Acronym for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection.

Rare disorder. Neuropsychiatric disorders of the child, autoimmune, and associated with a streptococcal infection.

5 specific clinical criteria:

*         onset in prepubertal period (between 3 and 12 years of age)

*         obsessive compulsive disorder (OCD) or motor or vocal tics 

*         brutal onset, evolution marked by alternating periods of improvement and episodes of sudden worsening for which a temporal association with streptococcal A beta-hemolytic infection can be established

*         temporal association with an infection by streptococcus A beta-hemolytic (strep throat, scarlet fever)

*         neuropsychiatric symptoms during periods of aggravation: attacks of dystonia or chorea, tics and hyperactivity.

These disorders seem to appear following the formation of autoantibodies against cells of the basal ganglia. Initially, these antibodies are produced against the M protein of the streptococcus A beta-hemolytic.

Treatment: psychotropic drugs (inhibitors of the neuronal reuptake of serotonin, antipsychotics), immunoglobulin, plasmapheresis sessions.

The concept of PANDAS is questioned by some paediatricians who prefer the term CANS (acronym for Childhood Acute Neuropsychiatric Symptoms) which corresponds also to neuropsychiatric disorders with a brutal onset in a child previously in good mental and physical health but has more etiologies and some specific treatments: 

-         infectious: encephalitis, meningitis

-         post-infectious: acute disseminated encephalomyelitis

-         metabolic: diabetes, hyperammonemia

-         toxic: lead, heavy metals 

-         drug: steroids, amphetamines, marijuana, cocaine

-         autoimmune: Sydenham chorea, lupus, Hashimoto encephalitis, NMDA, AMPA or GABA b receptor encephalitis

-         etc: non-convulsive status epilepticus, hypoxia-ischemia

Anesthetic implications: 

behavioral disorders (induction and emergence of anesthesia), drugs interactions, control of hemostasis if surgery is performed shortly after a plasma exchange (possible fall of the platelets count and fibrinogen level). Depending on the known or possible etiology (metabolic, toxic).

References: 

-        Sadhavisam S, Litman RS. 
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections- anesthetic implications and literature review. 
Pediatr Anesth 2006; 16: 573-7

-         Singer HS, Gilbert DL, Wolf DS, Mink JW, Kurlan R. 
Moving from PANDAS to CANS. 
J Pediatr 2012; 160: 725-31. 

Updated: March 2019