Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Lancet Child Adolesc Health. 2019 Mar;3(3):175-180. doi: 10.1016/S2352-4642(18)30404-8. Epub 2019 Jan 29.
Paediatric acute-onset neuropsychiatric syndrome (PANS) is a newly defined symptom-based condition that mainly occurs in children and adolescents. Few studies have described the clinical characteristics of the syndrome.
We clinically assessed and reviewed the medical histories of children and adolescents (aged 4-14 years) with suspected PANS who were referred to a specialist clinic in Gothenburg, Sweden, by local paediatricians and child psychiatrists. We scored severity of symptoms and impairment retrospectively for the timepoint with the most severe symptoms using the PANS scale.
Of 41 patients (37 referred and four visited upon parents' request), 23 (ten girls and 13 boys) met PANS diagnostic criteria. Mean age at PANS onset was 8·5 years (SD 3·37). 11 (48%) patients had a family history of developmental or neuropsychiatric disorders in a first-degree relative and 11 (48%) had a family history of autoimmune or inflammatory diseases in a first-degree relative. 17 (74%) patients had been previously diagnosed with a developmental disorder (n=5) or had symptoms indicative of developmental problems (n=12). A verified or suspected infection was temporally related to PANS onset in all patients; the infection was bacterial in ten (43%) patients (eight had streptococcal infection and two an infection caused by other bacteria) and viral in 13 (57%) patients. All patients had a relapsing-remitting course of illness. The mean PANS scale symptom score was 46 (SD 3·67) and the mean impairment score was 45 (2·74). Antibiotic treatment was reported as beneficial by the parents of 12 (63%) of the 19 children who received antibiotics.
Our PANS cohort had severe, acute-onset, complex neuropsychiatric symptoms, a relapsing-remitting symptom course, and possible infectious triggers. Further research into the cause of, and appropriate treatment for, PANS is warranted.
Swedish Brain Foundation.
儿科急性发作的神经精神综合征（PANS）是一种新定义的基于症状的疾病，主要发生在儿童和青少年中。很少有研究描述过该综合征的临床特征。
我们对由当地儿科医生和儿童精神病医生转介到瑞典哥德堡一家专科诊所的疑似 PANS 患儿和青少年（年龄 4-14 岁）进行了临床评估和回顾性病历审查。我们使用 PANS 量表对症状最严重时的时间点进行症状严重程度和损伤程度的回顾性评分。
41 名患者（37 名由儿科医生转介，4 名由父母要求就诊）中，有 23 名（10 名女孩，13 名男孩）符合 PANS 诊断标准。PANS 发病的平均年龄为 8.5 岁（标准差 3.37）。11 名（48%）患者一级亲属中有发育或神经精神障碍病史，11 名（48%）患者一级亲属中有自身免疫或炎症性疾病病史。17 名（74%）患者曾被诊断为发育障碍（n=5）或有发育问题的症状（n=12）。所有患者的感染均与 PANS 发病有时间上的相关性；10 名（43%）患者的感染为细菌性（8 名患者为链球菌感染，2 名患者为其他细菌感染），13 名（57%）患者为病毒性感染。所有患者的疾病均呈复发-缓解过程。PANS 量表的平均症状评分为 46（标准差 3.67），平均损伤评分为 45（2.74）。接受抗生素治疗的 19 名儿童中，有 12 名（63%）的家长报告抗生素治疗有效。
我们的 PANS 队列有严重的、急性发作的、复杂的神经精神症状、复发-缓解的症状病程和可能的感染触发因素。需要进一步研究 PANS 的病因和适当的治疗方法。
瑞典脑基金会。
