"overnight onset" "acute onset" etc. Swedo case study

[EAMom]

Hi,

What constitutes "acute onset" or "overnight onset" occasionally gets brought up on these forums.

 

We know not ALL pandas kids have an overnight onset (or the onset is mistaken for the "terrible twos" etc). Per Dr. Latimer (IOCDF conf 2012): "Acute onset kids are easiest ones to diagnose."

 

And parents have wondered what constitutes "acute onset"? Does it truly have to be "overnight"? or can it be something that evolves over weeks/months?

 

Here is an interesting case study(1998, Swedo) on young girl with PANDAS. Her "overnight onset" actually evolved over a course of 2 mo. (started with hypersensitivity to clothing)....evolved to tics a few weeks later, then obsessions/compulsions a few days after that.

 

http://journals.psychiatryonline.org/article.aspx?Volume=155&page=1592&journalID=13

 

So, it seems that "evolving over 2 mo." would still be considered "acute onset"...

[MomWithOCDSon]

Was it Swedo or Buster, or Swedo via Buster, who, I think, redefined her criteria in recent years to reflect a 10+ change in a Yale-Bocs score as evidence of "sudden onset," as least so far as the OCD component of PANDAS/PANS is concerned?

[norcalmom]

I also recall her saying, I think one of her old videos that talks about the initial episode being perhaps milder (or less defined) AND PROBABLY MISSED by the parents several weeks after the initial infection. Then the next time the child get sick its closer to the infection, and by the 3rd or 4th infection, the child is reacting immediately with behaviors, rather than lagging behind. And that model follows the same timing as Sydenham Chorea.

 

I think it can depend upon what your child's symptoms are, and how well they are at hiding them. Even in Saving Sammy, Beth writes about some very odd things that happened a few(?) weeks before Sammy got really bad, and she didn't realize just how bad it was unitl they were moving to a new house.

 

My son's "initial onset" was over several weeks, and seemed to resolve, over the summer. But, the NEXT time he got sick - all of his symptoms came on within days And I almost thought he wasn't PANDAS because of this. But now I think maybe, I was just more observant, or he was better at hiding stuff from me, during that very first phase.