ITEM CRITERIA v2.1 PROPOSED REVISIONS TO THE CRITERIA SPECIALIST WORKING GROUP RATIONALE FOR ADDITIONS/CLARIFICATIONS Paediatric Acute Neuropsychiatric Disorders Paediatric autoimmune Condition Paediatric autoimmune neuropsychiatric disorder neuropsychiatric disorder (PANS) has been included in the condition Name associated with streptococcal infections (PANDAS) or associated with streptococcal name as streptococcal infection is not the only Paediatric Acute Neuropsychiatric Disorders (PANS) infection (PANDAS) trigger of acute neuropsychiatric disorders. Specialty Neurology Neurology No change Category Exceptional circumstances only Exceptional circumstances only No change PANDAS; Specific PANDAS/tic disorders Added PANS PANS Conditions Level of Evidence of probable benefit Evidence of probable benefit more research needed No change – – Evidence more research needed (Category 2a) (Category 2a) PANDAS was first described in A single randomised placebo-controlled trial using IVIg for Redrafted after consultation of the literature. Justification the early 1990s. PANDAS is for Evidence PANDAS showed prolonged and significant improvement in Some of the previous content is now covered characterised by rapid-onset Category obsessive-compulsive symptoms, anxiety, depression, within the and Diagnostic “Description tics associated with obsessive- emotional lability and overall function compared with Criteria” compulsive disorder (OCD) in placebo. Improvements in symptoms were still evident at the context of recovery from one-year follow-up. streptococcal infection. Molecular mimicry between streptococcal antigens and the A further uncontrolled retrospective description of 12 central nervous system is individuals with PANDAS described benefit when using thought to underlie the cause. 2g/kg of IVIg in the first course or 1-1.5g/kg of IVIg for Symptomatic therapy is used further doses. with variable response. A single randomised controlled trial using
ITEM CRITERIA v2.1 PROPOSED REVISIONS TO THE CRITERIA SPECIALIST WORKING GROUP RATIONALE FOR ADDITIONS/CLARIFICATIONS Condition Name Paediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) Paediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) or Paediatric Acute Neuropsychiatric Disorders (PANS) Paediatric Acute Neuropsychiatric Disorders (PANS) has been included in the condition name as streptococcal infection is not the only trigger of acute neuropsychiatric disorders. Specialty Neurology Neurology No change Category Exceptional circumstances only Exceptional circumstances only No change Specific Conditions PANDAS/tic disorders PANDAS; PANS Added PANS Level of Evidence Evidence of probable benefit – more research needed (Category 2a) Evidence of probable benefit – more research needed (Category 2a) No change Justification for Evidence Category PANDAS was first described in the early 1990s. PANDAS is characterised by rapid-onset tics associated with disorder (OCD) in the context of recovery from streptococcal infection. Molecular mimicry between streptococcal antigens and the central nervous system is thought to underlie the cause. Symptomatic therapy is used with variable response. A single randomised trial using A single randomised placebo-controlled trial using IVIg for PANDAS showed prolonged and significant improvement in obsessive-compulsive symptoms, anxiety, depression, emotional lability and overall function compared with placebo. Improvements in symptoms were still evident at one-year follow-up. A further uncontrolled retrospective description of 12 individuals with PANDAS described benefit when using 2g/kg of IVIg in the first course or 1-1.5g/kg of IVIg for further doses. controlled Redrafted after consultation of the literature. Some of the previous content is now covered within the “Description and Diagnostic Criteria” obsessive- compulsive
Neurology-Ch7-PANDAS-PANS.DOCX