PMID- 28832181
OWN - NLM
STAT- MEDLINE
DCOM- 20190416
LR  - 20190416
IS  - 1557-8992 (Electronic)
IS  - 1044-5463 (Print)
IS  - 1044-5463 (Linking)
VI  - 28
IP  - 2
DP  - 2018 Mar
TI  - Treatment of Pediatric Acute-Onset Neuropsychiatric Disorder in a Large Survey 
      Population.
PG  - 92-103
LID - 10.1089/cap.2017.0101 [doi]
AB  - OBJECTIVE: The goal of this study was to investigate treatment histories and 
      outcomes in a large community sample of youth with Pediatric Acute-onset 
      Neuropsychiatric Syndrome (PANS), and, where appropriate, to examine the impact 
      of immune deficiency on treatment outcomes. METHODS: A comprehensive 
      internet-based survey was completed by parents or guardians of youth who had 
      received physician diagnoses of PANS, or by young adults (age 18+) who had 
      themselves been diagnosed by a physician (N = 698). Data regarding the treatment 
      histories of these patients, including the variety of medical and psychological 
      treatments employed and the caregiver- or self-reported response to each, are 
      presented. RESULTS: The PANS patients in this study had commonly been treated 
      with antibiotic (N = 675), anti-inflammatory (N = 437), and/or psychotropic 
      therapy (N = 378). Response to antibiotic treatment was best when treatment was 
      relatively aggressive, with broad-spectrum antibiotics and courses of >30 days 
      generally producing the best results (i.e., up to 52% of patients achieving a 
      "very effective" response). For immune-deficient patients (caregiver-reported 
      laboratory studies below normal limits; N = 108), use of broad-spectrum 
      antibiotics appeared to be particularly desirable. Anti-inflammatory therapies, 
      including over-the-counter medications such as ibuprofen, were at least "somewhat 
      effective" for most patients. Intravenous immunoglobulin (IVIG) had been used to 
      treat PANS in 193 (28%) of the patients and was at least "somewhat effective" for 
      89%, although for 18% of these, the effect was not sustained. The highest rate of 
      sustained response to IVIG treatment was seen in immune-deficient patients who 
      received doses of at least 0.8 g/kg IVIG on a regular basis. Psychotropic 
      medications, most commonly SSRIs (38% reported a trial), were commonly employed, 
      but were often ineffective (e.g., 44% found SSRIs "somewhat" to "very 
      effective"). Many patients (N = 473) had received some form of psychotherapy with 
      some benefit, with cognitive behavioral therapy found to be at least somewhat 
      effective in a majority of those treated with this modality. CONCLUSION: Among 
      the PANS patients represented in this study, relatively aggressive treatment 
      courses targeted at eradicating infection and modulating the inflammatory 
      response appeared to provide the best caregiver-reported therapeutic results, and 
      to be generally well tolerated. Given its relative efficacy and tolerability, 
      treatment targeting the inflammatory response may represent an underutilized 
      approach in this population. The results of this study should be considered in 
      light of the limitations inherent in a self-selected and administered online 
      survey.
FAU - Calaprice, Denise
AU  - Calaprice D
AD  - 1 Calaprice-Whitty Consulting, Inc. , Lake Arrowhead, California.
FAU - Tona, Janice
AU  - Tona J
AD  - 2 Department of Rehabilitation Science, University at Buffalo , Buffalo, New 
      York.
FAU - Murphy, Tanya K
AU  - Murphy TK
AD  - 3 Department of Pediatrics, University of South Florida , St. Petersburg, 
      Florida.
AD  - 4 Department of Psychiatry, University of South Florida , St. Petersburg, 
      Florida.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20170823
PL  - United States
TA  - J Child Adolesc Psychopharmacol
JT  - Journal of child and adolescent psychopharmacology
JID - 9105358
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Anti-Inflammatory Agents)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Psychotropic Drugs)
RN  - Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal 
      infections
SB  - IM
MH  - Acute Disease
MH  - Adolescent
MH  - Adult
MH  - Anti-Bacterial Agents/administration & dosage
MH  - Anti-Inflammatory Agents/administration & dosage
MH  - Autoimmune Diseases/physiopathology/*therapy
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Humans
MH  - Immunoglobulins, Intravenous/administration & dosage
MH  - Immunologic Deficiency Syndromes/physiopathology/*therapy
MH  - Infant
MH  - Male
MH  - Obsessive-Compulsive Disorder/physiopathology/*therapy
MH  - Psychotherapy/*methods
MH  - Psychotropic Drugs/administration & dosage
MH  - Streptococcal Infections/physiopathology/*therapy
MH  - Surveys and Questionnaires
MH  - Syndrome
MH  - Treatment Outcome
MH  - Young Adult
PMC - PMC5826468
OTO - NOTNLM
OT  - obsessive-compulsive disorder
OT  - pediatric acute-onset neuropsychiatric syndrome
OT  - survey
OT  - treatment
EDAT- 2017/08/24 06:00
MHDA- 2019/04/17 06:00
PMCR- 2018/03/01
CRDT- 2017/08/24 06:00
PHST- 2017/08/24 06:00 [pubmed]
PHST- 2019/04/17 06:00 [medline]
PHST- 2017/08/24 06:00 [entrez]
PHST- 2018/03/01 00:00 [pmc-release]
AID - 10.1089/cap.2017.0101 [pii]
AID - 10.1089/cap.2017.0101 [doi]
PST - ppublish
SO  - J Child Adolesc Psychopharmacol. 2018 Mar;28(2):92-103. doi: 
      10.1089/cap.2017.0101. Epub 2017 Aug 23.