Pediatric Autoimmune Neuropsychiatric Disorders Associated with Steptococcal Infections
P.A.N.D.A.S.



Definition


From the Official PANDAS website:
http://intramural.nimh.nih.gov/pdn/web.htm
PANDAS, is an abbreviation for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Steptococcal Infections. The term is used to describe a subset of children who have Obsessive Compulsive Disorder(OCD) and/or tic disorders such as Tourette's Syndrome, and in whom symptoms worsen following strep. infections such as "Strep throat" and Scarlet Fever...
Research

The Official PANDAS Web Page for Recent Publications:
http://intramural.nimh.nih.gov/pdn/recent_publications.htm

Snider, Lisa A; Lougee, Lorraine; Slattery, Marcia; Grant, Paul; Swedo, Susan Antibiotic Prophylaxis with Azithromycin or Penicillin for Childhood-Onset Neurospychiatric Disorders. Biol Psychiatry 2005; 57: 788-792


J Child Psychol Psychiatry. 2005 Mar;46(3):227-34.
Annotation: PANDAS: a model for human autoimmune disease.
Swedo SE, Grant PJ.

National Institute of Mental Health, Bethesda, Maryland 20892-1255, USA.

BACKGROUND: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections (PANDAS) is a recently recognized syndrome in which pre-adolescent children have abrupt onsets of tics and/or obsessive-compulsive symptoms, a recurring and remitting course of illness temporally related to streptococcal infections, and associated neurologic findings including adventitious movements, hyperactivity and emotional lability. METHODS: Inspired by observations of similar symptoms in children with Sydenham's chorea, a search was undertaken for clinical and laboratory evidence in support of the new syndrome. RESULTS: Consistent and predictable clinical findings have been described in a large case series. Magnetic resonance imaging has supported the postulated pathobiology of the syndrome with evidence of inflammatory changes in basal ganglia. Antibasal ganglia antibodies have been found in some acute cases, mimicking streptococcal antigen epitopes. CONCLUSIONS: While PANDAS remains a controversial diagnostic concept, it has stimulated new research endeavors into the possible links between bacterial pathogens, autoimmune reactions, and neuropsychiatric symptoms.
PMID: 15755299 [PubMed - in process]

Post Streptococcal Autoimmune Disorders of the Central Nervous System
Lisa A Snider and Susan E. Swedo
2003
http://intramural.nimh.nih.gov/pdn/pub-2.pdf

Case Report
Childhood-Onset Obsessive-Compulsive Disorder and Tic Disorders: Case Report and Literature Review
Lisa A Snider, M.D. and Susan E. Swedo, M.D.
Journal of Child and Adolescent Psychopharmacology Volume 13, Supplement 1, 2003
http://intramural.nimh.nih.gov/pocd/pocd-article3.pdf

The PANDAS Subgroup: Recognition and Treatment
Susan E. Swedo, MD, Marjorie Garvey, MD, Lisa Snider, MD, Charlotte Hamilton, MD, and Henrietta L. Leonard, MD
http://www.cnsspectrums.com/article.php3?id=36

Varied Presentation of PANDAS: A Case Series
(Clinical Pediatrics)
http://mentalhelp.net/poc/view_doc.php?type=news&id=56185&cn=6

Abstracts for several studies
http://www.neurotransmitter.net/pandas.html

NIMH Roundtable PANDAS Aug 18, 2000:
http://www.nimh.nih.gov/research/pandassummary.cfm

Childhood Anxiety Disorders
2000
Susan Jo Perlmutter, M.D.
http://www.acnp.org/g4/GN401000163/CH159.html

REVIEW ARTICLE
Pediatric Autoimmune Neuropsychiatric Disorders
Associated with Streptococcal Infection (PANDAS)
Deborah Levy Miller1, MD FRCPC and Ronald M Laxer2, MD FRCPC
http://www.pedrheumonlinejournal.org/April/reviewarti.htm

Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood
Perlmutter, Leitman, Garvey, Hamburger, Feldman, Leonard, Swedo
The Lancet, Vol 354, October2, 1999
http://intramural.nimh.nih.gov/research/pdn/pub-5.pdf

Clinical Case Conference
Am J Psychiatry 155:1592-1598, November 1998
A Case of Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections
Susan J. Perlmutter, M.D., Marjorie A. Garvey, M.D., Xavier Castellanos, M.D., Barbara B. Mittleman, M.D., Jay Giedd, M.D., Judith L. Rapoport, M.D., and Susan E. Swedo, M.D
http://ajp.psychiatryonline.org/cgi/content/full/155/11/1592

