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PEDIATRICS Vol. 113 No. 4 April 2004, pp. 883-886

SPECIAL ARTICLE

The Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infection (PANDAS) Etiology for Tics and Obsessive-Compulsive Symptoms: Hypothesis or Entity? Practical Considerations for the Clinician

Roger Kurlan, MD* and Edward L. Kaplan, MD{ddagger}

* Cognitive and Behavioral Neurology Unit, Department of Neurology, University of Rochester School of Medicine, Rochester, New York
{ddagger} Department of Pediatrics, World Health Organization Collaborating Center for Reference and Research on Streptococci, University of Minnesota School of Medicine, Minneapolis, Minnesota

Clinicians have been faced with much publicity and contradictory scientific evidence regarding a recently described condition termed pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS). It has been proposed that children with PANDAS experience tics, obsessive-compulsive behavior, and perhaps other neuropsychiatric symptoms as an autoimmune response to streptococcal infection. We review current scientific information and conclude that PANDAS remains a yet-unproven hypothesis. Until more definitive scientific proof is forthcoming, there seems to be insufficient evidence to support 1) routine microbiologic or serologic testing for group A streptococcus in children who present with neuropsychiatric symptoms or 2) the clinical use of antibiotic or immune-modifying therapies in such patients. The optimum diagnostic and therapeutic approach awaits the results of additional research studies.

Key Words: tics • obsessive-compulsive symptoms • streptococcal infection • autoimmunity • PANDAS

Abbreviations: OCD, obsessive-compulsive disorder • PANDAS, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection • GABHS, group A ß-hemolytic streptococcus • TS, Tourette’s syndrome

Received for publication May 23, 2003; Accepted Jul 30, 2003.


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