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Thamotharampillai Dileepan, Erica D. Smith, Daniel Knowland, Martin Hsu, Maryann Platt, Peter Bittner-Eddy, Brenda Cohen, Peter Southern, Elizabeth Latimer, Earl Harley Dritan Agalliu. and P. Patrick Cleary
Journal of Clinical Investigation-2015
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Our results establish what we believe to be evidence of a novel crosstalk between the CNS and cellular immunity to infections, which may contribute to understanding the pathogenesis of many other CNS autoimmune diseases. Flare-ups associated with several chronic autoimmune conditions may be produced by the expansion of Th17 cells and the activation of cytokines induced by relatively common bacterial or viral infections. Aberrant cytokine expression could then disrupt the BBB to permit preexisting circulating autoantibodies to enter the brain, engage neural targets, and trigger the sudden onset of clinical symptoms.

Michelle M. Papachrisanthou, DNP, CPNP-PC, Renée L. Davis, DNP, CPNP-PC
Journal of Nurse Practitioners-2015

• PANDAS can occur during or after a streptococcal infection.
• PANDAS presents with sudden onset of personality changes.
• Workup may be necessary to rule out other organic or mental health diagnoses.
• Recognition is key to enable positive patient outcomes.

Molly McClelland, PhD, RN, Mary-Margaret Crombez, MEd, Catherine Crombez, BSc, Catherine Wenz, MSN, RN, FNP-BC, Margaret Lisius, MSW, Amanda Mattia, BSN, RN, Suzana Marku, BSN, RN
JPED-2015
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Using paradigmatic analysis of transcribed interviews, three themes were identified: fear, frustration, and not being heard.

Morchi, Ravi MD
Emergency Medicine News-2015

Antoine Louveau, Igor Smirnov, Timothy J. Keyes, Jacob D. Eccles, Sherin J. Rouhani, J. David Peske, Noel C. Derecki, David Castle, James W. Mandell, Kevin S. Lee, Tajie H. Harris & Jonathan Kipnis
Nature-2015

The research findings reported in this study challenge the dogmas regarding the immune privilege status of the central nervous system (CNS) and its isolation from the immune system by the blood-brain barrier. Functional meningeal lymphatic vessels capable of carrying immune cells and interstitial fluids from the CNS are identified and characterized. Findings provide novel understanding on how autoimmune encephalopathies, like PANS/ PANDAS, can develop when these unique lymphatic vessels malfunction. Structural and functional features of central nervous system lymphatic vessels.

Walls A, Cubangbang M, Wang H, Raiji M, Knight J, Steehler M, Latimer E, Harley EH Jr. 
Otolaryngol Head Neck Surg.-2015

Patients diagnosed with PANDAS appear to maintain significantly different concentrations of cytokines when compared with patients afflicted by chronic group A beta hemolytic streptococcus infections and obstructive sleep apnea. As a result, one could potentially use the described characterization of immunologic markers as a basis for future mechanistic and epidemiological studies.

Daniel Demesh, MD; Jordan M. Virbalas, MD; John P. Bent, MD
JAMA Otolaryngol Head Neck Surg.-2015

Conclusions: Although current evidence is inconclusive, the data reported herein support previously described smaller case series and further strengthens the notion that tonsillectomy may benefit patients with PANDAS whose symptoms are not controlled with antibiotic therapy

Nicolini H, López Y, Genis-Mendoza AD, Manrique V, Lopez-Canovas L, Niubo E, Hernández L, Bobes MA, Riverón AM, López-Casamichana M, Flores J, Lanzagorta N, De la Fuente-Sandoval C, Santana D. 
Actas Esp Psiquiatr-2015

The simultaneous detection of all three of these antibodies could provide valuable information for the etiologic diagnosis of individuals with early-onset obsessive-compulsive disorders associated with streptococcal infection and, consequently, for prescribing suitable therapy.

Kiki Chang, Jennifer Frankovich, Michael Cooperstock, Madeleine W. Cunningham, M. Elizabeth Latimer, Tanya K. Murphy, Mark Pasternack, Margo Thienemann, Kyle Williams, Jolan Walter, and Susan E. Swedo, From the PANS Collaborative Consortium
Journal of Child and Adolescent Psychopharmacology-2015
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On May 23 and 24, 2013, the First PANS Consensus Conference was convened at Stanford University, calling together a geographically diverse group of clinicians and researchers from complementary fields of pediatrics: General and developmental pediatrics, infectious diseases, immunology, rheumatology, neurology, and child psychiatry. Participants were academicians with clinical and research interests in pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS) in youth, and the larger category of pediatric acute-onset neuropsychiatric syndrome (PANS). The goals were to clarify the diagnostic boundaries of PANS, to develop systematic strategies for evaluation of suspected PANS cases, and to set forth the most urgently needed studies in this field. Presented here is a consensus statement proposing recommendations for the diagnostic evaluation of youth presenting with PANS.

Jennifer Frankovich, Margo Thienemann, Jennifer Pearlstein, Amber Crable, Kayla Brown, Kiki Chang
JCAP-2015

In our PANS clinic, 40% of patients had acute onset of symptoms. However, those with and without acute onset of symptoms had similar symptom presentation, rates of inflammatory conditions, somatic symptoms, and violent thoughts and behaviors. GAS infections were the most commonly identified infection at onset and at symptom flares. Because of the wide variety of medical and psychiatric symptoms, youth with PANS may require a multidisciplinary team for adequate care management.

Jennifer Frankovich, Margo Thienemann, Sonal Rana, Kiki Chang
JCAP-2015

Youth with PANS may present in differing ways, with psychiatric and physical symptoms overlapping with inflammatory or infectious diseases, pain syndromes, and other psychiatric diagnoses. Patients’ psychiatric symptoms may respond to treatments targeting the underlying cause of physical illness. Faced with a pediatric patient demonstrating the abrupt onset or exacerbation of psychiatric and physical symptoms, clinicians should consider PANS in their differential diagnosis.