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 Paediatric Acute-onset Neuropsychiatric Syndrome (Disorders Associated with Streptococcal Infections) 


PANDAS is a condition seen in the paediatric population consisting of tics or obsessive-compulsive disorder exacerbated or brought on by a common bacterial infection called Group A streptococcus (GAS).PANDAS symptoms typically start abruptly, almost as if a switch has been thrown. Symptoms include tics, sleep disturbance, obsessive-compulsive behaviour, deterioration in handwriting, eating disorders (including anorexia but the problems appear to be more centred on the difficulty in coordinating swallowing), behavioural regression, and urinary incontinence. By definition, these occur following a streptococcal infection which then results in the stimulation of antibodies stimulating the part of the brain involved in movement and behaviour regulation (the basal ganglia). Examination of the child reveals a child who is “trapped” or “psychologically burdened”. They may have reduced muscle power and may show abnormal movements.


Paediatric Acute-onset Neuropsychiatric Syndrome (PANS) is defined by the rapid onset of obsessive-compulsive disorder (OCD) or eating restrictions and co-occurring symptoms from at least two of seven categories:

  1. Anxiety (particularly separation anxiety)

  2. Emotional lability or depression

  3. Irritability

  4. Aggression, and/or severely oppositional behaviours

  5. Deterioration in school performance related to ADHD-like behaviours, memory deficits, and cognitive changes

  6. Sensory or motor abnormalities

  7. Somatic signs and symptoms, including sleep disturbances, enuresis, or urinary frequency (Swedo et al. 2012; Chang et al. 2015). Acute onset cases that are triggered by Group A streptococcal infections may meet diagnostic criteria for both PANS and PANDAS.

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