Highlights & Basics
- Suspect pediatric acute-onset neuropsychiatric syndrome (PANS) in a child with an abrupt and dramatic onset (<72 hours) of new obsessive-compulsive symptoms or severely restricted food intake, with similarly severe and acute onset of at least two concurrent cognitive, behavioral, or neurologic symptoms.
- PANS symptoms are thought to result from brain changes secondary to inflammation triggered by infections, metabolic disturbances, other inflammatory reactions, and psychological trauma.
- PANS is a diagnosis of exclusion and other causes for the neuropsychiatric symptoms, such as Sydenham chorea, systemic lupus erythematosus, or autoimmune encephalitis, should be ruled out at initial presentation.
- Treatment needs to be individually tailored and may include: education, supportive, and behavioral therapies; psychotropic drugs for neuropsychiatric symptoms; antibiotics for identified infections; and anti-inflammatory or immunomodulatory therapies. Management of the most impairing psychiatric symptoms should be prioritized.
- Effectiveness of treatment should be evaluated at frequent intervals and modified accordingly. Treatment can be tapered down or stopped when symptoms resolve. However, treatment may need to be restarted due to the relapsing-remitting nature of symptoms.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Pfeiffer HCV, Wickstrom R, Skov L, et al. Clinical guidance for diagnosis and management of suspected pediatric acute-onset neuropsychiatric syndrome in the Nordic countries. Acta Paediatr. 2021 Dec;110(12):3153-60.[Abstract][Full Text]
Chang K, Frankovich J, Cooperstock M, et al. Clinical evaluation of youth with pediatric acute-onset neuropsychiatric syndrome (PANS): recommendations from the 2013 PANS Consensus Conference. J Child Adolesc Psychopharmacol. 2015 Feb;25(1):3-13.[Abstract][Full Text]
Cooperstock MS, Swedo SE, Pasternack MS, et al. Clinical management of pediatric acute-onset neuropsychiatric syndrome: part III-treatment and prevention of infections. J Child Adolesc Psychopharmacol. 2017 Sep;27(7):594-606.[Abstract][Full Text]
Frankovich J, Swedo S, Murphy T, et al. Clinical management of pediatric acute-onset neuropsychiatric syndrome: part II-use of immunomodulatory therapies. J Child Adolesc Psychopharmacol. 2017 Sep;27(7):574-93.[Abstract][Full Text]
Thienemann M, Murphy T, Leckman J, et al. Clinical management of pediatric acute-onset neuropsychiatric syndrome: part I-psychiatric and behavioral interventions. J Child Adolesc Psychopharmacol. 2017 Sep;27(7):566-73.[Abstract][Full Text]
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