What Every Parent Should Know

PANDAS

Pediatric
Autoimmune
Neuropsychiatric
Disorders
Associated with
Streptococcal infections

PANDAS is a relatively new and controversial disorder, which means that in some children, exposure to Group A strep (the bacteria that cause strep throat) triggers the severe symptoms of OCD.  PANDAS was first identified in 1998 by investigators at the National Institute of Mental Health (NIMH), including pediatricians Suan Swedo, M.D., now chief of the pediatrics and developmental neuroscience branch. In the 1980's Dr. Swedo was among those studying a neurological disease called Syndenham's chorea (SC), marked by involuntary jerky movements, that occurs in up to 20 to 30 percent of children who have acute rheumatic fever, a rare illness caused by a strep infection. When the NIMH investigators began studying children who had severe, sudden-onset OCD, without jerking movements found in SC, they discovered that many of the kids had recently had a strep infection. If step was known to cause one neurological illness, researchers reasoned, it might cause another.
How does PANDAS take hold? It happens something like this: A bacterial infection such as strep triggers the immune system to produce antibodies. But instead of attacking the infection, they go after a basal ganglia, the part of the brain that controls emotions, behaviors, and physical movements. And the result is OCD-like behaviors and/or tics. "One distinguish feature of PANDAS is the abrupt onset of symptoms," says Dr. Swedo, one of the country's leading researchers focusing on the syndrome. "Typically, OCD develops over years or months, but in PANDAS the symptoms literally begin overnight. One parent said, 'It's like my child was possessed.' "  While there is no test to detect PANDAS, research published in February in the Journal of Pediatrics found that, compared with kids who have typical OCD, those diagnosed with PANDAS were more likely to have biological evidence of a recent strep infection, a sudden onset of psychiatric symptoms, and an easing of those symptoms while taking antibiotics.

Questioning the condition

PANDAS has its skeptics, who see it as more hypothesis than a real disorder. One is neurologist Roger Kurlan, M.D., director of the movement disorders program at Atlantic Neuroscience Institute at Overlook Medical Center, in Summit, New Jersey. He calls studies linking strep and PANDAS flawed, contending that their evidence has been mostly anecdotal and unreliable. "It's not uncommon for the tics and OCD to wax and wane," he says. Parents often take their child to the doctor when her symptoms have peaked, he adds, so the fact that they subside after treatment with antibiotics doesn't prove anything. Dr Kurlan isn't convinced that symptoms come on as suddenly as parents report, either . Most children diagnosed with PANDAS, he says, have prior tics or obsessive-compulsive symptoms, often for months or years. "The so-called 'onset' is just more severe."
This raises the question: Why is PANDAS linked to strep? "Because strep is extremely common, it can be connected to almost anything," say Dr. Kurlan. Back in the 1950s, researchers try to lay blame for autism on strep, he notes.
Even PANDAS advocates do not know how common it really is. Some experts estimate it affects 10 to 30 percent of children with OCD (OCD affects 1 to 2 percent of children). Others believe that figure is much higher. Researchers are trying to pinpoint which kids are most susceptible. "Studies have shown that both autoimmune and developmental disorders can increase the risk of OCD and tics," says Tanya Murphy, M.D., professor of pediatrics and psychiatry at University of South Florida, in Tampa. "So can birth complications, such as maternal infection at birth, prolonged labor; prematurity, and low Apgar scores. And children who have ADHD may have a higher risk."




Posted by:Georgie



Credit:Parents Magazine