The landscape of Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) is gradually evolving with emerging research shedding light on the underlying mechanisms and potential treatment avenues. Here are some of the notable advancements in the research and understanding of PANS and PANDAS:
Autoimmune Encephalitis Understanding:
A recent Yale study involving 27 children provided critical evidence that PANS and PANDAS fall under the category of autoimmune encephalitis. The study discovered misdirected autoimmune antibodies in the brains of children with PANDAS, which were found to irritate and bind to specific neurons often elevated in patients with OCD or Tourette’s syndrome. Following treatment with Intravenous Immunoglobulin (IVIG), a reduction in antibody presence and improvement in OCD symptoms were observed1.
Role of Common Infections:
Research is delving into how common infections can trigger psychiatric illnesses in children, exploring the link between infections like Streptococcus and the risk of major mental disorders2.
The cytokine profile of pediatric patients exhibiting obsessive-compulsive and/or movement disorder symptoms indicative of PANDAS has been reviewed. Differences were noted in cytokine levels during symptom exacerbation versus remission, with altered levels of specific cytokines like TNF-α, IL-1β, and IL-17, suggesting an immunological basis for these disorders
Autoantibodies and the Blood-Brain Barrier:
Understanding how autoantibodies circumvent the blood-brain barrier in autoimmune encephalitis is fundamental to unraveling the pathophysiology of PANS and PANDAS3.
Stress Circuitry in the Brain:
Investigations into the stress circuit in the brain and its impact on memory, fight or flight response, and more, are bringing new insights into how neurobiological factors might contribute to PANS and PANDAS2.
Clinical Management Advances:
The clinical management of PANS and PANDAS is being refined with updated psychiatric and behavioral interventions, alongside advancements in diagnosis and treatment protocols4.
Precision Medicine Goals:
The roadmap towards curing PANS and PANDAS also entails the development of personalized approaches to diagnose and treat these conditions, as part of a broader initiative towards precision medicine5.
Phenomenology of PANDAS/PANS:
Recent findings have reviewed the phenomenology of PANDAS/PANS subtypes of OCD and/or tic-related illnesses, providing a base for future treatment recommendations6.
Harmful Autoimmune Antibodies:
A study from Yale University found harmful, misdirected autoimmune antibodies in children with PANDAS/PANS, marking a critical step in understanding the autoimmune nature of these conditions1.
The ongoing research in understanding the underlying mechanisms of PANS and PANDAS is promising, paving the way for more effective and tailored treatment approaches in the near future. By continuing to investigate the immunological, neurobiological, and genetic factors contributing to PANS and PANDAS, the scientific community is moving closer to improved diagnostic methods and therapeutic interventions that can significantly enhance the quality of life for affected children and their families.