Posts by:
Gabriella True

Sizgoric MK, Kovac Sizgoric M, Miculinic A, et al. Clinical manifestations of patients with PANDAS in patients followed up at Srebrnjak children’s hospital in 5-year period. Archives of Disease in Childhood 2021;106:A169. Article

Clinical:
– 20 children, 16 (80%) male, 4 (20%) female, aged 3 to 11 years (median age 6.5)
-Elevated levels of antistreptolysin titers 19 of 20 (95%). Anti-DNAse-B levels were tested in 7 patients and was elevated in 4 (57%)
-Neuroimaging studies (N=12 or 60%) – no specific findings found
-Family history of tics and autoimmune disorders was positive in N=5
(25%)

Symptoms:
-All patients had OCD and tics with acute onset of symptoms
-Attention disorders N=17 (85%)
-Sleeping difficulties N=4 (20%)
-Speech difficulties N=5 (25%)
-Decline in school performance N=10 (71%)

Treatment:
-15 (75%) patients given first-line antibiotics. In 5 (25%) patients a full regression of symptoms was registered, 10 (50%) had partial improvement, 5 (25%) had no response.
-7 (35%) were given IVIG after initial antibiotic treatment with incomplete regression. Tics persisted in 11 patients and 4 had tics with behavioral difficulties. In 7 patients treated with IVIG we proceeded with parenteral antibiotics because of partial symptom regression and 2 were given corticosteroids (still followed).

A Krouse, H Li, JA Krenzer, WN Rose. Plasmapheresis, Rituximab, and Ceftriaxone Provided Lasting Improvement for a 27-Year-Old Adult Male with PANDAS. Dept of Pathology, University of Wisconsin Hospital. Article

• At 17 – developed sudden psychosis and confusion after GAS infection. Had elevated anti-streptolysin O (ASO) titers. Did not present with typical symptoms of PANDAS – OCD and/or tic-like symptoms were not observed. A tentative diagnosis of PANDAS was given. Treated with antipsychotics, antibiotics, tonsillectomy, and IVIG which resulted in remissions and relapses of his neuropsychiatric symptoms.
• At age 27 – received a trial of therapeutic plasma exchange (TPE), rituximab, and ceftriaxone. Eventually resulted in sustained benefit and minimal fluctuations of his clinical symptoms.

de Oliveira, K.C., Camilo, C., Gastaldi, V.D. et al. Brain areas involved with obsessive-compulsive disorder present different DNA methylation modulation. BMC Genom Data 22, 45 (2021). DOI:10.1186/s12863-021-00993-0

• Confirms involvement of previously associated genes and biological processes in OCD as well as reports differences related to specific brain areas
• Findings point to a role of cellular communication, inflammatory processes and behavior mediated by DNA methylation in OCD brain tissues.
• Findings were related to the immune system, reaffirming the current literature findings about its involvement with OCD.
• Changes in DNA methylation are involved with OCD and further studies are needed to characterize alterations in different paths in each brain area.

Dolce, J.L., LaRusso, M.D. & Abadia-Barrero, C. Disruptions and Adaptations in Family Functioning: A Study of Families’ Experiences with PANS/PANDAS. J Child Fam Stud (2021). DOI:10.1007/s10826-021-02101-3

• Examined family functioning utilizing online parent forums and nine semi-structured interviews with PANS/PANDAS families.
• Unpredictability & relapsing-remitting nature of neuropsychiatric symptoms cause significant disruptions to daily life.
• Financial strain, social isolation, and lack of support from schools and medical institutions transform family functioning.
• Parents’ frequent use of trauma metaphors to describe experience diverges from literature on other chronic illnesses.

Rea I, Guido CA, Spalice A. Clinical Features in Patients With PANDAS/PANS and Therapeutic Approaches: A Retrospective Study. Frontiers in Neurology. Vol. 12, 2021. DOI=10.3389/fneur.2021.741176  

• 62 patients with a clinical diagnosis of PANDAS/PANS.
  • 15 with PANS. 47 with PANDAS
• Mean age at onset of PANDAS/PANS symptoms was 6.2 ± 1.2 years
  • 6.2 for PANDAS. 6.0 for PANS
• Neurological and psychiatric symptoms were mostly evident in both groups with little difference
• 93.5% had vocal tics
• 79% had OCD
• PANS kids had more irritability, aggressivity, and food restriction
• PANDAS kids had 10 times higher levels of anti-streptolysin O and anti-DNAse B
• PANS kid had a higher percentage of metabolic disorders
• Psychotherapy significantly relieved OCD the most and reduced stress in patients and parents
• Antibiotic prophylaxis was the most frequently used (90%) for acute neurological symptoms