A parent presents with their 6 your old child concerned about obsessive compulsive features and facial tics. Their only background was a sore throat a week ago. What is the diagnosis?
PANDAS – Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.
PANDAS is a clinical diagnosis requiring:
- Presence of obsessive-compulsive disorder and/or tic disorder
- Paediatric onset of symptoms (age 3 years to puberty)
- Episodic course of symptom severity
- Association with group B beta-haemolytic streptococcal infection (+ve throat culture or history of scarlet fever)
- Association with neurological abnormalities (physical hyperactivity, or unusual, jerky movements that are not in the child’s control, mood changes, separation anxiety, trouble sleeping)
- Very abrupt onset or worsening of symptoms (out of the blue, seem to occur overnight).
In 2010, the PANDAS criteria was redefined and re-labelled to Paediatric Acute Onset Neuropsychiatric Syndrome (PANS). This widened the age range to <17 years, added restricted food intake as an alternative major symptom, and postulated a much broader aetiology, including a larger number of infectious causes including mycoplasma, HIV, VZV, HSV and the common cold.
By 2013, Singer proposed a move away from the term PANS to Childhood Acute onset Neuropsychiatric Syndrome (CANS), further amending the diagnostic criteria to broaden the causality and focus investigations on the exclusion of treatable causes. When none are found a diagnosis of Idiopathic CANS can be made.
See: Schrodinger’s PANDAS from DFTB for a more in-depth discussion about this diagnosis
References
- Chang K et al. Clinical evaluation of youth with pediatric acute-onset neuropsychiatric syndrome (PANS): recommendations from the 2013 PANS Consensus Conference. J Child Adolesc Psychopharmacol. 2015 Feb;25(1):3-13. doi: 10.1089/cap.2014.0084. Epub 2014 Oct 17.m
- Singer, HS et al. Moving from PANDAS to CANS. J Pediatr. 2012 May;160(5):725-31. doi:10.1016/j.jpeds.2011.11.040. Epub 2011 Dec 22.
In 2010, the PANDAS criteria was redefined and re-labelled to Paediatric Acute Onset Neuropsychiatric Syndrome (PANS). This widened the age range to <17 years, added restricted food intake as an alternative major symptom, and postulated a much broader aetiology, including a larger number of infectious causes including mycoplasma, HIV, VZV, HSV and the common cold.
By 2013, Singer proposed a move away from the term PANS to Childhood Acute onset Neuropsychiatric Syndrome (CANS), further amending the diagnostic criteria to broaden the causality and focus investigations on the exclusion of treatable causes. When none are found a diagnosis of Idiopathic CANS can be made.
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