Is remission possible in Pediatric Acute-onset Neuropsychiatric Syndrome (PANS)?

Remission in Pediatric Acute-onset Neuropsychiatric Syndrome (PANS)

Yes, remission is possible in Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). According to the 2021 American College of Rheumatology/Vasculitis Foundation guidelines, remission is defined as the "absence of clinical signs or symptoms attributed to the condition, on or off immunosuppressive therapy" 1.

Understanding Remission in PANS

• Remission in PANS is characterized by the complete resolution of neuropsychiatric symptoms that were previously present during active disease 1
• PANS typically follows a relapsing-remitting course, with periods of symptom improvement or complete resolution alternating with flares of active disease 2
• The duration and completeness of remission can vary significantly between patients, with some achieving long-term symptom-free periods while others experience more frequent relapses 3

Factors Associated with Achieving Remission

• Early treatment initiation: Research shows that earlier intervention after symptom onset is associated with shorter flare durations and improved likelihood of achieving remission 2, 3
• Appropriate antimicrobial therapy: For PANDAS (PANS associated with streptococcal infections), prompt and adequate treatment of the triggering infection can lead to symptom resolution in some cases 4
• Corticosteroid treatment: Studies indicate that oral corticosteroid treatment can significantly shorten flare duration (6.4 ± 5.0 weeks vs. 11.4 ± 8.6 weeks without treatment) 2
• Treatment duration: Longer courses of corticosteroids may result in more durable remissions compared to shorter courses 2

Barriers to Achieving Remission

• Delayed diagnosis and treatment: Longer intervals between symptom onset and treatment are associated with greater symptom persistence and reduced likelihood of achieving complete remission 3
• Limited access to specialized care: Patients with less persistent symptoms are more likely to have been diagnosed by the first practitioner seen (34% vs. 13% of those with daily symptoms) 3
• Financial barriers: Affordability issues impacting diagnosis and treatment are associated with more persistent symptoms 3

Treatment Approaches to Achieve Remission

• Antimicrobial therapy: An initial course of anti-streptococcal treatment is recommended for all newly diagnosed PANS cases, with consideration of prophylaxis for recurrent cases 4
• Corticosteroids: For acute flares, oral corticosteroid bursts can help achieve faster symptom resolution 2
• Immunomodulatory therapy: For severe or refractory cases, more aggressive immunomodulatory approaches may be necessary to achieve remission 3
• Monitoring for intercurrent infections: Vigilance for and prompt treatment of infections is essential, as these can trigger relapses 4

Monitoring for Remission

• Regular clinical assessments are needed to evaluate symptom resolution and determine if remission has been achieved 1
• In PANS, particular attention should be paid to both psychiatric symptoms (OCD, anxiety, etc.) and associated neurological manifestations 5
• The absence of symptoms should be distinguished from mere improvement, as true remission requires complete resolution of disease activity 1

Long-term Outlook

• Many patients with PANS can achieve periods of remission, though the disease often follows a relapsing-remitting pattern 2, 5
• Some patients may experience a monophasic course with a single episode followed by sustained remission 1
• For others, ongoing vigilance and potentially maintenance therapy may be needed to sustain remission 4