Garvey M A, Giedd J, Swedo S E
Pediatrics and Developmental Neuropsychiatry Branch, National Institutes of Mental Health, Bethesda, MD 20892-1255, USA.
J Child Neurol. 1998 Sep;13(9):413-23. doi: 10.1177/088307389801300901.
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) is a relatively new diagnostic construct applied to children or adolescents who develop, and have repeated exacerbations of, tic disorders and/or obsessive-compulsive disorder following group A beta-hemolytic streptococcal infections. The proposed pathophysiology is that the group A beta-hemolytic streptococcal bacteria trigger antibodies that cross-react with the basal ganglia of genetically susceptible hosts leading to obsessive-compulsive disorder and/or tics. This is similar to the etiologic mechanisms proposed for Sydenham's chorea, in which group A beta-hemolytic streptococcal antibodies cross-react with the basal ganglia and result in abnormal behavior and involuntary movements. When first proposed, there was much controversy about the idea that streptococcal infections were etiologically related to rheumatic fever. In a like manner, discussion has arisen about the concept of infection-triggered obsessive-compulsive disorder and tic disorders. We review the historical background to these controversies, give an update on the findings provided by research on PANDAS, and address areas of future study.
小儿自身免疫性神经精神障碍伴链球菌感染（PANDAS）是一种相对较新的诊断概念，适用于在A组β溶血性链球菌感染后出现抽动障碍和/或强迫症并反复发作的儿童或青少年。其提出的病理生理学机制是，A组β溶血性链球菌触发的抗体与遗传易感性宿主的基底神经节发生交叉反应，导致强迫症和/或抽动。这与风湿性舞蹈病提出的病因机制相似，其中A组β溶血性链球菌抗体与基底神经节发生交叉反应，导致异常行为和不自主运动。最初提出时，关于链球菌感染与风湿热存在病因学关联这一观点存在诸多争议。同样，关于感染引发的强迫症和抽动障碍的概念也引发了讨论。我们回顾了这些争议的历史背景，介绍了PANDAS研究的最新发现，并探讨了未来的研究方向。
