Obsessive-Compulsive Disorder in PANS/PANDAS in Children: In Search of a Qualified Treatment—A Systematic Review and Metanalysis

Abstract

Background: Several treatment options have been proposed for pediatric acute-onset neuropsychiatric syndrome/pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANS/PANDAS). Still, no clear therapeutic protocol has been recognized to prevent these neuropsychiatric diseases. The study aims to report on the literature evidence and different treatment strategies related to these disorders. Methods: We analyzed the last 20 years’ English language literature and performed a comprehensive review of the PANS/PANDAS treatment, including studies reporting OCD outcomes post-treatment follow-up. Results: We covered 11 articles in our systematic literature review for a total of 473 patients, of which four studies included 129 surgical subjects and seven papers with 326 medically treated patients. Pooled outcomes analysis, surgical and medical treatment reported an OCD reduction, but no statistical significance was obtained (p < 0.05 for both). Conclusions: Surgical therapy in selected patients can lead to promising results, although further evidence is needed. On the other hand, the role of medical therapy remains controversial, often due to the lack of univocal curative protocols and variable responses depending on the drug used and the timing of administration. Therefore, further investigations are necessary to clarify the most appropriate therapeutic procedure.

Pediatric Acute Onset Neuropsychiatric Syndrome Presenting with Atypical Eating Disorder: A Case Report

“…Empirical studies and case reports suggest that treatment should consist mostly of therapies that target immune and infectious causes. 1 We chose fluoxetine, because of its proven efficacy in treating selective neuropsychiatric symptoms of PANS.…”

“…Pediatric Acute Onset Neuropsychiatric Syndrome (PANS) is defined by abrupt onset of obsessive-compulsive disorder (OCD) or severely restricted food intake, associated with other fluctuating neuropsychiatric symptoms such as anxiety, emotional lability and/or depression, irritability, aggression, and/or severe oppositional behaviors, developmental regression, deterioration in school performance, sensory or motor abnormalities, and somatic symptoms. 1 About 10% to 20% of pediatric onset OCD and 50% of pediatric onset anorexia are linked with PANS. 2,3 To date, studies in the area of PANS, including pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) and pediatric infection-triggered neuropsychiatric disorder (PITAND), have been relatively small and hence unable to comprehensively address questions of heterogeneity in clinical presentation.…”

“…Differential Diagnosis of the Reported Case 1,3. PANS, Pediatric Acute-onset Neuropsychiatric Syndrome; PANDAS, Pediatric Acute-onset Neuropsychiatric Disorders Associated with Streptococcus; ARFID, Avoidant Restrictive Food Intake Disorder; AN, Anorexia Nervosa; OCD, Obsessive-Compulsive Disorder; COVID-19, Coronavirus Disease 2019; GAS, Group A Streptococcus.…”

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) Syndrome: A 10-Year Retrospective Cohort Study in an Italian Centre of Pediatric Rheumatology

“…Although, in recent years, there has been an increasing understanding of its pathophysiology, it remains still not completely clear [ 5 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. In fact, there is a dearth of comprehensive data regarding its management and clinical characterization [ 15 , 16 , 17 , 18 ]. There exist numerous analogies between PANDAS and Sydenham’s chorea (SC), including molecular mimicry that has been proposed as a key factor in the development of both conditions, resulting in the spreading of various types of autoantibodies that target neuronal cells [ 13 , 14 , 19 , 20 , 21 ].…”

“…As introduced above, treatment strategies are currently based on some expert opinions and small observational trials, while large trials have provided controversial results. Moreover, there is no agreement on the appropriate dosage of drugs used for PANDAS syndrome [ 5 , 18 ].…”