PANDAS, or pediactric autoimmune neuropsychiatric disorder associated with Streptococcus pyogenes, is characterized by an acute onset of neuropsychiatric symptoms which seem unexplainable. These symptoms usually include obsessive-compulsive disorder, and a variety of tics, that appear in children before puberty.

The aim of this study was to compare the clinical manifestations of our patients with PANDAS to the latest studies and report our findings.

This retrospectiove study included 20 patients with valid clinical features of PANDAS who were treated and followed at Srebrnjak Children’s Hospital between 2014 and 2019.

Our examinees were children before puberty which fullfilled the main criterion of early-onset and at least two major criteria – obsessions/compulsions (OCD) and neuromotor dysfunction (tics, hyperactivity). We retrospectively analized all the data with special focus on neuropsychiatric symptoms.

In 5-year period a total of 20 children, 16 (80%) male and 4 (20%) female, aged 3 to 11 years (median age 6,5) were followed up under the diagnosis of PANDAS. Only one patient had a burdened perinatal history (prematurity, short-term mechanical ventilation, neuromotor habilitation). Family history of tics and autoimmune disorders was positive in N=5 (25%). All patients had OCD and tics with acute onset of symptoms.

Elevated levels of antistreptolysin titers were found in all but one patient (95%). Anti-DNAse-B levels were tested in 7 patients and was elevated in 4 (57%).

Attention disordes were present in N=17 (85%) and 4 (20%) patients had sleeping difficulties. Speech difficulties were detected in N=5 (25%).

Decline in school performance was also commun in children attending school N=10 (71%).

None of the patients had pathological changes in EEG, and those with neuroimaging studies (N=12 or 60%) did not have any speciffic findings.

First-line antibiotics were given to 15 (75%) patients. In 5 (25%) patients a full regression of symptoms was registered, 10 (50%) had partial improvement, 5 (25%) had no response.In 7 (35%) patients intravenous immunoglobulins (IVIG) were given after initial antibiotic treatment with incomplete regression. Tics persisted in 11 patients and 4 had tics with behavioral difficulties. In 7 patients treated with IVIG we proceeded with parenteral antibiotics because of partial symptom regression and 2 were given corticosteroids (still followed).

We observed a higher rate of full symptom regression with first-line parenteral antibiotics and some of them improved after IVIG. Further research on larger cohorts of patients are necessary for better management of this clinical entity.