Signs and Symptoms

 

Children with PANDAS must be initially diagnosed with Obsessive Compulsive disorder or a tic disorder [Swedo2004]. These children may have some of the following symptoms that accompany the OCD or tic disorder [Swedo1998][Moretti2006]:

 

  • Obsessions (e.g., preoccupation with a fixed idea or an unwanted feeling, often accompanied by symptoms of anxiety)
  • Compulsions (e.g., an irresistible impulse to act, regardless of the rationality of the motivation)
  • Choreiform movements (e.g., milk-maid grip, fine finger playing movements in stressed stance)
  • Emotional lability (e.g.,irritability, sudden unexplainable rages, fight or flight behaviors) (66%)
  • Personality changes (54%)
  • Age inappropriate behaviors particularly regressive bedtime fears/rituals (50%)
  • Separation anxiety (46%)
  • Oppositional defiant disorder (40%)
  • Tactile/sensory defensiveness (40%)
  • ADHD, fidgetiness, or inability to focus (40%)
  • Major Depression (36%)
  • Marked deterioration in handwriting or math skills. (26%)
  • Daytime urinary frequency/enuresis (12%)
  • Anorexia (particularly fear of choking, being poisoned, contamination fears, fear of throwing up)

 

PANDAS/OCD is a clinical diagnosis, often marked by the sudden onset and extreme symptom exacerbations (such as an increase of +18 points on the OCD CY-BOCS score during an exacerbation [Murphy2004]). The abrupt onset and remission after eradication of streptococcal infection separates the child from non-PANDAS OCD[Swedo2004]. Many parents can pinpoint a day or a week when behaviors changed [Çengel-Kültür2009]

When a child has primarily vocal and motor tics, the symptoms may appear to overlap with symptoms of Tourettes Syndrome; however, the children can be differentiated by observing symptom exacerbations over time [Pavone2006]. In PANDAS children, a streptococcal infection coincides with symptom exacerbation and once treated, initial exacerbations generally remit. The rapid onset with significant remission is characteristic of PANDAS.

Researchers have described chronic PANDAS [Pavone2006] where the tics and/or obsessive-compulsive disorder have a much more gradual course. These cases are difficult to separate from non-PANDAS tics or OCD. Some researchers have found other immunologic markers (anti-neuronal and anti-basal-ganglia antibodies) that help separate PANDAS and non-PANDAS children [Kirvan2006].

 

Adapted from (Dec 2009): http://www.latitudes.org/forums/index.php?showtopic=6265

Adapted from (Dec 2009): http://www.latitudes.org/forums/index.php?showtopic=6266