Wilbur Colin, Bitnun Ari, Kronenberg Sefi, Laxer Ronald M, Levy Deborah M, Logan William J, Shouldice Michelle, Yeh E Ann
Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Division of Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.
Paediatr Child Health. 2019 May;24(2):85-91. doi: 10.1093/pch/pxy145. Epub 2018 Dec 9.
Since first defined in 1998, paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and its later, broader iteration, paediatric acute-onset neuropsychiatric syndrome (PANS), have garnered significant attention and controversy. The role of streptococcal infection in children with explosive onset obsessive-compulsive disorder and new onset tics, the natural history of this entity, and the role of symptomatic and disease-modifying therapies, including antibiotics, immunotherapy, and psychoactive drugs, are all issues that have yet to be definitively addressed. While definitive proof of the autoimmune hypothesis of PANDAS is lacking, given the heightened attention to this entity and apparent rise in use of this diagnostic category, addressing questions around diagnosis, treatment, and etiology is imperative. In this paper, we review current working definitions of PANDAS/PANS, discuss published evidence for interventions related to this entity, and propose a clinical approach to children presenting with acute symptoms satisfying criteria for PANDAS/PANS.
自1998年首次被定义以来，与链球菌感染相关的儿童自身免疫性神经精神障碍（PANDAS）及其后来更广泛的形式——儿童急性起病神经精神综合征（PANS），引起了广泛关注并引发了争议。链球菌感染在急性起病的强迫症和新发抽动症儿童中的作用、该疾病实体的自然病程，以及包括抗生素、免疫疗法和精神活性药物在内的对症治疗和疾病改善疗法的作用，都是尚未得到明确解决的问题。虽然缺乏PANDAS自身免疫假说的确切证据，但鉴于对该疾病实体的关注度不断提高以及该诊断类别的使用明显增加，解决围绕诊断、治疗和病因的问题势在必行。在本文中，我们回顾了PANDAS/PANS的当前工作定义，讨论了与该疾病实体相关干预措施的已发表证据，并针对出现符合PANDAS/PANS标准的急性症状的儿童提出了一种临床方法。
