Course of Neuropsychiatric Symptoms After Introduction and Removal of Nonsteroidal Anti-Inflammatory Drugs: A Pediatric Observational Study

J Child Adolesc Psychopharmacol. 2017 Sep;27(7):652-659. doi: 10.1089/cap.2016.0179. Epub 2017 Jul 11.


Objective: Accumulating evidence suggests that anti-inflammatory interventions can modulate neuropsychiatric symptoms. Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is characterized by an abrupt and dramatic onset of obsessive-compulsive (OC) symptoms and/or severely restrictive food intake and at least two coinciding, equally debilitating neuropsychiatric symptoms. When associated with group A Streptococcus, the syndrome is labeled Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections (PANDAS). Here, we describe the course of neuropsychiatric symptoms in patients diagnosed with PANS and PANDAS after introduction or removal of nonsteroidal anti-inflammatory drugs (NSAIDs).

Study design: We reviewed the electronic medical records (EMR) of 218 consecutive patients evaluated in our Stanford PANS Clinic for patients who met strict PANS or PANDAS research criteria and received NSAIDs for arthritis, pain, and/or psychiatric symptoms. We describe neuropsychiatric symptoms that were noted in the EMR before, during, and after NSAIDs were introduced or removed as the sole change in pharmacologic treatment.

Results: Seventy-seven patients were included in the current study. Of the 52 trials in which NSAID addition was the sole change in treatment, 16 (31%) coincided with an improvement in patients' neuropsychiatric symptoms. Of the 57 trials in which removal of NSAID treatment was the sole change in treatment, 20 (35%) coincided with escalation in patients' neuropsychiatric symptoms. Thirty patients (39%) experienced side effects, mainly mild gastrointestinal symptoms, which self-resolved after removal of NSAID, reduction of dose, or change in NSAID.

Conclusions: Improvement in neuropsychiatric symptoms was evident in roughly one-third of NSAID treatment trials. A randomized clinical trial will be necessary to confirm whether NSAIDs are successful in reducing neuropsychiatric symptoms in youth with PANS.


Publication types

  • Case Reports
  • Observational Study

MeSH terms

  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage*
  • Autoimmune Diseases / diagnosis
  • Autoimmune Diseases / drug therapy*
  • Autoimmune Diseases / psychology
  • Child
  • Child Behavior Disorders / diagnosis
  • Child Behavior Disorders / drug therapy*
  • Child Behavior Disorders / psychology
  • Child, Preschool
  • Drug Administration Schedule
  • Female
  • Humans
  • Male
  • Neurodevelopmental Disorders / diagnosis
  • Neurodevelopmental Disorders / drug therapy*
  • Neurodevelopmental Disorders / psychology
  • Obsessive-Compulsive Disorder / diagnosis
  • Obsessive-Compulsive Disorder / drug therapy
  • Obsessive-Compulsive Disorder / psychology
  • Streptococcal Infections / diagnosis
  • Streptococcal Infections / drug therapy*
  • Streptococcal Infections / psychology


  • Anti-Inflammatory Agents, Non-Steroidal