The Institute of Neurology (Queen Square)
University College London
Department of Neuroinflammation
From the site, description of ongoing research regarding PANDAS: We are currently investigating whether there is persistent colonisation of the nasopharynx by using sensitive extended-culture and DNA-based diagnostic assays for streptococci. In preliminary studies, a subset of patients with these disorders have persistent colonisation; whether the strains of streptococci from these patients differ from other strains is under investigation. http://www.ion.ucl.ac.uk/research/neuroinf/neuroinf_neuroimmunology.htm


Articles

Collection of PANDAS articles
http://www.alertpubs.com/pandas.htm

Editorial
Brain, Vol. 127, No. 1, 2-3, January 2004
Encephalitis lethargica: part of a spectrum of post-streptococcal autoimmune diseases?
http://brain.oupjournals.org/cgi/content/full/127/1/2

Mental ailments in children being linked to strep
 By Carey Goldberg, Globe Staff, 6/28/2003
http://www.vaccinationnews.com/DailyNews/2003/June/29/MentalAilmentsInChildren29.htm

UF RESEARCHERS PROBE POSSIBLE LINK BETWEEN STREP, OBSESSIVE-COMPULSIVE DISORDER
Oct. 10, 2002
GAINESVILLE, Fla. --- A new University of Florida study may settle once and for all the baffling question of whether common strep infections are linked to obsessive-compulsive disorder or tics in some children.
http://www.napa.ufl.edu/2002news/strep-ocd.htm

Obsessed by a Bug?
In Study, Bizarre Child Behaviors Possibly Linked to Strep Infection Respond to Antibiotics
By Miriam E. Tucker
Special to The Washington Post
Tuesday, June 18, 2002; Page HE01
www.washingtonpost.com

Sudden Onset of Obsessive-Compulsive Disorder May Point to PANDAS
[reviews Murphy and Pichichero study]
Neurology Reviews.com April 2002
http://www.neurologyreviews.com/apr02/pandas.html

Strep Threat
Can a sore throat lead to Tourette's syndrome?
By Emily Yoffe
Posted Wednesday, Feb. 27, 2002, at 12:22 PM PT
http://slate.msn.com/?id=2062577

Plasmapheresis May Benefit Strep-Related OCD
Betsy Bates, Los Angeles Bureau
[Pediatric News 33(1):28, 1999. © 1999 International Medical News
Group.]
http://neuro-www.mgh.harvard.edu/forum_2/ChildNeurologyF/11.6.997.30AMStrep-relate.html


Websites
Wonderful new OCD website, with information for schools!!!
http://www.worrywisekids.org/index.html

http://www.tourettesyndrome.net/pandas.htm
From the site:
Perhaps one of the "hottest" topics in the professional literature concerns the possible relationship between group A beta-hemolytic streptococci ("strep") infections and acute-onset of, or worsening of, Tourette's Syndrome (TS) and/or Obsessive-Compulsive Disorder (OCD) in children.

http://www.lifesatwitch.com/pandas.html
From the site:
Sydenham's Tourettic PANDAS??!
Bringing the Most Recent Data to 'Bear' In Carving Nature at its Joints
(article)

http://www.ocfoundation.org/ocf_0001.htm
Obsessive Compulsive Foundation
PANDAS
By Michael Jenike, M.D.

Again and Again
Obsessive-Compulsive Disorder Websites


Message Boards

Message boards can give you live, instant help from others.

Lattitudes OCD message board (often has PANDAS topics):
http://www.latitudes.org/forums/index.php?act=SF&s=&f=8
Lattitudes Tourette's message board (often has PANDAS topics):
http://www.latitudes.org/forums/index.php?act=SF&s=&f=1

BrainTalk Communities: Online Support Groups for Neurology (Updated links March 2004)
http://brain.hastypastry.net/forums/
This forum is owned and maintained by the Department of Neurology at Massachusetts General Hospital.  Read at the PANDAS, OCD and Tourrette's forums; all may have PANDAS information:

OCD and Parenting
http://health.groups.yahoo.com/group/ocdandparenting/
The OCD and Parenting List serves as an online support group for parents of children with OCD. Our list is advised by Gail B. Adams, Ed.D., Tamar Chansky, Ph.D., Aureen Wagner, Ph.D., and Dan Geller, M.D.
Our list moderators are Wendy Birkhan, Chris Castle, Emily Fowler, Kathy Hammes, Cindy Joye, Kathy McDonald, Gail Pesses, Kathy Robinson, Vivian Stembridge, and Jackie Stout.  [This is one of the more active OCD lists.]

