Multidisciplinary Clinic Dedicated to Treating Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome: Presenting Characteristics of the First 47 Consecutive Patients

By Frankovich, Jennifer; Thienemann, Margo et al. | Journal of Child and Adolescent Psychopharmacology, February 2015 | Go to article overview

Multidisciplinary Clinic Dedicated to Treating Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome: Presenting Characteristics of the First 47 Consecutive Patients


Frankovich, Jennifer, Thienemann, Margo, Pearlstein, Jennifer, Crable, Amber, Brown, Kayla, Chang, Kiki, Journal of Child and Adolescent Psychopharmacology


[Author Affiliation]

Jennifer Frankovich. Stanford PANS Clinic and Research Program at Lucille Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California.

Margo Thienemann. Stanford PANS Clinic and Research Program at Lucille Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California.

Jennifer Pearlstein. Stanford PANS Clinic and Research Program at Lucille Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California.

Amber Crable. Stanford PANS Clinic and Research Program at Lucille Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California.

Kayla Brown. Stanford PANS Clinic and Research Program at Lucille Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California.

Kiki Chang. Stanford PANS Clinic and Research Program at Lucille Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California.

Address correspondence to: Jennifer Frankovich, MD MS, Division of Pediatrics, Department of Pediatric Rheumatology, Stanford University School of Medicine, 700 Welch Road, Suite 301, MC: 5896, Palo Alto, CA, 94301, E-mail: jfranko@stanford.edu

Introduction

Pediatric acute-onset neuropsychiatric syndrome (PANS) is a condition characterized by the abrupt, dramatic onset of obsessive-compulsive disorder (OCD) or eating restriction accompanied by equally abrupt and severe comorbid neuropsychiatric symptoms, which include anxiety, emotional lability, depression, irritability, aggression, oppositionality, deterioration in school performance, behavioral (developmental) regression, sensory amplification, movement abnormalities, sleep disturbance, and urinary frequency (Swedo 2012). PANS is felt to be caused by infection, inflammation, or some other trigger that is associated with a brain response that leads to these symptoms (Swedo et al. 2012; Chang et al. 2015; Murphy et al. 2014). In an effort to organize etiologic research and treatment trials for this disorder, we started the Stanford PANS Clinic, an interdisciplinary clinic designed to evaluate and treat youth with suspected PANS. Many of these children have been extremely ill with destructive rage outbursts, debilitating compulsions, motor and vocal tics, school dysfunction, and multiple psychiatric hospitalizations. As little precedence exists to guide treatment, our interventions are based on those thought to be useful in pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS) (Garvey et al. 1999; Perlmutter et al. 1999; Snider et al. 2005; Murphy et al. 2014) and related conditions such as acute rheumatic fever, postinfectious/reactive arthritis, and Sydenham chorea. In an effort to increase knowledge about this condition, we report here on the first 53 patients evaluated in the Stanford Children's PANS Clinic.

Methods

Pediatric referrals and parents desiring evaluation for a child were referred to our intake coordinator who did the initial screening of patients. Forty-seven of 53 patients who were ultimately evaluated in PANS clinic met research criteria for diagnosing PANS, except for the criteria for acuity of onset. Patients who had an abrupt onset of symptoms were compared with patients who did not have an abrupt onset of symptoms. We reviewed the results from clinical evaluations, patient questionnaires, PANS Impairment Scale (Table S1), and Caregiver Burden Inventory (Fig. S1) (see online supplementary material at http://www.liebertonline.com/jcap).

Clinical evaluations

Patients underwent standard psychiatric (with K.C., M.T.) and medical evaluation (with J.F.), results of which were recorded in the electronic medical record (EMR).

Laboratory workup

All patients underwent evaluation for Group A streptococcus (GAS) (throat culture, perianal culture [if there were symptoms of redness, pain, or itching], antistreptolysin O [ASO], and antideoxyribonuclease B [DNase B]) at presentation to PANS clinic or flare after being established in PANS clinic. …

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