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589 An unusual case of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections(PANDAS) – diagnostic evaluation, treatment and the remarkable outcome
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  1. TG Divya Raj1,
  2. H Santosh2,
  3. Surbhi Chaturvedi2
  1. 1Consultant Pediatrician and Neonatologist at Specialist Hospital, Bangalore
  2. 2Consultant Neurologist, Specialist Hospital, Bangalore

Abstract

Aims Our goal was to correlate emergence and worsening of tics in Obsessive- Compulsive disorder(OCD) patients following streptococcal infection. To test safety and effectiveness of Intravenous Immunoglobulin(IVIG) for treatment of tics in PANDAS. Improvement in global functioning following IVIG transfusion.

Methods This was an observational case in a 7 year old OCD child. The primary endpoint was to consider PANDAS as a diagnosis when there is a very close relationship between the abrupt onset of tics and worsening of OCD post-streptococcal infection.

For diagnosis, an elevated anti-streptococcal titre was used. The test measures a normal healthy response - the production of antibodies to fight off an infection. The antibodies stay in the body for sometime but the amount of time that the antibodies persist varies greatly between individuals. Child had a preceding throat infection probable streptococcal. Inflammatory markers like C-Reactive Protein(CRP), Erythrocyte Sedimentation Rate(ESR), Procalcitonin were elevated at the initial stage of illness.

All occult infections were ruled out and the child was watched for any response to antibiotics. Standard medications for OCD and cognitive behavioral therapy was continued.

A search for publications documenting the experience of PANDAS treated with IVIG therapy was carried out. IVIG transfusion was given to our patient based on body weight. The dose was individualised and titrated to achieve the best clinical effect. Child was monitored for any adverse reactions.

PRIMARY Improvement in OCD, tics and other neuropsychiatric symptoms.

EXPLORATORY Reduction of titres of cross-reactive antibodies. Resolution of basal ganglia inflammation. Normalization of inflammatory markers.

Conclusion Our observation in this case confirms the value of early diagnosis to reduce the risk of progression to disabling chronic neurologic sequelae in the PANDAS.

Children with PANDAS derive a favourable response to IVIG. Our findings support its administration early in the course of the disease and continued until significant improvement or remission is achieved without side-effects.

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