PANDAS: A commentary
Section snippets
Sydenham's chorea
SC is considered the prototype for an infectious agent (i.e., GABHS) triggering an autoimmune disorder that, in turn, causes a variety of neuropsychiatric symptoms. SC has a clearly defined association with RF [10] and with a preceding GABHS infection [11]. The distinguishing clinical feature of this disorder is the presence of chorea that typically involves the face and extremities. Motor and vocal tics have been reported in patients with SC [12], [13]. Affected individuals may present with
Tourette syndrome
The Gilles de la Tourette syndrome is characterized clinically by the presence of involuntary chronic motor and vocal tics that wax and wane [25]. Tics are exacerbated by stress, anxiety, and fatigue and may improve during activities that require concentration. In addition, individuals have a variety of comorbid neurobehavioral problems including OCD, attention-deficit hyperactivity disorder, anxiety, mood disorders, and episodic behavior disorder. TS typically begins in childhood, usually
GABHS infection as a primary trigger for tics: PANDAS
A hypothesized role for infections, especially streptococcal infections, as the primary etiology for tics is not new. Several early case reports described children with tic disorders and associated acute sinusitis [35], [36]. Kondo et al. [37] reported on an 11-year-old who, 10 days after a streptococcal infection, developed tics that responded to prednisolone but not neuroleptics. Two similar cases, with tic onset associated with GABHS infection and tic suppression requiring ACTH and
Conclusion
The originators of the PANDAS diagnosis had the laudable goal of defining a clinical syndrome in which a subset of individuals with diagnoses of tic disorders and/or OCD could be subcategorized based on the induction of symptoms after a GABHS infection. This concept has generated broad interest from divergent groups and caused many physicians to become polarized on opposing sides of the issue. If true, identification of factors that convey susceptibility or render the host less susceptible
Acknowledgements
The authors thank Pamela Talalay PhD for her editorial assistance. This work was supported in part by a grant from the National Institutes for Health, NS 37706.
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Cited by (54)
Post-infectious group A streptococcal autoimmune syndromes and the heart
2015, Autoimmunity ReviewsCitation Excerpt :PANDAS comprise neuropsychiatric manifestations, including the abrupt onset of choreoathetosis (reminiscent of Sydenham's chorea), obsessive compulsive behaviour (OCD) or tic disorder, that may follow exposure to GAS [31]. The connection between GAS infection and neurological symptoms in PANDAS remains contentious [32–36]. In the original description of PANDAS, a temporal relationship between GAS infection, the onset of neuropsychiatric symptoms, and exacerbations was observed [31].
Tics and Gilles de la Tourette Syndrome
2010, Blue Books of NeurologyCitation Excerpt :On the basis of a model proposed for Sydenham's chorea, it has been hypothesized that the underlying pathology in PANDAS involves an immune-mediated mechanism with molecular mimicry.65 The PANDAS hypothesis remains controversial on clinical criteria grounds and measurement of antineuronal antibodies.67-71 A longitudinal study in children with PANDAS showed little association between β-hemolytic streptococcal infection and symptom exacerbation,72 and no correlation between exacerbation of symptoms and changes in antineuronal antibodies, anti-lysoganglioside GM1 antibodies, or cytokines.71
Sydenham's chorea, and its complications affecting the nervous system
2009, Brain and DevelopmentCircuits to synapses: The pathophysiology of tourette syndrome
2007, Neurobiology of DiseaseCircuits to synapses: The Pathophysiology of Tourette Syndrome
2006, Neurobiology of DiseaseThe neural bases of obsessive - Compulsive disorder in children and adults
2008, Development and Psychopathology