AbstractA subgroup of patients with childhood-onset obsessive-compulsive disorder (OCD) has been identified who share a common clinical course characterized by dramatic symptom exacerbations following Group A beta-hemolytic streptococcal (GABHS) infections. The term PANDAS has been applied to the subgroup, to indicate the postulated etiology of their symptoms: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. Five clinical characteristics define the PANDAS subgroup: presence of OCD and/or tic disorder, prepubertal symptom onset, sudden onset or abrupt exacerbations (sawtooth course), association with neurological abnormalities (presence of adventitious movements or motoric hyperactivity during exacerbations), and temporal association between symptom exacerbations and GABHS infections. Post-streptococcal symptom exacerbations are typically quite dramatic, with patients reporting that their symptoms “…came on overnight” or “…appeared all of a sudden a few days after I had a sore throat.” The post-streptococcal inflammatory nature of the neuropsychiatric symptoms provides novel opportunities for treatment and prevention, including immunomodulatory therapies such as therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG). A recently completed placebo-controlled trial revealed that both IVIG and TPE were effective in reducing neuropsychiatric symptom severity (40% to 55% reductions, respectively) for a group of severely ill children with OCD and/or tic disorders. Further research is required to determine why the treatments are helpful, as well as to ascertain whether or not antibiotic prophylaxis can help prevent post-streptococcal symptom exacerbations.
摘要 在儿童期发病的强迫症(OCD)患者中发现了一个亚群,他们具有共同的临床病程,其特点是在感染 A 组β-溶血性链球菌(GABHS)后症状急剧加重。PANDAS 一词已用于该亚群,以表明其症状的假定病因:与链球菌感染相关的小儿自身免疫性神经精神障碍。PANDAS 亚组有五个临床特征:存在强迫症和/或抽搐症、青春期前发病、突然发病或突然加重(锯齿状病程)、与神经系统异常有关(加重时出现临近运动或运动亢进)以及症状加重与 GABHS 感染在时间上有关。链球菌感染后的症状加重通常相当剧烈,患者会说他们的症状"......一夜之间就出现了 "或"......在我喉咙痛几天后突然出现"。链球菌感染后神经精神症状的炎症性质为治疗和预防提供了新的机会,包括治疗性血浆置换(TPE)和静脉注射免疫球蛋白(IVIG)等免疫调节疗法。最近完成的一项安慰剂对照试验显示,对于一组患有强迫症和/或抽搐症的重症儿童,静脉注射免疫球蛋白和治疗性血浆置换疗法都能有效减轻神经精神症状的严重程度(分别减轻 40% 至 55%)。还需要进一步的研究来确定为什么这些治疗方法有帮助,以及抗生素预防是否有助于预防链球菌感染后症状加重。