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Thienemann Margo, Murphy Tanya, Leckman James, Shaw Richard, Williams Kyle, Kapphahn Cynthia, Frankovich Jennifer, Geller Daniel, Bernstein Gail, Chang Kiki, Elia Josephine, and Swedo Susan
Journal of Child and Adolescent Psychopharmacology-July 2017
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While underlying infectious and inflammatory processes in PANS and PANDAS patients are treated, psychiatric and behavioral symptoms need simultaneous treatment to decrease suffering and improve adherence to therapeutic intervention. Psychological, behavioral, and psychopharmacologic interventions tailored to each child’s presentation can provide symptom improvement and improve functioning during both the acute and chronic stages of illness. In general, typical evidence-based interventions are appropriate for the varied symptoms of PANS and PANDAS. Individual differences in expected response to psychotropic medication may require marked reduction of initial treatment dose. Antimicrobials and immunomodulatory therapies may be indicated, as discussed in Parts 2 and 3 of this guideline series.

Swedo Susan E., Frankovich Jennifer, and Murphy Tanya K
Journal of Child and Adolescent Psychopharmacology-2017

Thus, treatment of PANS depends on three complementary modes of intervention:

• Treating the symptoms with psychoactive medications, psychotherapies (particularly cognitive behavioral therapy), and supportive interventions.
• Removing the source of the inflammation with antimicrobial interventions.
• Treating disturbances of the immune system with immunomodulatory and/or anti-inflammatory therapies.

Dale RC, Gorman MP, Lim M
Current Opinion Neurololgy-2017

This review summarizes autoimmune encephalitis in children. PANS/PANDAS is included as a subgroup of acquired encephalopathy with focal neurological deficits of infectious and/or immune origin.

Maryann P. Platt, Dritan Agalliu, Tyler Cutforth
Frontiers in Immunology-2017

Autoimmunity in the CNS remains confoundingly complex, in both etiology and treatment. While triggers for AE are defined in some cases, frequently, no clear infectious or cancerous cause can be found. BBB integrity clearly plays a role in disease development, and more research on differential barrier permeability over the course of disease would resolve many questions about autoantibody entry and pathogenesis.

Mahony Talia, Sidell Douglas, Gans Hayley, Cooperstock Michael, Brown Kayla, Cheung Joanne M, Farhadian Bahare, Gustafson Melissa, Thienemann Margo, and Frankovich Jennifer
JCAP-2017

Despite the established relationship between palatal petechiae and GAS, no patient with palatal petechiae in our clinic tested positive for GAS and only 32% had evidence of recent GAS. Most did not have an identifiable cause for the palatal lesions. This finding suggests the potential for alternative causes of palatal petechiae or undetectable GAS in our patient population. The high prevalence of palatal petechiae without GAS infection suggests that the pathogenesis of PANS is multifactorial and may involve disruption or inflammation of the microvasculature.

G.P.Tisi, M.Marzolini, G.Biffi
European Psychiatry-2017

Epstein–Barr virus infection has been reported to precede various neuropsychological disorders, but to the best of our knowledge, rare cases of PANS following mononucleosis have been described in literature. In our case, psychopharmacological treatment for OCD symptoms was the only treatment performed and led to a partial remission of symptoms.

A.Pozza
European Psychiatry-2017

Along with psychiatric and antibiotic medications, CBT may be a valid augmentation strategy for PANDAS to reduce risk of exacerbations and enhance symptom improvement.

Janice Trigilio Tona; Sutanuka Bhattacharjya; Denise Calaprice
AJOT-2017

Children with PANS present with pervasive occupational performance needs during exacerbation. Children and families may benefit from accommodations to maximize function during this turbulent period.

Nicholas D. Hysmith, Edward L. Kaplan, P. Patrick Cleary, Dwight R. Johnson, Thomas A. Penfound, James B. Dale
Journal of Pediatric Infectious Disease Society-2017
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The prospective study examining the immunological response to infection by group A streptococcus (GAS) was performed in serum samples obtained from pediatric subjects. Study examined the immune response to 13 shared GAS antigens and 18 type-specific M peptides, but found no novel pattern of immune responses. Importantly, the study found that 65% of new streptococcus infections did not result in symptoms despite a detectable immunological response. This finding is supported by previous research and suggests that the majority of GAS infections remain undetected and contribute to the burden of the disease when left untreated.

Talia Mahony, Douglas Sidell, Hayley Gans, Kayla Brown, Bahare Farhadian, Melissa Gustafson, Janell Sherr, Margo Thienemann, Jennifer Frankovich
International Journal of Pediatric Otorhinolaryngology-2017

Improvement of psychiatric symptoms correlated with resolution of sinus disease in this retrospective study. Identification, treatment, and resolution of underlying infections, including sinusitis, may have the potential to change the trajectory of some neuropsychiatric illnesses.

Tromba V, Spalice A, Lambiase C, Favoriti A and Tancredi G
Austin Journal of Clinical Medicine-2017

Our data confirm that patients with suspected restless leg
syndrome could present PANDAS.

Pawela C, Brunsdon RK, Williams TA, Porter M, Dale RC, Mohammad SS
Dev Med Child Neurol-2016
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Although based on a small, cross‐sectional case series, our results highlight the potential importance of early identification and IVIg treatment of BGE. Given the cognitive and behavioural deficits described in this report, our clinical recommendation would be to try to treat patients rapidly with immune therapies, when clinical suspicion of BGE is high, to minimize the inflammatory component of the disease.