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Cited by 104Autoimmune Neurological Disorders and TreatmentsStreptococcal Infections and TreatmentsPeripheral Neuropathies and Disorders

Overview of treatment of pediatric acute-onset neuropsychiatric syndrome

Open access
Swedo, Susan E., Frankovich, Jennifer, Murphy, Tanya K.·2017·Journal of Child and Adolescent Psychopharmacology
DOI 10.1089/cap.2017.0042PMC PMC5610386
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Abstract

Keywords: pediatric acute-onset neuropsychiatric syndrome, pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections, overview of PANS/PANDAS treatments, treatment with antibiotics, treatment with antiinflammatory or immune modulating therapies, treatment with psychiatric medications and behavioral interventionsis a clinical condition defined by the unusually abrupt onset of obsessive-compulsive symptoms and/or severe eating restrictions and at least two concomitant cognitive, behavioral, or neurological symptoms (Swedo et al. 2012).Because the PANS criteria define a broad spectrum of neuropsychiatric conditions, the syndrome is presumed to result from a variety of disease mechanisms and to have multiple etiologies, ranging from psychological trauma or underlying neurological, endocrine, and metabolic disorders to postinfectious autoimmune and neuroinflammatory disorders, such as pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS), cerebral vasculitis, neuropsychiatric lupus, and others (Swedo et al. 2012;Chang et al. 2015).In cohorts of well-characterized PANS patients, evidence of postinfectious autoimmunity and/or neuroinflammation is found in more than 80% of cases (Frankovich et al. 2015; Murphy et al. 2015;Swedo et al. 2015).Thus, treatment of PANS depends on three complementary modes of intervention:1. Treating the symptoms with psychoactive medications, psychotherapies (particularly cognitive behavioral therapy), and supportive interventions.2. Removing the source of the inflammation with antimicrobial interventions.3. Treating disturbances of the immune system with immunomodulatory and/or anti-inflammatory therapies. MethodsMembers of the PANS/PANDAS Research Consortium (PRC) began development of the treatment guidelines in May 2014 at a meeting held at the National Institutes of Health in Bethesda, Maryland.Refinements and modifications were made for the ensuing 2 years by three workgroups that separately addressed (1) use of psychiatric medications and behavioral interventions, (2) use of antimicrobials, and (3) use of anti-inflammatory and immunomodulating therapies (see Fig. 1).The workgroups followed similar procedures, first reviewing the published literature and drawing upon their combined clinical experience with more than 1000 children with PANS/PANDAS to formulate an initial set of recommendations, which were then sent to a separate group of expert clinicians for critical review and comment.The review panels included not only clinicians with expertise in the diagnosis and treatment of PANS/PANDAS but also experts in the fields of child psychiatry, pediatrics, infectious diseases, microbiology, neurology, neuroimmunology, immunology, and rheumatology.The reviewers' suggestions were incorporated into a revised set of guidelines, which was also circulated for comment and correction before being submitted to the PRC for adoption.In a few instances, consensus could not be reached on a single approach to treatment, so the PRC opted to include both options for intervention (e.g., whether or not to use antibiotics in children without documented infections).Thus, the three sets of guidelines truly represent ''best practices'' from across the country.We expect that these recommendations will evolve over time, as controlled trials begin to test the efficacy of the various treatment combinations, and clinical experience broadens and deepens.In the interim, we wish to acknowledge the valuable contributions of the following individuals:

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  • Successful treatment recommendations for patients with IAE include psychiatric medications and behavioral interventions, antimicrobials, and anti-inflammatory and/or immunomodulating therapies such as intravenous immunoglobulin and plasmapheresis.

    “Successful treatment recommendations for patients with IAE include psychiatric medications and behavioral interventions, antimicrobials, and anti-inflammatory and/or immunomodulating therapies such as intravenous immunoglobulin and plasmapheresis.”

