What is Panda’s?


Paediatric Autoimmune Neuropsychiatric Disorders associated with Streptococcus (PANDAS) presents as an acute onset of Obsessive Compulsive Disorder (OCD) in children.  Research led by Susan Swedo led to a publication in the American Journal of Psychiatry in 1998 (Swedo, Leonard , Garvey, Mittleman, Allen, et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry 155: 264-271.) There are 5 criteria for the diagnosis of PANDAS:  acute onset and episodic relapses of OCD and/or tic disorder; onset before puberty; association with Group A Streptococcal infection and symptom onset or aggravation; association with neurological abnormalities, such as motor hyperactivity or abnormal movements.  Treatment involves immune regulation and antibiotic prophylaxis.  Further work has led to the development of a further concept, called Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) with a more acute onset of symptoms and not related to any particular infection.  

The criteria for PANS would include:

I.  Abrupt, dramatic onset of obsessive-compulsive disorder or severely restricted food intake
II.  Concurrent presence of additional neuropsychiatric symptoms, with similarly severe and acute onset, from at least two of the following seven categories (see text for full description):
1. Anxiety
2. Emotional lability and/or depression
3. Irritability, aggression and/or severely oppositional behaviors
4. Behavioral (developmental) regression
5. Deterioration in school performance
6. Sensory or motor abnormalities
7. Somatic signs and symptoms, including sleep disturbances, enuresis or urinary frequency
III.  Symptoms are not better explained by a known neurologic or medical disorder, such as Sydenham chorea, systemic lupus erythematosus, Tourette disorder or others.

Note: The diagnostic work-up of patients suspected of PANS must be comprehensive enough to rule out these and other relevant disorders.  The nature of the co-occurring symptoms will dictate the necessary
assessments, which may include MRI scan, lumbar puncture, electroencephalogram or other diagnostic tests.  (From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS (Pediatric Acute-onset Neuropsychiatric Syndrome: Susan E. Swedo, James F. Leckman and Noel R. Rose)