PANS/PANDAS: Clinical Experience in IVIG Treatment and State of the Art in Rehabilitation Approaches

Pediatricacute-onsetneuropsychiatricsyndrome(PANS) isaconditioncharacterized by theabrupt, dramaticonset of obsessive–compulsivedisorder (OCD) or eating restriction accompaniedbyequallyabruptandseverecomorbidneuropsychiatricsymptoms.PANDAS(pediatric autoimmuneneuropsychiatricdisorderassociatedwithstreptococcalinfection)isaheterogeneous syndromeidentifiedaspost-Streptococcuspyogenesinfection(β-hemolyticStreptococcusgroupA) complicationsregardingthecentralnervoussystemwithspecificinvolvementofneuropsychiatric andbehavioral skills. Inthefirstpartofourstudy,weshareourexperience inthetreatment ofagroupofextreme-grade(accordingtoCY-BOCSseverityscale)symptomaticpatientswith intravenousimmunoglobulin(IVIG),followingthemostrecentstudiesregardingthedosageofthe drug.Ourcontributionistoshareourexperiencemadeonasampleof55patientsallinthehighestlevel ofaseveritygrade. Inthesecondpartofourstudy,wealsoanalyzetheliteratureonPANS/PANDAS rehabilitationtherapy,sinceintheliteraturethereisnodiscussionofunionandcomparisononthis method.Objective:Thisstudyaimstoevaluatetheclinicalfeaturesofthepatientsobservedfrom differentItaliancohorts,withtheattemptatevaluatingclinicalresponsetoIVIGtreatmentinchildren withanextremeseveritygradeofPANS/PANDASdisease.Furthermore,afterhavinganalyzedthe literature,weproposerehabilitationtherapyasanaddedvaluetothepharmacologicaltreatment. MaterialsandMethods:Atotalof55patientswithadiagnosisofPANS/PANDAS,whobelongedtoan extremegradeofdisease,wereenrolled.AllpatientswereadministeredwithIVIGtreatmentat2g/kg perdayfortwoconsecutivedays.Results:Fromourstudy,anoticeableimprovement(untilcomplete remission)ofsymptomswasevidentforatleastoneyearin47outof55(85%)observedchildren, while11outofthese43(25%)showedanevidentsymptomsremissioninasingleattemptandthe remaining32(75%)requiredasecondadministrationtonoticealastingsymptomaticimprovement.