Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections or else called PANDAS is a relatively new but debatable diagnosis that affects hundreds of children and their families. It is thought to be an autoimmune disorder emerging from a Group A beta-hemolytic streptococcal infection (GABHS) that activates a misdirected immune response that results in inflammation on a child’s brain. This, triggers significant and bizarre behavioral changes in children such as an abrupt onset or exacerbation of tics and obsessive-compulsive behaviors, anxiety, personality changes, sensory sensitivities, restrictive eating and more. Due to the fact that this condition received widespread infame and its existence its being questioned everyday, it needs further investigation and research. The aim of the essay is the extend to which PANDAS influence children.
Main Body
As stated from Richard P Bathel some disorders that show up after the infection in response to Streptococcus, is Rheumatic Fever (RF), that was the prototype disorder and Sydenham’s Chorea (SC) which was a criteria for the diagnosis of RF and also a stand-alone indication of the central nervous system’s autoimmune response. Based on (ninds.nih.gov) Sydenham’s Chorea is a neurological disorder which is caused from an infection from GABHS which causes rapid, irregular, and aimless reflexive movements of the arms and legs, trunk, and facial muscles….Also behavioral abnormalities and psychiatric symptoms are common among patients with SC. They show symptoms of emotional lability in over 90% of cases, obsessions and compulsions in 60-80%, frequent hyperactivity, Separation Anxiety Disorder and irritability (Garvey & Swedo, 1997). Therefore Dr. Susan Swedo from the Pediatric Developmental and Neuropsychiatry branch of the National Institute of Mental Health (NIMH) argues that the criteria for a PANDAS presentation require the occupancy of associated neurologic problems. These are usually repetitive and rapid, jerky, involuntary movement which by definition are not entirely like Sydenham’s Chorea and they do not interfere with voluntary motor control.
On the other hand Findley claims that the episodic course of the children who suffer from PANDAS may be temporally but not causally related to streptococcal infections. GABHS infections might only be an ‘incidential’ finding and the exacerbations can be comprehensive reactions to the stress of illness, rather than related to GABHS triggered autoimmunity…. Also supporters of the PANDAS disorder emphasize its laboratory and clinical similarities to SC, but on the other hand, people who question its existence, cause concerns with its diagnostic criteria and the lack of evidence if this disorder is really associated with GABHS infection and tics/OCD (Harvey S. Singer, Christopher Loiselle).
Furthermore Richard P Barthel notes that it appears to be a genetic sensitivity to poststreptococcal autoimmune disorders… Unfortunately though it has been found to be non specific in neuropsychiatric disorders(Dr. Tanya Murphy). That’s why Dr. McMahon studied the area of general familial genetic risks, where he looked in different families if someone of the family presented any OCD or tic disorders. In a pilot survey of 100 families he found an amount of 4 times as many SC probands had relatives with tics or OCD, that’s why he feels that this is a yet unidentified “genetic risk factor” but he notes that clinicians should be really careful about the family history of children who suspect they suffer from PANDAS.
Conclusions
The main conclusion driven from the articles above is that PANDAS is a concept that generated broad interest from different groups and caused many physicians to become divided on opposing sides of the issue. It’s a must that research remains to be done in the clarification of the etiopathogenesis of the PANDAS disorder (Susan E. Swedo and Paul J Grant). As noted, despite claims of a distinct clinical syndrome, multiple areas of concern remain. It’s a really uncommon disease that very few know about but a condition that unfortunately influences children’s health and life negatively and also their families. Possible treatment methods have been found but its unsure that they are efficient and that they can really prevent tics and OCD disorders. Lastly, I believe that clinicians should be more aware about this disorder since many of them don’t recognize it easily and as a result it causes more problems to the children’s health and also their lives.