PANDAS_Support · A Global Health Network Support Group
http://health.groups.yahoo.com/group/PANDAS_Support/
From the Site:  Welcome to the Global Health Network's support community for people affected by "Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS). This group is open to anyone interested in making friends, sharing information and support with others affected by this disorder.

HAandGlycine · hippuric acid and glycine
http://health.groups.yahoo.com/group/HAandGlycine/
Site Description:This list is set up to investigate the simililarity in stories among people who have high hippuric acid and/or glycine on laboratory testing. We are especially interested if there is any link in history to PANDAS or strep infection.  Discussion of medical articles relevant to this issue is welcomed.


Information About Strep Throat

Group A Streptococcal Infections
National Institute of Allergy and Infectious Diseases
http://www.niaid.nih.gov/factsheets/strep.htm

Meta-analysis of Chephalosporin Versus Penicillin Treatment of Group A Streptococcal Tonsillopharyngitis in Children
PEDIATRICS Vol. 113 No. 4 April 2004, pp. 866-882
[Oral cephalosproins were more successful in treatment of strep throat than oral penicillin]
http://pediatrics.aappublications.org/cgi/content/abstract/113/4/866

American Academy of  Family Physicians
Management of Group A Beta-Hemolytic Streptococcal Pharyngitis
CYNTHIA S. HAYES, M.D., M.H.A., and HAROLD WILLIAMSON, JR., M.D., M.S.P.H.
University of Missouri­Columbia School of Medicine, Columbia, Missouri
http://www.aafp.org/afp/20010415/1557.html

Acute Strep Throat
by Michael E. Pichichero, MD
Professor of Microbiology and Immunology, Pediatrics and Medicine
University of Rochester Medical Center
Elmwood Pediatric Group
http://www.pediatricweb.com/seattle/article.asp?ArticleID=850&ArticleType=9


Use of Medications and Supplements for Obsessive Compulsive Disorder

FDA Issues Public Health Advisory on Cautions for Use of  Antidepressants in Adults and Children
March 22, 2004
http://www.fda.gov/bbs/topics/ANSWERS/2004/ANS01283.html

Article on Inositol
http://www.homestead.com/westsuffolkpsych/Inositol_and_OCD.html


Books, Articles, and Websites  for OCD in Children

Books and Articles

Freeing Your Child From Obsessive Compulsive Disorder
Freeing Your Child From Anxiety
By Tamar E. Chansky, Ph.D.

Up and Down the Worry Hill: A children's book about obsessive-compulsive disorder
By Aureen Pinto Wagner, Ph.D.

Cognitive-Bahvioral Therapy for Children and Adolescents with Obsessive-Compulsive Disorder
Paper by Aureen Pinto Wagner, Excellent for explaining how OCD is an anxiety disorder, not a thought disorder, and each episode is best dealt with right when it starts.

The Explosive Child: An New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children, a book by Ross W. Greene, Ph.D. available at www.amazon.com and major booksellers.  I highly recommend this book for children who don't respond to more traditional methods of discipline (or any child, any age).  As some children get older, the approach discussed in this book may be appropriate.  The book teaches the parent how to prioritize what situations to deal with and shows how to teach your child the skills to be more flexible.  Great book and DVD.  Your library may have either.

Articles by Western Suffolk Psychological Services Practitioners

Websites and Message Boards

OCD and Parenting
http://health.groups.yahoo.com/group/ocdandparenting/
From the site: The OCD and Parenting List serves as an online support group for parents of children with OCD.  Our list is advised by Gail B. Adams, Ed.D., Tamar Chansky, Ph.D., Aureen Wagner, Ph.D., and Dan Geller, M.D.  [This is one of the more active lists.]

Latitudes forums for OCD and Tourrette's http://www.latitudes.org/forums/index.php?

BrainTalk Communities: Online Support Groups for Neurology (Updated links March 2004)
http://brain.hastypastry.net/forums/ 
This forum is owned and maintained by the Department of Neurology at Massachusetts General Hospital.  Read their OCD, PANDAS and Tourrette's forums for discussions on OCD.


Disclaimer
The information on this site is intended for information and education only.  It is not intended to be construed as medical or legal advice, nor do I endorse any of the material contained in the outside sites I have included as links.  Each individual and parent is responsible for exercising his/her own judgment in researching information relevant to his/her own situation.  The contents of this site and all original material are copyright © and are the property of the respective writers.
enzymestory homepage
email me
Updated August 18, 2005.