Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)

Excerpt

To the Editor: The term Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) denotes a group of childhood obsessive-compulsive disorders (OCD) and tic disorders (TD) triggered by Group-A Beta Hemolytic Streptococci (GABHS) infection. Its validity as a nosological entity generates controversy. PANDAS have been propounded to result from an autoimmune mediated process, in which anti-streptolysin-O (ASO) antibodies are thought to be involved, affecting the basal ganglia, [1] much along the lines of the pathogenesis of rheumatic chorea. Specific antibodies targeted to the dominant epitope of GABHS (N-acetyl-beta-D-Glucosamine) might influence neuronal signal transduction thus causing alterations in behavior and movement control by inducing calcium-calmodulin dependent protein (CaM) kinase II activity [2]. The autoimmune mediated mechanism is substantiated by the excellent response of children with PANDAS to immunotherapies (plasma exchange and intravenous immunoglobulin) [3]. Nonetheless, an individual’s susceptibility to PANDAS, like other infection-triggered autoimmune disorders, may be genetically predisposed. Characteristics linked to basal ganglia functions such as urinary urgency, hyperactivity, impulsivity, and deterioration in handwriting may distinguish PANDAS from non-PANDAS OCD [4]. Arguably, the temporal association between GABHS infection (whose incidence in school-age children is high) and the onset of neuropsychiatric symptoms does not necessarily mean causality, hence the continuing debate over the PANDAS construct despite growing evidence in its support. …