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Treatment Guidelines

Clinical Management of PANS: Part II—Use of Immunomodulatory Therapies

Frankovich Jennifer, Swedo Susan, Murphy Tanya, Dale Russell C., Agalliu Dritan, Williams Kyle, Daines Michael, Hornig Mady, Chugani Harry, Sanger Terence, Muscal Eyal, Pasternack Mark, Cooperstock Michael, Gans Hayley, Zhang Yujuan, Cunningham Madeleine, Bernstein Gail, Bromberg Reuven, Willett Theresa, Brown Kayla, Farhadian Bahare, Chang Kiki, Geller Daniel, Hernandez Joseph, Sherr Janell, Shaw Richard, Latimer Elizabeth, Leckman James, Thienemann Margo, and PANS/PANDAS Consortium
Journal of Child and Adolescent Psychopharmacology-2017

These recommendations will help guide the use of anti-inflammatory and immunomodulatory therapy in the treatment of PANS.

Clinical Management of PANS: Part I–Psychiatric and Behavioral Interventions

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

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.

Overview of Treatment of Pediatric Acute-Onset Neuropsychiatric Syndrome

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.