Overview of Treatment of Pediatric Acute-Onset Neuropsychiatric Syndrome

Pediatric acute-onset neuropsychiatric syndrome (PANS) is a clinical condition defined by the unusually abrupt onset of obsessive-compulsive symptoms and/or severe eating restrictions and at least two concomitant cognitive, behavioral, or neurological symptoms (Swedo et al. 2012). Because the PANS criteria define a broad spectrum of neuropsychiatric conditions, the syndrome is presumed to result from a variety of disease mechanisms and to have multiple etiologies, ranging from psychological trauma or underlying neurological, endocrine, and metabolic disorders to postinfectious autoimmune and neuroinflammatory disorders, such as pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS), cerebral vasculitis, neuropsychiatric lupus, and others (Swedo et al. 2012; Chang et al. 2015). In cohorts of well-characterized PANS patients, evidence of postinfectious autoimmunity and/or neuroinflammation is found in more than 80% of cases (Frankovich et al. 2015; Murphy et al. 2015; Swedo et al. 2015). Thus, treatment of PANS depends on three complementary modes of intervention: