2018 : Twenty years of PANDAS/PANS

2018 : Twenty years of PANDAS/PANS

 

            PANS is very common in the autistic population. This is usually manifest as a sudden worsening of behavioral symptoms, especially OCD, aggression and impulsivity against a stable behavioral background. It is usually not responsive to standard psychopharmacologic agents.

 

2018 is the 20th anniversary of the introduction of the concept of PANDAS, the notion that specific psychiatric symptoms (motor tics and OCD) can be associated with a specific infectious disease (Group A streptococcal infection). I have been studying this disease intensively since 1998, shortly after its description by Swedo et al.

 

 

We have come a long way in the understanding of this condition during this time. In this lecture, we trace the history of PANDAS, beginning in antiquity, to its refinement as PANS in 2010, and subsequent understanding of the condition as an “variant brain mechanism” rather than a disease. In this time, the relationship to autoimmune encephalopathy has been further clarified. PANS is, early on, an alternative fever response and later, ibuprofen-sensitive chronic encephalopathy. Good treatment pathways and medication for PANS have become available and will be reviewed.

 

Rosario Trifiletti, MD, PhD