Steroid treatment response to post SARS-CoV-2 PANS symptoms: Case series

Abstract

BackgroundPediatric acute-onset neuropsychiatric syndrome (PANS) is characterized by a wide spectrum of symptoms, including the onset of obsessive-compulsive disorder and/or severely restricted food intake, associated with emotional symptoms, behavioral symptoms, developmental regression, and somatic symptoms. Among the possible triggering agents, infectious agents have been extensively explored. More recently, sporadic case reports describe a possible association between PANS and SARS-CoV-2 infection but data on clinical presentation and treatment are still scarce.MethodsWe describe a case series (10 children) with acute onset or relapse of PANS symptoms after SARS-CoV-2 infection. Standardized measures (CBCL, CPRS, C-GAS, CGI-S, Y-BOCS, PANSS, and YGTSS) were used to describe the clinical picture. The efficacy of a pulse treatment with steroids for three consecutive months was assessed.ResultsOur data suggest that the clinical presentation of the COVID-19-triggered PANS is largely similar to that reported in typical PANS, including acute onset, with OCD and/or eating disorders, and associated symptoms. Our data suggest that treatment with corticosteroids may be beneficial for both global clinical severity and global functioning. No serious adverse effects were observed. Both OCD symptoms and tics consistently improved. Among psychiatric symptoms, affective and oppositional symptoms appeared more sensitive to the steroid treatment than the other symptoms.ConclusionOur study confirms that COVID-19 infection in children and adolescents could trigger acute-onset neuropsychiatric symptoms. Thus, in children and adolescents with COVID-19, a specific neuropsychiatric follow-up should be routinely included. Even if a small sample size and a follow-up with only two points (baseline and endpoint, after 8 weeks) limit the conclusions, it seems that steroid treatment in the acute phase may be beneficial and well tolerated.

Microbes and Mental Illness: Past, Present, and Future

“…Persistent symptoms may include fatigue, post-exertional malaise, and multiple emotional and cognitive impairments (memory impairment, attention deficits, cognitive difficulties, executive dysfunction) [ 422 ]. In addition to cognitive deficits, mental symptoms include anxiety, depression, mood swings, bipolar/manic episodes, obsessive–compulsive disorders, posttraumatic stress, new-onset psychosis, sleep disturbances, substance use disorders, suicidality, and symptom constellations consistent with pediatric acute-onset neuropsychiatric syndrome (PANS; see Section 3.8.5 for additional PANS information) [ 5 , 50 , 81 , 82 , 83 , 84 , 85 , 422 , 425 , 426 , 427 , 428 , 429 , 430 , 431 , 432 ]. One retrospective cohort study using electronic health record data comprising 81 million patients in healthcare organizations primarily in the US showed that the risk of common neuropsychiatric disorders (mood disorders, anxiety disorders) returned to baseline in 1–2 months, but there remained an elevated risk of psychotic disorders, cognitive deficit, dementia, and seizures at two years of follow-up [ 83 ].…”

“…Since the original description of PANDAS, it has subsequently become recognized as part of a broader category called pediatric acute-onset neuropsychiatric syndrome (PANS) [ 243 , 498 ]. Unlike PANDAS, the name PANS recognizes that the neuropsychiatric and other manifestations of this syndrome can be triggered by not just streptococcal infections but also a variety of other infections [ 243 , 499 ] (e.g., Mycoplasma [ 263 ], Borrelia (Lyme disease) [ 500 ], Bartonella [ 162 ], SARS-CoV-2 [ 82 , 425 , 437 ]), as well as, potentially, non-infectious triggers, such as environmental exposure to toxins or other inducers of inflammatory reactions [ 498 , 501 ]. As originally defined, the primary symptoms of PANS are the sudden onset of obsessive–compulsive symptoms or restricted eating behaviors.…”