Esposito S, Bianchini S, Baggi E, Fattizzo M, Rigante D
Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda n. 9, 20122, Milan, Italy,
Eur J Clin Microbiol Infect Dis. 2014 Dec;33(12):2105-9. doi: 10.1007/s10096-014-2185-9. Epub 2014 Jun 24.
The acronym PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) has been used to describe a syndrome characterized by various obsessions, compulsions, tics, hyperactivity, motor stereotypies, and paroxysmal movement disorders that are correlated with prior infection by group A beta-hemolytic Streptococcus pyogenes (GABHS) infections. Five clinical criteria can be used to diagnose PANDAS: (1) the presence of obsessive-compulsive disorder (OCD) and/or any other tic disorders; (2) prepuberal onset (between 3 years of age and the start of puberty); (3) abrupt onset and relapsing-remitting symptom course; (4) a distinct association with GABHS infection; and (5) association with neurological abnormalities during exacerbations (adventitious movements or motoric hyperactivity). The exact pathogenesis of PANDAS remains unclear, and several theories that focus on multiple etiologic or contributive factors have emerged. PANDAS appears to be a neurobiological disorder that potentially complicates GABHS infections in genetically susceptible individuals. The current standard of care for PANDAS patients remains symptomatic, and cognitive behavioral therapy, such as exposure and response prevention, combined with family counseling and psychoeducation, should be the first approach for treating PANDAS. This review examines current theories of PANDAS pathogenesis, identifies possible treatments for managing this complex condition, and highlights areas for future research. Moving forward, developing more standardized diagnostic criteria and identifying specific laboratory markers to facilitate PANDAS diagnoses are crucial.
首字母缩略词PANDAS（与链球菌感染相关的小儿自身免疫性神经精神障碍）已被用于描述一种综合征，其特征为各种强迫观念、强迫行为、抽动、多动、运动刻板动作以及阵发性运动障碍，这些症状与A组β溶血性化脓性链球菌（GABHS）感染相关。有五条临床标准可用于诊断PANDAS：（1）存在强迫症（OCD）和/或任何其他抽动障碍；（2）青春期前发病（3岁至青春期开始之间）；（3）起病突然且症状呈复发-缓解过程；（4）与GABHS感染有明显关联；（5）在病情加重期间与神经异常有关（偶发运动或运动性多动）。PANDAS的确切发病机制仍不清楚，并且已经出现了几种关注多种病因或促成因素的理论。PANDAS似乎是一种神经生物学障碍，在遗传易感性个体中可能使GABHS感染复杂化。目前对PANDAS患者的护理标准仍然是对症治疗，认知行为疗法，如暴露与反应阻止疗法，结合家庭咨询和心理教育，应是治疗PANDAS的首选方法。这篇综述探讨了当前关于PANDAS发病机制的理论，确定了管理这种复杂病症的可能治疗方法，并突出了未来研究的领域。展望未来，制定更标准化的诊断标准并确定有助于PANDAS诊断的特定实验室标志物至关重要。
