Question for Pandas kids

[CKJ]

Interestingly, I found this information today regarding PITANDS & PANDAS. Check out #7 under PITANDS and #6 under PANDAS. Just found this interesting....

 

PITANDS diagnostic criteria

(1) At some time in his or her life, the patient must have met diagnostic criteria (DSM IV) for one of the following neuropsychiatric disorders: Obsessive Compulsive Disorder, Tic Disorder (including Tourette's), Autism, (or Autistic Spectrum Disorder).

(2) Pediatric onset: symptoms of the disorder first become evident between 18 months of age and the beginning of puberty.

(3) The onset of clinically significant symptoms must be sudden (with or without a sub clinical prodrome), and/or there must be a pattern of sudden, recurrent, clinically significant symptom exacerbation and remissions ("wax and waning pattern"). Onset of a specific episode typically can be assigned to a particular day or week, at which time symptoms seem to "explode" in severity, and they are frequently associated with an infectious episode.

(4) There must be evidence of an antecedent or concomitant infection. Such evidence might include a positive throat culture, positive streptococcal serologic findings (e.g. anti-streptolysin O or anti-streptococcal DNAse , or a history of illness (e.g. pharyngitis, sinusitis, infection with Epstein-Barr virus, influenza, ?recurrent otitis media), and possibly recent exposure to childhood vaccination.

(5) Presence of auto antibodies (anticardiolipin, antineuronal, antibody/antigen complexes, etc.)

(6) During the exacerbation, the majority of patients will have an abnormal neuropsychiatric examination, frequently with hyperactivity and adventitious movements ("choreiform" movements).

(7) Measurable clinical improvement following "Steroid Burst".

PANDAS diagnostic criteria

(1) Current presence of symptoms (DSM IV) of Obsessive Compulsive Disorder, Tic Disorder (including Tourette's), Autism or Autistic Spectrum Disorder, and Anorexia Nervosa*.

(2) Symptom onset between 18 months of age and puberty.

(3) Episodic course of symptom severity characterized by the abrupt onset of symptoms and/or frequent, dramatic symptom exacerbation.

(4) Symptom exacerbation associated with beta-haemolytic streptoccocal infection.

(5) Presence of abnormal neuropsychiatric examination, including motor hyperactivity, adventitious movements, tics, etc.

(6) Measurable clinical improvement following "Steroid Burst".

DISQUALIFYING FACTORS (absolute): Presence of symptoms before 1 year of age.

DISQUALIFYING FACTORS (relative): Confirmed Dg. of Autism and/or Autistic Spectrum Disorder in sibling(s).

(*) Male patients with Anorexia Nervosa should be of a particular interest.

Modified "Allen criteria" (from Albert J. Allen Group A Streptococcal Infections and Childhood Neuropsychiatric Disorders CNS Drugs Oct. 1997 8(4) 267-275

 

Here's the complete article:

 

http://www.webpediatrics.com/pandas.html

[Chemar]

Hi

 

altho PITANDS & PANDAS may show clinical improvement after a "steroid burst" as per that article, giving steroids to someone with clinically dx Tourette Syndrome is like pouring gasoline on a fire! Steroids and TS are a big NoNo. Steroidal aspects are why so many people with TS tic more when stressed (cortisol) and also why males exhibit TS more than females (androgen)

 

also, Kim's info re steroids exsacerbating candida/gut flora issues is a very important one.

 

so I think the potential benefits of steroids always need to be very carefully weighed against the OVERALL diagnosis and prognosis, and potential side effects

 

for example, my son has a recent dx of Crohn's Disease for which the std treatment is prednisone (a cortizone) btu we would not dare give it to him, and his GI specialist agrees, because of the potential for a major impact on his TS