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This is a PatientPlus article. PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.
This is a rare condition in which a young child (typically aged 6 or 7) develops a neuropsychiatric disorder (usually obsessive-compulsive disorder (OCD) or tics) following a Group A beta haemolytic streptococcal infection (GABHS). Although the acronym PANDAS was first cited in 1998,1 the neurological sequelae of Streptococcal infection have been well recognised (e.g. Sydenham's chorea described by William Osler in 1894).2
PresentationThis is usually dramatic, with the sudden development of psychiatric/behavioural problems such as emotional lability, anxiety, night-time fears, hyperactivity and oppositional behaviour with some cognitive deficits. There may be dyskinesias e.g. mild facial or vocal tics; although if overtly choreiform movements develop the child should be considered to have developed Sydenham's chorea and these children require antibiotic prophylaxis against subsequent GABHS infection.1
The condition generally follows a relapsing and remitting course - with exacerbations commonly triggered by infections, both bacterial and viral.
ManagementThis is mainly supportive, although the case has been made for looking for and treating active streptococcal infection (i.e. throat swabs and culture if children develop sore throat with pyrexia),1 and some advocate tonsillectomy.3
OCD is treated in similar ways whatever the cause, e.g. with behavioural therapy.
Document references
- Swedo SE, Leonard HL, Garvey M, et al; Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry. 1998 Feb;155(2):264-71. [abstract]
- Osler W, On Chorea and Choreiform Affections. 1894
- Lynch NE, Deiratany S, Webb DW, et al; PANDAS (Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection). Ir Med J. 2006 May;99(5):155. [abstract]
Acknowledgements EMIS is grateful to Dr Huw Thomas for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2008.
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Last Updated: 27 Apr 2008Review Date: 27 Apr 2010
The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.
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