Diagnostic Criteria for Pediatric Acute-onset Neuropsychiatric Syndrome (PANS)
The National Institute of Mental Health describes current criteria for recognizing and diagnosing PANS (pediatric acute-onset neuropsychiatric syndrome) with the following explanation.
Because it is often difficult to demonstrate the relationship between strep infections and OCD/tic symptoms in PANDAS, clinicians and researchers met at NIH in July 2010 to discuss changes to the diagnostic criteria that would facilitate more rapid diagnosis and treatment of affected children. The meeting participants agreed that attention should be focused on the unique features of the children’s clinical presentation, rather than on the role that strep infections might play. To accomplish this goal, the PANDAS criteria were modified to describe PANS – Pediatric Acute-onset Neuropsychiatric Syndrome. PANS encompasses the whole group of acute-onset cases of OCD while PANDAS describes those cases of PANS that have a documented association with streptococcal infections. PANS and PANDAS are comparable to cancer and leukemia (respectively) as PANS is the large class of disorders and PANDAS is one specific type. The diagnosis of PANS is made entirely on the basis of the history and physical examination.
The diagnostic criteria for PANS are:
1) Abrupt, dramatic onset of obsessive-compulsive disorder (including severely restricted food intake)
2) Concurrent presence of additional neuropsychiatric symptoms, with similarly severe and acute onset, from at least two of the following seven categories:
- Anxiety (particularly, separation anxiety)
- Emotional lability (extreme mood swings) and/or depression
- Irritability, aggression and/or severely oppositional behaviors
- Behavioral (developmental) regression (examples, talking baby talk, throwing temper tantrums, etc)
- Deterioration in school performance
- Sensory or motor abnormalities
- Somatic signs and symptoms, including sleep disturbances, bedwetting or urinary frequency.
3) Symptoms are not better explained by a known neurologic or medical disorder, such as Sydenham chorea, systemic lupus erythematosus, Tourette disorder, or others. NOTE: The diagnostic work-up of patients suspected of PANS must be comprehensive enough to rule out these and other relevant disorders. The nature of the co-occurring symptoms will dictate the necessary assessments, which might include MRI scan, lumbar puncture or electroencephalogram (EEG) in some cases. More often, laboratory studies will be warranted and should include tests to determine if there is a current infection or ongoing immunologic dysfunction.
