PANDAS

The acronym PANDAS is short for. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. It describes a now widely recognized and successful nachvollzogenes already in animal experiments syndrome, sudden use in the in childhood and adolescence after infection with β -hemolytic group A streptococci neuropsychiatric symptoms that can Untreated take a long-term, chronic course.

Causes and History

It is assumed that antibodies in streptococcal infections of the ear and throat and the middle ear ( scarlet fever, otitis media) are formed and are directed against the cell surface of the bacteria with specific structures of the brain cross-react - especially the basal ganglia, which for the coordination of movements are responsible. Studies with imaging Verfahrungen indicate changes in parts of the brain ( striatum ) in PANDAS patient. As a result, it comes to behavioral changes and disturbances in motor behavior and to OCD with sudden, often fulminant onset, which become chronic untreated and may persist for life. That resulted in some of the cases of forced and tic disorders in adults may be the result of an acquired in childhood PANDAS syndrome. Early and consistent treatment is therefore advocated by some researchers to avoid chronicity.

PANDAS vs. PANS

Under PANS ( Pediatric Acute- onset Neuropsychiatric Syndrome) subsumes the state National Institute of Mental Health of the United States since 2012 PANDAS as streptococcal subcategory. PANS and PANDAS share the diagnostic criteria, but PANS must not necessarily be caused by a streptococcal infection. Current research give evidence that a more decisive factor than a certain pathogen, the presence of basal ganglia antibodies in the brain of patients could be due to a previous infection. PANS summarizes the one under the name PITANDS infectious trigger together, on the other hand would not infectious reasons, such as metabolic disorders in question. PANDAS in this case forms a subgroup of PITANDS. A possible cause of the syndrome PANS by mycoplasmas and other pathogens will be accepted and currently being explored.

Symptoms

Diagnostic criteria for PANDAS are according to NIMH:

State of research

PANDAS is currently not listed as ones available in researching syndrome in the ICD -10 or DSM -5 as an independent disease, but it was discussed in the context of the development of DSM -5 and described as really existing entity. The European guidelines for Tourette syndrome and other tic disorders (European clinical guidelines for Tourette syndrome and other tic disorders ) are considered PANDAS since 2011. The German Society for Child and Adolescent Psychiatry mentions in its treatment guidelines for obsessive-compulsive disorder (2007), the PANDAS syndrome and the need for the determination of the antistreptolysin titer in children and adolescents with newly erupted compulsive disorder, that have recently gone through an infection allegedly caused by streptococci. Also in the new German S3 guideline on obsessive-compulsive disorder in adults PANDAS is considered.

The International OCD Foundation in 2011 for the first time openly called that generally a streptococcal antibody test should be performed in children with sudden onset of tic or obsessive-compulsive disorder.

Increasingly advances in the research of the issue into focus, whether tic and obsessive-compulsive disorder in adulthood can not be triggered by the mechanism described above. Corresponding first indication of this in giving a work of the " Dipartimento di Scienze e Medicina Psichiatiche Psicologica " La Sapienza University in Rome. and advanced study. Also in Germany PANDAS is now as a research approach in the field of tic and obsessive-compulsive Erkankungen subject of studies and scientific work.

The NIMH has caused the end of 2011 a long-term study to determine whether intravenous immunoglobulin therapy can lead to relief of symptoms caused by PANDAS. This study aims to provide first robust results in 2016 and would allow for a causal therapy in case of success, which does not exist yet.

A total of PANDAS is still in intensive research, both in terms of its points value as an independent disease, as well as to its consequences.

Discovery and History

A connection between rheumatic fever, Sydenham 's chorea and obsessive-compulsive symptoms was known in the research already in the 1970s and 80s. PANDAS was as symptom complex systematically explored and named for the first time in 1998 by S. E. Swedo, et al. The authors hypothesized that this is an incomplete form of chorea, as it occurs when rheumatic fever is. The PANDA Syndrome is still in the research and the subject of scientific debate. The National Institute of Mental Health of the United States, the International OCD Foundation and the German Society for Child and Adolescent Psychiatry take PANDAS but already seriously. The last major criticism of the PANDAS concept was launched in 2004 by Kaplan and Kurlan. They criticized that the diagnostic criteria be formulated to focus on the one hand and on the other hand protected enough by prospective studies. Therefore, imagine especially the question of practical clinical diagnostic and therapeutic consequences. They reject the concept of PANDAS not completely off, but come to the conclusion that the PANDAS hypothesis must still be explored sound. Further research would be necessary for this purpose. Practical diagnostic or therapeutic measures should be derived only after the presence of further controlled prospective studies. Leonard and Swedo have taken this complaint seriously and started another job, which is to refute the objections of Kurlan and Kaplan.

Roger Kurlan published along with Harvey S. Singer, Donald L. Gilbert, David S. Wolf and Jonathan W. Mink in December 2011, another article in the journal Pediatrics, which recognized the concept of induced antibodies psychiatric and / or neurological disorders will. However, Kurlan calls now together with the other authors, based on streptococcal antibodies limited PANDAS under a "Childhood Acute Neuropsychiatric symptoms" ( CANS) to subsume called disease. Background is that the state of research have now shown that also other antibodies and autoimmune process can cause PANDAS -like symptom pictures. This discussion culminated in early 2012 in the " agreement " on a white paper to PANS ( Pediatric Acute- onset Neuropsychiatric Syndrome). PANS describes the process as well as PANDAS that there is the phenomenon of rapid onset of forced and tic disorders in childhood, but goes by several infectious and non-infectious triggers as a possible cause. PANDAS as caused by streptococcal syndrome would thus only a subcategory of PANS. The National Institute of Mental Health of the USA ( NIMH) recognizes this redefinition of now.

Treatment

Since PANDAS is still in the research, the treatment is usually symptomatic. As a causal treatment promising seemed to be immune -based studies and antibiotic therapies. In cases of confirmed streptococcal infection can be effective antibiotic administration. His research in this are not yet completed, the antibiotic prophylaxis has not yet found its way into routine clinical practice. To this end, are so far available only study results for PANDAS subgroup. Early treatment, symptomatic as well as the cause, it seems advisable to avoid chronicity.