Written by Kimiko Dunbar
Spoon Feed
According to the AAP, Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) is a recognized and important condition, best diagnosed and treated with a family-centered, multidisciplinary approach including behavioral and psychiatric therapies.
What’s black and white and hard to treat?
Pediatric Acute-Onset Neuropsychiatric Syndrome, PANS, defined as the sudden onset of severe behavioral and neuropsychiatric symptoms, is an umbrella term that includes PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections). Hypothesized to be triggered by infection or autoimmunity, the onset of PANS is often frightening to families and puzzling to clinicians given lack of clinical guidelines. The American Academy of Pediatrics (AAP) offer guidance to evaluate and manage PANS. PANS is rapid onset and differs from autoimmune encephalitis (AE), which is subacute and has evidence of abnormal EEG, MRI, or CSF studies. Diagnosis of PANS is complicated given lack of consensus on diagnostic criteria (it’s not in the DSM); it’s considered a diagnosis of exclusion. Using systematic literature reviews and consensus discussions, the panel concluded that evidence supports behavioral and psychiatric therapies (cognitive behavioral therapy, SSRIs; 50–70% response in OCD) and standard antibiotic treatment only for confirmed group A streptococcal infection. However, current data are limited by small samples, retrospective designs, reliance on parental report, and a paucity of RCTs. The report emphasizes cautious, evidence-based, family-centered, multidisciplinary care while highlighting the urgent need for large, prospective trials to clarify etiology, diagnostic markers, and treatment efficacy.
How does this change my practice?
PANDAS has historically been a hot topic among pediatric providers. Despite universal acceptance of similar entities, such as autoimmune encephalitis and Sydenham’s chorea, lack of specific diagnostic testing has led some clinicians to question the validity of PANS. I think there’s been broader acceptance in the past 5-10 years, but this report by the AAP solidifies the diagnostic legitimacy. I’ll be keeping this report in my back pocket for the next patient with rapid-onset symptoms and no clear cause.
Source
Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Clinical Report. Pediatrics. 2025 Mar 1;155(3):e2024070334. doi: 10.1542/peds.2024-070334. PMID: 39676248.