    From An updated review of pediatric autoimmune neuropsychiatric disorders associated with Streptococcus/pediatric acute-onset neuropsychiatric syndrome, also known as idiopathic autoimmune encephalitis: What the allergist should know (2023) · cites this paper as [37]

    The Abstract and the treatment summary under Fig. 1 recommend psychiatric and behavioral interventions, antimicrobials, and anti-inflammatory or immunomodulatory therapies for children with PANS. The cited paper does not establish these recommendations for patients with IAE or name intravenous immunoglobulin or plasmapheresis as examples in the passages found; it also describes the guidelines as best practices awaiting controlled trials, rather than established successful treatments. (LLM, conf=0.86)

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  • Current recommended treatments for IAE include psychiatric medication, behavioral intervention, antibiotics, anti-inflammatory therapy, and immunomodulating therapy.

    “Current recommended treatments include psychiatric medication, behavioral intervention, antibiotics, anti-inflammatory therapy, and immunomodulating therapy.”

    From An updated review of pediatric autoimmune neuropsychiatric disorders associated with Streptococcus/pediatric acute-onset neuropsychiatric syndrome, also known as idiopathic autoimmune encephalitis: What the allergist should know (2023) · cites this paper as [37]

    The Abstract and the treatment summary near Fig. 1 recommend psychiatric medication, behavioral interventions, antibiotics, and anti-inflammatory or immunomodulatory therapy for pediatric acute-onset neuropsychiatric syndrome (PANS). The cited paper does not establish these as recommended treatments for IAE, as the contextualized claim states; it also says the treatment chosen depends on the child’s presentation. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • The IAE (PANS/PANDAS) Research Consortium introduced treatment guidelines in 2014, which comprised the use of psychiatric medications and behavioral interventions, antimicrobials, and anti-inflammatory and/or immunomodulating therapies.

    “The IAE (PANS/PAN-DAS) Research Consortium introduced treatment guidelines in 2014, which comprised the use of psychiatric medications and behavioral interventions, antimicrobials, and anti-inflammatory and/or immunomodulating therapies (Fig 3).37”

    From An updated review of pediatric autoimmune neuropsychiatric disorders associated with Streptococcus/pediatric acute-onset neuropsychiatric syndrome, also known as idiopathic autoimmune encephalitis: What the allergist should know (2023) · cites this paper as [37]

    The Abstract (page not provided) says the PANS/PANDAS Research Consortium began developing the guidelines in May 2014 and identifies all three treatment areas. It also says revisions continued for the next two years, so it does not support the claim that the guidelines were introduced in 2014. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

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Authors
Swedo, S. E., Frankovich, J., & Murphy, T. K.
Affiliations
  • National Institute of Mental Health (US)
  • Lucile Packard Children's Hospital (US)
  • University of South Florida St. Petersburg (US)
Corresponding author
Swedo, Susan E.
ORCID
Venue
Journal of Child and Adolescent Psychopharmacology
Publisher
SAGE Publications
Published
2017-09
Volume
27
Issue
7
Pages
562-565
ISSN
  • 1044-5463 (ISSN-L)
  • 1557-8992
DOI
10.1089/cap.2017.0042
PMC
PMC5610386
OpenAlex
W2738007331
Cited by
104
References
23
Citations by year
2026: 8 · 2025: 9 · 2024: 14 · 2023: 14 · 2022: 11 · 2021: 13 · 2020: 10 · 2019: 16 · 2018: 9
FWCI
6.67
Type
journal article
Language
en
Open access
Licence
www.liebertpub.com/nv/resources-tools/text-and-data-mining-policy/121/ (tdm)
Locations
  • Journal of Child and Adolescent Psychopharmacology (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health
Topics
  • Health Sciences › Medicine › Neurology › Autoimmune Neurological Disorders and Treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
  • Health Sciences › Medicine › Neurology › Peripheral Neuropathies and Disorders
Keywords
pediatric acute-onset neuropsychiatric syndrome, PANS, PANDAS, obsessive-compulsive symptoms, dietary restriction, treatment guidelines, antibiotic therapy, anti-inflammatory therapy, immunomodulatory therapy, psychiatric medication, behavioral interventions, cognitive behavioral therapy, neuroinflammation, children and adolescents
MeSH terms
Child, Humans, Obsessive-Compulsive Disorder, Syndrome, Neurodevelopmental Disorders

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