Spartz Ellen J, Freeman G Mark, Brown Kayla, Farhadian Bahare, Thienemann Margo, Frankovich Jennifer
1 Pediatric Divisions of Allergy, Immunology, & Rheumatology, Stanford University School of Medicine , Stanford, California.
2 Pediatric Divisions of Psychiatry and Behavioral Sciences, Stanford University School of Medicine , Stanford, California.
J Child Adolesc Psychopharmacol. 2017 Sep;27(7):652-659. doi: 10.1089/cap.2016.0179. Epub 2017 Jul 11.
Accumulating evidence suggests that anti-inflammatory interventions can modulate neuropsychiatric symptoms. Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is characterized by an abrupt and dramatic onset of obsessive-compulsive (OC) symptoms and/or severely restrictive food intake and at least two coinciding, equally debilitating neuropsychiatric symptoms. When associated with group A Streptococcus, the syndrome is labeled Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections (PANDAS). Here, we describe the course of neuropsychiatric symptoms in patients diagnosed with PANS and PANDAS after introduction or removal of nonsteroidal anti-inflammatory drugs (NSAIDs).
We reviewed the electronic medical records (EMR) of 218 consecutive patients evaluated in our Stanford PANS Clinic for patients who met strict PANS or PANDAS research criteria and received NSAIDs for arthritis, pain, and/or psychiatric symptoms. We describe neuropsychiatric symptoms that were noted in the EMR before, during, and after NSAIDs were introduced or removed as the sole change in pharmacologic treatment.
Seventy-seven patients were included in the current study. Of the 52 trials in which NSAID addition was the sole change in treatment, 16 (31%) coincided with an improvement in patients' neuropsychiatric symptoms. Of the 57 trials in which removal of NSAID treatment was the sole change in treatment, 20 (35%) coincided with escalation in patients' neuropsychiatric symptoms. Thirty patients (39%) experienced side effects, mainly mild gastrointestinal symptoms, which self-resolved after removal of NSAID, reduction of dose, or change in NSAID.
Improvement in neuropsychiatric symptoms was evident in roughly one-third of NSAID treatment trials. A randomized clinical trial will be necessary to confirm whether NSAIDs are successful in reducing neuropsychiatric symptoms in youth with PANS.
越来越多的证据表明，抗炎干预措施可调节神经精神症状。儿童急性起病神经精神综合征（PANS）的特征是强迫症状突然且急剧发作和/或严重限制食物摄入，以及至少两种同时出现且同样使人衰弱的神经精神症状。当与A组链球菌相关时，该综合征被称为与链球菌感染相关的儿童自身免疫性神经精神障碍（PANDAS）。在此，我们描述了在引入或停用非甾体抗炎药（NSAIDs）后，被诊断为PANS和PANDAS的患者的神经精神症状病程。
我们回顾了在斯坦福PANS诊所接受评估的218例连续患者的电子病历（EMR），这些患者符合严格的PANS或PANDAS研究标准，并因关节炎、疼痛和/或精神症状接受了NSAIDs治疗。我们描述了在引入或停用NSAIDs作为药物治疗的唯一变化之前、期间和之后，EMR中记录的神经精神症状。
本研究纳入了77例患者。在52次以添加NSAIDs作为唯一治疗变化的试验中，16次（31%）与患者神经精神症状的改善同时出现。在57次以停用NSAIDs治疗作为唯一治疗变化的试验中，20次（35%）与患者神经精神症状的加重同时出现。30例患者（39%）出现副作用，主要是轻度胃肠道症状，在停用NSAIDs、减少剂量或更换NSAIDs后自行缓解。
在大约三分之一的NSAIDs治疗试验中，神经精神症状有明显改善。需要进行一项随机临床试验来确认NSAIDs是否能成功减轻患有PANS的青少年的神经精神症状。
