Catholic University of Louvain, Belgium
Title: We need to talk about PANDAS
Biography: Sophie Dechene
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is a serious medical condition in childhood belonging to the PANS (pediatric acute-onset neuropsychiatric syndrome) category. Affected children are still frequently misdiagnosed as suffering from a psychiatric illness of psychosocial origin and their health can be affected for many years if left either untreated or treated only with psychotropic medication. Clinical symptoms typically have a waxing and waning course. This syndrome can present with OCD (obsessive compulsive disorder) symptoms, tics, restricted food intake and various other neuropsychiatric pathologies, such as different forms of anxiety, depression and sometimes isolated neuropsychiatric symptoms including increased urinary frequency, bed-wetting and sleep disturbance. The long-term risks are significant with not only severe psychological suffering, but also impaired stages of development in every area of life. Although PANDAS remains a diagnosis of exclusion, the important aetiological factor to look for is an infection with, or the asymptomatic presence of, Streptococcus A. A differential diagnosis must be made to distinguish PANDAS from other syndromes in the PANS spectrum without infectious triggers and PITANDS (pediatric infection-triggered autoimmune neuropsychiatric disorders) where non-streptococcal infections are implicated. Today, we give an overview of the current literature on PANDAS and present a clinical case of a boy suffering from PANDAS, who was first misdiagnosed as epilepsy and then with a psychiatric illness. The epilepsy was diagnosed during the first acute episode when the boy presented with a mild confessional state and, after excluding other aetiological factors, a degree of learning difficulty probably contributed to the diagnosis of a psychiatric illness. A 10 day-treatment with amoxycillin and ibuprofen given during the fourth acute episode led to a complete recovery. This case emphasizes the need to educate mental health professionals about the illness. Furthermore, given the elevated risks of false positive and false negative diagnoses and taking into consideration the pressure brought by distressed parents, professionals need to have a good awareness of this illness. Taking thorough personal and family histories combined with exhaustive mental, physical and neurological examinations is recommended to make a PANS diagnosis and the presence of or an illness related to Streptococcus, will direct you to a diagnosis of PANDAS. Other factors can contribute to a diagnosis of PANDAS, including the presence of autoimmune diseases such as rheumatic fever or streptococcal-mediated Sydenham chorea, recent travel in low income countries where the prevalence of Streptococcus in the general population is high or a recent generalized skin or throat infection.