Pediatric Acute-onset Neuropsychiatric Syndrome (PANS)

PANS is a clinical diagnosis characterized by the sudden onset of obsessive-compulsive disorder (OCD) or severely restricted food intake, accompanied by concurrent neuropsychiatric symptoms.

Key Points

• Typical age of onset: 3-12 years
• Acute, dramatic symptom onset (24-48 hours)
• Associated with immune dysfunction
• Distinguished from PANDAS by broader range of triggers
• Significant impact on daily functioning

Historical Context

• Evolution from PANDAS concept
• First described in 2012
• Broader diagnostic criteria than PANDAS
• Ongoing research into pathophysiology

Clinical Presentation

Core Diagnostic Criteria

• Primary Criterion
• Abrupt onset of OCD and/or
• Severe restriction of food intake
• Secondary Criteria (≥2 required)
• Anxiety
• Emotional lability or depression
• Irritability, aggression, or oppositional behavior
• Behavioral regression
• Deterioration in school performance
• Sensory or motor abnormalities
• Somatic signs/symptoms

Detailed Symptom Presentation

• Psychiatric Symptoms
• Separation anxiety
• Panic attacks
• Emotional lability
• Depression
• ADHD-like symptoms
• Oppositional behaviors
• Behavioral Changes
• Age regression
• Personality changes
• Loss of math/handwriting skills
• New onset bedwetting
• Physical Symptoms
• Sleep disturbances
• Urinary frequency
• Fine/gross motor changes
• Sensory sensitivities

Diagnostic Approach

Initial Evaluation

• Comprehensive History
• Symptom onset and progression
• Previous infections/illnesses
• Family history
• Environmental factors
• Physical Examination
• Neurological assessment
• Psychiatric evaluation
• Signs of infection/inflammation

Laboratory Testing

• Basic Studies
• Complete blood count
• Metabolic panel
• ESR and CRP
• Thyroid function tests
• Infectious Disease Workup
• Strep throat culture
• Anti-streptolysin O titer
• Anti-DNase B
• Mycoplasma testing
• Immunologic Studies
• Autoimmune markers
• Immunoglobulin levels
• Inflammatory markers

Additional Testing

• Neuroimaging (if indicated)
• Lumbar puncture (selected cases)
• EEG (if neurological symptoms)
• Sleep studies (if indicated)

Treatment & Management

Treatment Tiers

• First-line Treatments
• Antibiotics (if infection present)
• NSAIDs for inflammation
• Cognitive behavioral therapy
• Supportive care
• Second-line Treatments
• Corticosteroids
• IVIG therapy
• Plasmapheresis
• Rituximab (selected cases)

Psychiatric Management

• Medications
• SSRIs for OCD/anxiety
• Antipsychotics (if needed)
• Sleep medications
• Behavioral Interventions
• Exposure and response prevention
• Family therapy
• Social skills training

Educational Support

• School accommodations
• IEP or 504 plans
• Academic modifications
• Communication with school staff

Research & Updates

Current Research Areas

• Pathophysiology
• Immune system dysfunction
• Blood-brain barrier studies
• Microbiome research
• Genetic factors
• Treatment Studies
• New immunomodulatory approaches
• Targeted therapies
• Biomarker development
• Clinical trials

Long-term Outcomes

• Course Patterns
• Monophasic course
• Sawtooth progression
• Chronic-static course
• Prognostic Factors
• Age at onset
• Time to treatment
• Treatment response
• Environmental factors