The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) etiology for tics and obsessive-compulsive symptoms: hypothesis or entity? Practical considerations for the clinician

Pediatrics. 2004 Apr;113(4):883-6. doi: 10.1542/peds.113.4.883.

Abstract

Clinicians have been faced with much publicity and contradictory scientific evidence regarding a recently described condition termed pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS). It has been proposed that children with PANDAS experience tics, obsessive-compulsive behavior, and perhaps other neuropsychiatric symptoms as an autoimmune response to streptococcal infection. We review current scientific information and conclude that PANDAS remains a yet-unproven hypothesis. Until more definitive scientific proof is forthcoming, there seems to be insufficient evidence to support 1) routine microbiologic or serologic testing for group A streptococcus in children who present with neuropsychiatric symptoms or 2) the clinical use of antibiotic or immune-modifying therapies in such patients. The optimum diagnostic and therapeutic approach awaits the results of additional research studies.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adjuvants, Immunologic / therapeutic use
  • Adolescent
  • Age of Onset
  • Anti-Bacterial Agents / therapeutic use
  • Autoimmune Diseases / etiology*
  • Child
  • Child, Preschool
  • Humans
  • Obsessive-Compulsive Disorder / drug therapy
  • Obsessive-Compulsive Disorder / etiology
  • Obsessive-Compulsive Disorder / immunology*
  • Streptococcal Infections / complications*
  • Streptococcal Infections / diagnosis
  • Streptococcal Infections / prevention & control
  • Streptococcus pyogenes* / isolation & purification
  • Tic Disorders / drug therapy
  • Tic Disorders / etiology
  • Tic Disorders / immunology*

Substances

  • Adjuvants, Immunologic
  • Anti-Bacterial Agents