PANDAS: How do we classify it?

Over the course of history, "tics and obsessive-compulsive symptoms occur so frequently together in the same patient or in different members of the same family that they are now considered by some investigators to be alternate manifestations of the same neuropsychiatric disorder" (Garvey, Giedd and Swedo 1998). This neuropsychiatric disorder has come to be known as pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections, or PANDAS, which has come to puzzle scientists and doctors alike over recent decades. PANDAS is a disorder that is characterized by the sudden onset of symptoms similar to those seen in tic and obsessive-compulsive disorders (OCD). A child is only diagnosed with PANDAS when there is a clinical history of having a streptococcal infection prior to the sudden onset of these symptoms. These children make up a subgroup of children that have been diagnosed with Sydenham’s chorea, which is a disease that has been found to be closely related to OCD and tic disorders, therefore suggesting that PANDAS is also a part of this group.

Issues that have arisen can in part be attributed to the small sample sizes used for testing, which do not provide scientists samples that will allow them to look at all of the possibilities that may play a role into the sudden onset of these disorders. However, a connection was found between streptococcal infections and PANDAS, but is debated as to whether this streptococcal infection causes the onset of PANDAS and in result the onset of OCD and tic disorders. According to Dr. Edward L. Kaplan, current research is not evident enough to identify a causative relationship. Kaplan mentions that not all children show the symptoms of a streptococcal infection, and are therefore simply carriers, resulting in a lack of clinical records of a streptococcal infection that were being used to previously diagnose children with PANDAS.

Currently, the etiology of the disease is unknown, and scientists agree that more research needs to be done in order to come to a definitive classification of this disorder. This disorder is one in which it is debated as to whether the streptococcal infection is what is causing the disorder or if it is just coincidence. However, evidence that has been presented thus far supports the hypothesis that the onset of PANDAS and tic and obsessive-compulsive disorders are causative as more research is revealing the two disorders being present together in many individuals. However, in order to fully understand the etiopathogenesis of PANDAS, we would first need to fully understand the etiopathogenesis of the disorders closely related to it, starting with Syndenham’s chorea, which currently serves as the medical model for PANDAS. Whether or not the onset of PANDAS is due to an evolutionary advance of streptococcus or just coincidence is a question that must be answered by the use of genetically similar disease to piece together the current enigma that is PANDAS. 

Works Cited:

Garvey, M., Giedd, J., & Swedo, S. (1998). PANDAS: the search for environmental triggers of pediatric neuropsychiatric disorders. Lessons from rheumatic fever. Journal Of Child Neurology, 13(9), 413-423.

PANDAS to CANS: Evolution of a controversial disorder | Infectious Diseases in Children. (n.d.). Healio: Medical Specialty News, Journals, and Free CME. Retrieved from http://www.healio.com/pediatrics/news/print/infectious-diseases-in-children/%7BCAFAB629-3452-44AF-BA2D-4D99A8012DFC%7D/PANDAS-to-CANS-Evolution-of-a-controversial-disorder

                Snider, L., & Swedo, S. (n.d). PANDAS: current status and directions for research. Molecular Psychiatry, 9(10), 900-907.


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Melissa Martinez