PANDAS Syndrome
Introduction to PANDAS
- The American Heart Association considers PANDAS as "an unproven hypothesis" and emphasizes the need for careful consideration of this concept 1, 2
Diagnosis and Treatment
- The American Heart Association recommends against routine laboratory tests for GAS screening 1, 2
- The American Heart Association recommends against long-term antistreptococcal prophylaxis 1, 2
- The American Heart Association recommends against immunoregulatory treatments (intravenous immunoglobulin, plasma exchange) as routine therapy 1, 2
Treatment Approach
- The first line of treatment for a patient presenting with PANDAS is antibiotic therapy to eradicate the streptococcal infection, with Penicillin V (500 mg four times a day for 10 days) being the preferred option 3
- Amoxicillin (500 mg three times a day for 10 days) is an equally effective alternative 3
- For patients allergic to penicillin, erythromycin can be used 3
- Clindamycin (300 mg four times a day for 10 days) can be considered especially in cases of eradication failures 3
- Azithromycin (maximum 500 mg once daily for 3-5 days) is another option for patients allergic to penicillin 3
Differential Diagnosis
- Sydenham chorea is a major manifestation of rheumatic fever and shares a similar autoimmune mechanism with PANDAS 1, 2
- Classic OCD has a more gradual onset, differing from the abrupt onset in PANDAS 4, 5
PANDAS Diagnosis and Management
Introduction to PANDAS
- The American Heart Association states that PANDAS should be considered only as a yet-unproven hypothesis, with a controversial evidence base 6
Diagnostic Considerations
- PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a broader disorder with sudden-onset OCD symptoms that can occur in response to various infections and insults, not just streptococcal 7
Differential Diagnosis
- Sydenham chorea shares a similar autoimmune mechanism with PANDAS and is a major manifestation of rheumatic fever, although the exact relationship between the two conditions is still being researched 7