PANDAS

Pediatric autoimmune neuropsychiatric disorders associated with a streptococcal infection (PANDAS) was proposed almost two decades ago as an etiology for children with an acute onset of tics and obsessive compulsive disorder. Modeled on the post infectious disorder Sydenham chorea, etiologically it is proposed that antibodies against group A β-hemolytic streptococci cross react with neuronal antigens or alter neuronal cell signal transduction. Despite a rapid acceptance by some, the existence of this diagnosis as a distinct clinical and autoimmune entity is actually quite controversial. In this article, the diagnostic criteria, confounding clinical issues, and difficulties encountered in attempts to demonstrate a clear association with a streptococcal infection are reviewed. Pathophysiologically, evidence required for an autoimmune disorder and the results of laboratory studies attempting to confirm an autoantibody-mediated disorder are assessed. Lastly, the outcome of therapeutic trials using antibiotics, tonsillectomy/adenoidectomy, and immunotherapy are examined. Based on all of the aforementioned, there continues to be a lack of convincing evidence to support for the clinical entity of PANDAS.