PANDAS Syndrome is a symptom complex that occurs in children after streptococcal infections. Pathology is accompanied by tics and neurosis-like conditions. This is a fairly rare disease. The link between neurological disorders and infectious diseases has been discovered relatively recently. Currently, there are discussions among doctors about the origin of this syndrome. For this reason, it is still not included in the ICD-10 as a separate pathology. However, methods have been developed to diagnose and treat this disorder.
What is a syndrome?
The name of the symptom complex (PANDAS syndrome) is an abbreviation. The full name of the pathology in English is Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection. Translated into Russian, this means "childhood autoimmune neuropsychiatric disorders associated with streptococcal infection."
As the name implies, this complex of symptoms occurs after diseases caused by beta-hemolytic streptococcus group A. This microorganism is the causative agent of scarlet fever, tonsillitis, and tonsillitis. PANDAS syndrome is noted in children aged 3 years and over. But most often teenagers suffer from it. In the puberty, the body undergoes a serious hormonal rearrangement, and the infection can adversely affect the nervous system.
How do neuropsychiatric disorders occur?
Currently, it is believed that the cause of this syndrome is autoimmune disorders. During an infectious disease, the body produces antibodies against group A beta-hemolytic streptococcus. However, the proteins of this microorganism are similar in structure to their own proteins in human tissues. As a result, antibodies begin to attack healthy body cells. The basal ganglia of the brain are exposed. This CNS department is responsible for movement. The defeat of the ganglia and leads to the appearance of tics in the child.
How is the pathology
This disease is characterized by acute onset. The first neurological disorders occur suddenly. This usually occurs 7-14 days after an infectious disease. Symptoms increase and reach a maximum within 24-48 hours. Then the neurological and psychiatric manifestations gradually decrease and slowly disappear within 7-30 days.
PANDAS syndrome always occurs in paroxysmal form. After the first episode of the disease, relapse soon follows. The interval between seizures is several weeks. This disease greatly reduces the quality of life of the child. Due to tics and other neuropsychiatric disorders, it becomes difficult for children to attend an educational institution, their performance is significantly reduced and sleep is disturbed.
Neurological manifestations
One of the main neurological manifestations of this syndrome is the occurrence of a tick in a child. Involuntary movements can affect various groups of facial muscles.
In addition, other motor disorders are noted in children. Hyperkinesis occurs as a chorea. The child makes active, erratic movements of the limbs and the whole body. Muscle tone is usually reduced.
Myoclonia is often observed. This is a convulsive twitching of a large muscle group. In this case, an attack of hiccups and trembling in the body may occur.
A special type of hyperkinesis is Tourette’s syndrome. For this violation, not only motor, but also voice tics are characteristic. A child can shout out individual syllables or sounds. Coprolalia is often noted. This term refers to the involuntary shouting of swear words.
It used to be that Tourette's syndrome is a pathology of unknown origin. It was assumed that a hereditary factor plays a large role in its occurrence. However, it has now been established that the cause of this syndrome is an autoimmune lesion of the basal ganglia of the brain.
Psychiatric symptoms
PANDAS syndrome is also accompanied by mental disorders. Most often, sick children have obsessive-compulsive disorder. The child is disturbed by obsessive thoughts, he often performs repeated ritual actions.
In addition, children often have difficulties in learning. There may be increased anxiety and hyperactivity in combination with attention deficit. A sick child becomes emotionally unstable, his mood often changes.
Diagnostics
Diagnosis of PANDAS syndrome begins with a medical history. The following signs indicate that the child has this pathology:
- a combination of hyperkinesis with mental disorders;
- the relationship of neurological symptoms with transferred tonsillitis or scarlet fever;
- sudden onset of the disease and paroxysmal course;
- the age of the child is from 3 to 14 years.
Additionally, the following diagnostic procedures are prescribed:
- MRI and CT of the brain. Typically, in sick children, these research methods do not show changes in the central nervous system.
- Electroencephalogram. If this study is conducted while awake, it shows increased convulsive readiness. If the EEG is done during sleep, then the results show spike waves, which also indicate convulsive activity.
- Blood test for titer of antibodies to streptococcus. An increased titer indicates enhanced antibody activity. However, this does not always indicate an autoimmune process.
- Blood test for antigens of B-lymphocytes D8 / 17 and antibodies to the basal ganglia. These are the most accurate diagnostic methods for this syndrome. However, in clinical practice they are rarely used, since these studies are not carried out in all laboratories.
Treatment methods
An effective treatment for PANDAS syndrome in children has been developed. Prescribe injections of the antibiotic "Bicillin" or "Retarpen". This helps prevent the development of acute rheumatic fever, which is often associated with this pathology.
To reduce convulsive readiness, the drug "Depakin" is prescribed. Also shown are the use of the Milgamma vitamin complex to improve the condition of nerve cells.
Antipsychotics and antidepressants are ineffective. Patients should regularly visit a neurologist, as well as a rheumatologist and otolaryngologist.
Prevention
How to prevent neurological disorders after streptococcal infections? Specific prevention of such conditions has not been developed. You should pay attention to the neurological condition of the child after suffering a sore throat or scarlet fever. When involuntary movements or muscle twitches appear, it is urgent to visit a neurologist.
If the child is prone to frequent inflammation of the throat of streptococcal origin, then it is advisable to make a tonsillectomy (removal of the tonsils). This will prevent exacerbation of the infection and minimize the risk of neurological pathology.