Misstänk PANDAS hos barn med akuta neuropsykiatriska symtom. Infektion bakom sjukdomen - långvarig antibiotikabehandling bör övervägas
Sammanfattning
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) was proposed as a specific disorder in 1995, but its validity has been questioned. Recently, however, more evidence has become available, supporting an autoimmune mechanism and suggesting that an expanded clinical entity, Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) should be considered in cases of rapidly emerging obsessions, compulsions, tics or anorexia accompanied with separation anxiety and/or personality change, motor impairment or urinary frequency among children. Three cases (4–11 years of age) with varying courses are reported. In these cases, psychotic symptoms were evident, variously responsive to antibiotics/immunoglobulins. All cases were related to infections, but group A Streptococci were verified in only one case. For treatment, antibiotics and/or intravenous immunoglobulin may apply. If obsessive-compulsive symptoms remain, cognitive behavioural therapy should be initiated, if necessary, combined with carefully titrated serotonin reuptake inhibitors.