Am J Psychiatry 155:264-271, February 1998
© 1998 American Psychiatric Association
Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections: Clinical Description of the First 50 Cases
Susan E. Swedo, M.D.,
Henrietta L. Leonard, M.D.,
Marjorie Garvey, M.D.,
Barbara Mittleman, M.D.,
Albert J. Allen, M.D., Ph.D.,
Susan Perlmutter, M.D.,
Sara Dow, B.A.,
Jason Zamkoff, B.A.,
Billinda K. Dubbert, M.S.N., and
Lorraine Lougee, L.C.S.W.
OBJECTIVE: The purpose of this study was to describe the clinical characteristics of a novel group of patients with obsessive-compulsive disorder (OCD) and tic disorders, designated as pediatric autoimmune neuropsychiatric disorders associated with streptococcal (group A ß-hemolytic streptococcal [GABHS]) infections (PANDAS). METHOD: The authors conducted a systematic clinical evaluation of 50 children who met all of the following five working diagnostic criteria: presence of OCD and/or a tic disorder, prepubertal symptom onset, episodic course of symptom severity, association with GABHS infections, and association with neurological abnormalities. RESULTS: The children's symptom onset was acute and dramatic, typically triggered by GABHS infections at a very early age (mean=6.3 years, SD=2.7, for tics; mean=7.4 years, SD=2.7, for OCD). The PANDAS clinical course was characterized by a relapsing-remitting symptom pattern with significant psychiatric comorbidity accompanying the exacerbations; emotional lability, separation anxiety, nighttime fears and bedtime rituals, cognitive deficits, oppositional behaviors, and motoric hyperactivity were particularly common. Symptom onset was triggered by GABHS infection for 22 (44%) of the children and by pharyngitis (no throat culture obtained) for 14 others (28%). Among the 50 children, there were 144 separate episodes of symptom exacerbation; 45 (31%) were associated with documented GABHS infection, 60 (42%) with symptoms of pharyngitis or upper respiratory infection (no throat culture obtained), and six (4%) with GABHS exposure. CONCLUSIONS: The working diagnostic criteria appear to accurately characterize a homogeneous patient group in which symptom exacerbations are triggered by GABHS infections. The identification of such a subgroup will allow for testing of models of pathogenesis, as well as the development of novel treatment and prevention strategies. (Am J Psychiatry 1998; 155:264–271)
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A. J. CHURCH and R. C. DALE
Antistreptolysin-O Titers: Implications for Adult PANDAS
Am J Psychiatry,
February 1, 2002;
159(2):
320 - 320.
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M. C. do Rosario-Campos, J. F. Leckman, M. T. Mercadante, R. G. Shavitt, H. d. S. Prado, P. Sada, D. Zamignani, and E. C. Miguel
Adults With Early-Onset Obsessive-Compulsive Disorder
Am J Psychiatry,
November 1, 2001;
158(11):
1899 - 1903.
[Abstract]
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P. D. Arnold and M. A. Richter
Is obsessive-compulsive disorder an autoimmune disease?
Can. Med. Assoc. J.,
November 1, 2001;
165(10):
1353 - 1358.
[Abstract]
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E. C. Nelson, G. L. Hanna, J. J. Hudziak, K. N. Botteron, A. C. Heath, and R. D. Todd
Obsessive-Compulsive Scale of the Child Behavior Checklist: Specificity, Sensitivity, and Predictive Power
Pediatrics,
July 1, 2001;
108(1):
e14 - 14.
[Abstract]
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S. J. MATHEW
PANDAS Variant and Body Dysmorphic Disorder
Am J Psychiatry,
June 1, 2001;
158(6):
963 - 963.
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N. A. Halsey, S. L. Hyman, and the Conference Writing Panel
Measles-Mumps-Rubella Vaccine and Autistic Spectrum Disorder: Report From the New Challenges in Childhood Immunizations Conference Convened in Oak Brook, Illinois, June 12-13, 2000
Pediatrics,
May 1, 2001;
107(5):
84e - 84.
[Abstract]
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D. E. Lyon and K. Midkiff
Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infection: Overview and Nursing Implications
Journal of the American Psychiatric Nurses Association,
April 1, 2001;
7(2):
35 - 38.
[Abstract]
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P. Sandor
Plasma exchange and intravenous immunoglobulin improved symptoms in a subtype of obsessive compulsive disorder and tic disorders
Evid. Based Ment. Health,
May 1, 2000;
3(2):
49 - 49.
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P. G. Jorens, A. VanderBorght, B. Ceulemans, H. P. Van Bever, L. L. Bossaert, M. Ieven, H. Goossens, P. M. Parizel, H. Van Dijk, J. Raus, et al.
Encephalomyelitis-associated antimyelin autoreactivity induced by streptococcal exotoxins
Neurology,
April 11, 2000;
54(7):
1433 - 1441.
[Abstract]
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B. S. Peterson, J. F. Leckman, D. Tucker, L. Scahill, L. Staib, H. Zhang, R. King, D. J. Cohen, J. C. Gore, and P. Lombroso
Preliminary Findings of Antistreptococcal Antibody Titers and Basal Ganglia Volumes in Tic, Obsessive-compulsive, and Attention-Deficit/Hyperactivity Disorders
Arch Gen Psychiatry,
April 1, 2000;
57(4):
364 - 372.
[Abstract]
[Full Text]
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A. B. Granok, D. Parsonage, R. P. Ross, and M. G. Caparon
The RofA Binding Site in Streptococcus pyogenes Is Utilized in Multiple Transcriptional Pathways
J. Bacteriol.,
March 15, 2000;
182(6):
1529 - 1540.
[Abstract]
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M. M. Robertson
Tourette syndrome, associated conditions and the complexities of treatment
Brain,
March 1, 2000;
123(3):
425 - 462.
[Abstract]
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J. N. Giedd, J. L. Rapoport, M. A. Garvey, S. Perlmutter, and S. E. Swedo
MRI Assessment of Children With Obsessive-Compulsive Disorder or Tics Associated With Streptococcal Infection
Am J Psychiatry,
February 1, 2000;
157(2):
281 - 283.
[Abstract]
[Full Text]
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B. Lorber
Are All Diseases Infectious? Another Look
Ann Intern Med,
December 21, 1999;
131(12):
989 - 990.
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L. E. Arnold
Treatment alternatives for Attention-Deficit! Hyperactivity Disorder (ADHD)
J Atten Disord,
April 1, 1999;
3(1):
30 - 48.
[Abstract]
[PDF]
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S. J. Perlmutter, M. A. Garvey, X. Castellanos, B. B. Mittleman, J. Giedd, J. L. Rapoport, and S. E. Swedo
A Case of Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections
Am J Psychiatry,
November 1, 1998;
155(11):
1592 - 1598.
[Full Text]
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Obsessive Compulsive Spectrum Disorders: Biological Roots
Journal Watch Psychiatry,
April 1, 1998;
1998(401):
7 - 7.
[Full Text]
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