Pediatrics & Therapeutics
Open Access

Abstract

From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS (Pediatric Acute-onset Neuropsychiatric Syndrome)

Susan E. Swedo, James F. Leckman and Noel R. Rose

Despite continued debates about the role of Group A streptococcal infections in the etiopathogenesis of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections), experts on both sides of the controversy agree that a subgroup of children with obsessive-compulsive disorder (OCD) have an unusually abrupt onset of symptoms, accompanied by a variety of comparably severe and acute neuropsychiatric symptoms. The acuity of symptom onset is the hallmark feature of their clinical presentation and the basis for the name proposed for an expanded clinical entity: Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). Modifying the PANDAS criteria to eliminate etiologic factors and to clarify the initial clinical presentation produced three potential diagnostic criteria for PANS. These three criteria are discussed in detail. The article also proposes strategies for applying the PANS criteria in clinical settings and evaluating their validity and reliability through prospective research investigations.