Treatment of PANDAS and PANS: a systematic review

Neurosci Biobehav Rev. 2018 Mar;86:51-65. doi: 10.1016/j.neubiorev.2018.01.001. Epub 2018 Jan 6.

Abstract

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are a subtype of acute-onset obsessive-compulsive disorder (OCD) thought to be caused by an autoimmune response to group A streptococcal infection. Based on this proposed pathophysiology, alternative treatments for acute-onset OCD have been introduced, including antibiotics and immunomodulatory interventions. However, the literature on treatment of PANDAS is diverse, and clinical consensus regarding optimal treatment strategy is lacking. We conducted a systematic review of articles in PubMed, Cochrane Library, and Scopus that addressed treatment for PANDAS and related disorders. Twelve research studies involving the following treatments met inclusion criteria: penicillin, azithromycin, intravenous immunoglobulin, plasma exchange, tonsillectomy, cognitive behavior therapy, NSAID and corticosteroids. In addition, 65 case reports in which patients received immunomodulatory treatments, antibiotics, and/or psychotropics were identified. We determined that rigorously conducted research regarding treatments for PANDAS is scarce, and published studies have a high risk of bias. Further research is needed in which promising treatment strategies for PANDAS and other variants of OCD with proposed autoimmune etiology are rigorously investigated.

Keywords: CANS; Childhood acute neuropsychiatric symptoms; OCD; Obsessive-compulsive disorder; Obsessive-compulsive symptoms; PANDAS; PANS; PITAND; Pediatric acute-onset neuropsychiatric syndrome; Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections; Systematic review; Therapy; Treatment.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Autoimmune Diseases / complications*
  • Cognitive Behavioral Therapy
  • Humans
  • Obsessive-Compulsive Disorder / complications*
  • Obsessive-Compulsive Disorder / drug therapy
  • Obsessive-Compulsive Disorder / surgery
  • Obsessive-Compulsive Disorder / therapy*
  • Plasma Exchange
  • Streptococcal Infections / complications*
  • Tonsillectomy

Substances

  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents, Non-Steroidal