Differentiating PANDAS and non-PANDAS disorders

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Not unlike autism spectrum disorder (ASD), more cases of obsessive-compulsive disorder (OCD) and/or tic disorders are being diagnosed in prepubertal children. Also, not unlike ASD, the cause of most cases is unclear. Frustrated families seeking answers frequently think we don't care. We care. We just do not have the answers. Much debate has focused on the purported role of group A streptococcus (GAS) in causing or precipitating the so-called Pediatric Autoimmume Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS). Using objective criteria to define at least the most typical clinical constellation could benefit future investigations of etiology, natural history, and management.

In this study, investigators invited participation of patients 4-17 years of age with childhood onset of OCD and/or tic disorders, attempting to enrich the study sample for enrollment of children with a history of any infection-related symptom flare-ups or a history of dramatic onset of either OCD or tics. Interviews, neuropsychiatric testing, streptococcal antibody testing, and review of the medical records were performed on 109 children. Cases were assigned as PANDAS (including requirement of at least one elevated GAS-associated antibody level) or non-PANDAS by criteria of Swedos, then additional clinical characteristics of groups were compared. Significant group differences were found, such as dramatic onset, definite remissions, history of tonsillectomy/adenoidectomy, and others in patients with PANDAS.

Despite inherent limitations of the study, the description of typical objective findings of so-called PANDAS cases will help focus future investigations on subjects with a similar clinical entity.

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