry (London) . 2012 August ; 2(4): 331–343. doi:10.2217/npy.12.41.
  17. ↑ Perlmutter, Susan J; Leitman, Susan F; Garvey, Marjorie A; Hamburger, Susan; Feldman, Elad; Leonard, Henrietta L; Swedo, Susan E (1999). "Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood". The Lancet. 354 (9185): 1153–8. doi:10.1016/S0140-6736(98)12297-3. PMID 10513708.
  18. ↑ "International OCD Foundation Warns Infections May Trigger Some Mental Illness". International OCD Foundation. Retrieved 2012-11-13.

External links

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