What are the symptoms of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections)?

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From the Guidelines

PANDAS symptoms include obsessive-compulsive disorder (OCD) and/or tics, which may arise as a result of a poststreptococcal autoimmune process.

Key Symptoms

  • Obsessive-compulsive symptoms
  • Tics These symptoms are thought to be triggered by a streptococcal infection, similar to the autoimmune response believed to be responsible for the manifestations of Sydenham chorea, a major manifestation of acute rheumatic fever 1.

Diagnostic Considerations

The diagnostic criteria for OCD, which may be relevant to PANDAS, emphasize the presence of obsessions and/or compulsions, as well as clinically significant distress or functional impairment 1.

Important Notes

It is essential to note that the concept of PANDAS is still considered a hypothesis, and more research is needed to establish a causal relationship between PANDAS and streptococcal infections 1.

From the Research

Symptoms of PANDAS

The symptoms of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) include:

  • Obsessive-compulsive disorder (OCD) and/or tic disorders 2, 3, 4, 5, 6
  • Hyperactivity 2, 6
  • Motor stereotypies 2
  • Paroxysmal movement disorders 2
  • Anxiety 3
  • Emotional instability 3
  • Cognitive difficulties 3
  • Mild choreiform movements 6
  • Inattention 6

Diagnostic Criteria

The diagnostic criteria for PANDAS include:

  • Presence of OCD and/or tic disorder 2, 5
  • Prepuberal onset (between 3 years of age and the start of puberty) 2, 5
  • Abrupt onset and relapsing-remitting symptom course 2, 5
  • A distinct association with group A beta-hemolytic Streptococcus pyogenes (GABHS) infection 2, 5
  • Association with neurological abnormalities during exacerbations (adventitious movements or motoric hyperactivity) 2, 5

Neuropsychiatric Symptoms

The neuropsychiatric symptoms of PANDAS are thought to arise from an autoimmune basis related to the production of antibodies directed at antigens of the putative causative infectious disease agents that are cross-reactive with antigenic epitopes on selected brain nuclei, leading to neuroinflammatory sequelae 6.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: an overview.

European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2014

4
Research

An expert opinion on PANDAS/PANS: highlights and controversies.

International journal of psychiatry in clinical practice, 2017

5
Research

Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS).

The international journal of neuropsychopharmacology, 2001

Related Questions

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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