Pediatric AutoImmune Neuropsychiatric Disorders Associated with Streptococcal Infections or PANDAS describes a group of disorders characterized by the sudden onset or worsening of obsessive-compulsive symptoms and/or tics that occur after a streptococcal infection. In PANDAS, it has been hypothesized that streptococcal infections trigger the production of antibodies which cross-react with neuronal tissues, resulting in the psychiatric symptoms characteristic of PANDAS.
While PANDAS were first identified several decades ago, we still lack consensus regarding the diagnosis of PANDAS and have few evidence-based treatments. In this webinar, Kyle Williams, MD, PhD, Director of the Pediatric Neuropsychiatry and Immunology Research Program at MGH discusses new breakthroughs in PANDAS research.
One of the most important goals of PANDAS research is to improve diagnostic accuracy. Currently we rely upon clinical evaluation of symptoms to make the diagnosis of PANDAS; ideally we would be able to use other tests, including neuroimaging and blood testing, to confirm the diagnosis.
Neuroimaging is being used to identify brain changes associated with PANDAS. In general, it is difficult to identify inflammation using MRI; however, new research is focusing on developing new methodologies to improve the visualization of subtle changes in the brains of children affected by PANDAS. This information could ultimately help to improve the diagnosis of PANDAS and may also help to measure the effectiveness of new treatments.
Are there blood tests which could be used to identify patients with PANDAS? Recent research indicates that IgG antibodies taken from children with PANDAS bind to cholinergic interneurons (CINs) in the basal ganglia. While these IgG autoantibodies could be used to identify those with PANDAS, this is a time-intensive and costly approach to making the diagnosis. Future research will focus on converting this finding into a more readily available diagnostic tool.
Neuropsychological testing has helped to objectively specify and measure the specificity of PANDAS symptoms, including inattention, alterations in processing speed, and motor precision.
Other research has focused on the connection between PANDAS and immunodeficiency. Do repetitive infections trigger PANDAS in some children?
Learn more about current research studies on PANDAS HERE.
References
Chain JL, Alvarez K, Mascaro-Blanco A, Reim S, Bentley R, Hommer R, Grant P, Leckman JF, Kawikova I, Williams K, Stoner JA, Swedo SE, Cunningham MW. Autoantibody Biomarkers for Basal Ganglia Encephalitis in Sydenham Chorea and Pediatric Autoimmune Neuropsychiatric Disorder Associated With Streptococcal Infections. Front Psychiatry. 2020; 11:564.
Chain JL, Alvarez K, Mascaro-Blanco A, Reim S, Bentley R, Hommer R, Grant P, Leckman JF, Kawikova I, Williams K, Stoner JA, Swedo SE, Cunningham MW. Autoantibody Biomarkers for Basal Ganglia Encephalitis in Sydenham Chorea and Pediatric Autoimmune Neuropsychiatric Disorder Associated With Streptococcal Infections.Front Psychiatry. 2020 Jun 24;11:564. Free article.
Williams KA. Defining paediatric acute-onset neuropsychiatric syndrome. Lancet Child Adolesc Health. 2019 03; 3(3):134-135.
Williams KA, Swedo SE, Farmer CA, Grantz H, Grant PJ, D’Souza P, Hommer R, Katsovich L, King RA, Leckman JF. Randomized, Controlled Trial of Intravenous Immunoglobulin for Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections. J Am Acad Child Adolesc Psychiatry. 2016 10; 55(10):860-867.e2.
Xu J, Liu RJ, Fahey S, Frick L, Leckman J, Vaccarino F, Duman RS, Williams K, Swedo S, Pittenger C. Antibodies From Children With PANDAS Bind Specifically to Striatal Cholinergic Interneurons and Alter Their Activity. Am J Psychiatry. 2021 Jan 1;178(1):48-64.
Kyle Williams, MD PhD
Kyle Williams, MD, PhD is the Director of the Pediatric Neuropsychiatry and Immunology Research Program at MGH and an Instructor in Psychiatry at Harvard Medical School. Dr. Williams’s primary clinical and research interests involve the intersection of the brain and the immune system, and in particular, the psychiatric and behavioral consequences of these interactions.
