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Neurosci Biobehav Rev. 2018 Mar;86:51-65. doi: 10.1016/j.neubiorev.2018.01.001. Epub 2018 Jan 6.

Treatment of PANDAS and PANS: a systematic review.

Author information

1
School of Medical Sciences, Örebro University, Örebro, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
2
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Electronic address: eva.hesselmark@ki.se.
3
School of Medical Sciences, Örebro University, Örebro, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Abstract

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are a subtype of acute-onset obsessive-compulsive disorder (OCD) thought to be caused by an autoimmune response to group A streptococcal infection. Based on this proposed pathophysiology, alternative treatments for acute-onset OCD have been introduced, including antibiotics and immunomodulatory interventions. However, the literature on treatment of PANDAS is diverse, and clinical consensus regarding optimal treatment strategy is lacking. We conducted a systematic review of articles in PubMed, Cochrane Library, and Scopus that addressed treatment for PANDAS and related disorders. Twelve research studies involving the following treatments met inclusion criteria: penicillin, azithromycin, intravenous immunoglobulin, plasma exchange, tonsillectomy, cognitive behavior therapy, NSAID and corticosteroids. In addition, 65 case reports in which patients received immunomodulatory treatments, antibiotics, and/or psychotropics were identified. We determined that rigorously conducted research regarding treatments for PANDAS is scarce, and published studies have a high risk of bias. Further research is needed in which promising treatment strategies for PANDAS and other variants of OCD with proposed autoimmune etiology are rigorously investigated.

KEYWORDS:

CANS; Childhood acute neuropsychiatric symptoms; OCD; Obsessive-compulsive disorder; Obsessive-compulsive symptoms; PANDAS; PANS; PITAND; Pediatric acute-onset neuropsychiatric syndrome; Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections; Systematic review; Therapy; Treatment

PMID:
29309797
DOI:
10.1016/j.neubiorev.2018.01.001
[Indexed for MEDLINE]
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