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METHODS article

Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
Volume 15 - 2024 | doi: 10.3389/fimmu.2024.1420663

Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS): a Delphi Study and Consensus Document about Definition, Diagnostic Criteria, Treatment and Follow-up

Provisionally accepted
Roberto Grandinetti Roberto Grandinetti 1Nicole Mussi Nicole Mussi 1Simone Pilloni Simone Pilloni 1Greta Ramundo Greta Ramundo 1Angela Miniaci Angela Miniaci 2Emanuela Turco Emanuela Turco 1Bendetta Piccolo Bendetta Piccolo 1Maria Elena Capra Maria Elena Capra 3Roberta Forestiero Roberta Forestiero 1Serena R. Laudisio Serena R. Laudisio 1Giovanni Boscarino Giovanni Boscarino 1Laura Pedretti Laura Pedretti 1Martina Menoni Martina Menoni 1Giuditta Pellino Giuditta Pellino 4Silvia Tagliani Silvia Tagliani 4Andrea Bergomi Andrea Bergomi 5FRANCESCO ANTODARO FRANCESCO ANTODARO 5Maria C. Cantù Maria C. Cantù 6Maria T. Bersini Maria T. Bersini 6Sandra Mari Sandra Mari 6Franco Mazzini Franco Mazzini 7Giacomo Biasucci Giacomo Biasucci 3Agnese Suppiej Agnese Suppiej 4Susanna M. Esposito Susanna M. Esposito 1*
  • 1 Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126, Parma, Emilia-Romagna, Italy
  • 2 Pediatric Clinic, IRCCS Azienda Ospedaliera Universitaria di Bologna, 40138, Bologna, Italy
  • 3 Pediatrics and Neonatology Unit, Department of Medicine and Surgery, University of Parma, Guglielmo da Saliceto Hospital, 29122, Piacenza, Italy
  • 4 Pediatric Clinic, University of Ferrara, 44124, Ferrara, Italy
  • 5 Primary Care Pediatricians, Azienda Unità Sanitaria Locale (AUSL) Modena, 41125, Modena, Italy
  • 6 Primary Care Pediatricians, Azienda Unità Sanitaria Locale (AUSL) Parma, 43126, Parma, Italy
  • 7 Primary Care Pediatricians, Azienda Unità Sanitaria Locale (AUSL) Romagna, 47521 Forlì-Cesena, Cesena, Italy

The final, formatted version of the article will be published soon.

    Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) are broad diagnoses that encompass a range of sudden-onset neuropsychiatric symptoms in children, which can include obsessive-compulsive disorder (OCD), tics, anxiety, emotional instability, and cognitive difficulties.Unlike PANDAS, PANS is not strictly linked to group A streptococcal infections but can be triggered by various infectious or environmental factors. Lights and shadows remain upon the management of children with PANS and PANDAS and there is no clear consensus regarding definition, diagnostic criteria, treatment, and follow-up. The aim of the present study was to evaluate the level of agreement on PANS and PANDAS definition, diagnostic criteria, treatment and follow-up and to assess on the basis of recent studies whether there is a need to modify the current recommendations used by primary care pediatricians and hospital pediatricians in clinical practice in order to improve outcomes. Using the Delphi method, this consensus provides shared indications on PANS and PANDAS management in pediatric age, based on the most updated literature. This work represents, in our opinion, the most complete and up-to-date information on the diagnosis of PANS and PANDAS, as well as consensus statements about several aspects of clinical care. Undoubtedly, more randomized and controlled trials are needed in the pediatric population to better define the best management, also in terms of adequate follow-up examinations and period of observation.

    Keywords: group A streptococcus, Neuroinflammation, Obsessive-Compulsive Disorder, pandas, pans, Tics

    Received: 20 Apr 2024; Accepted: 07 Oct 2024.

    Copyright: © 2024 Grandinetti, Mussi, Pilloni, Ramundo, Miniaci, Turco, Piccolo, Capra, Forestiero, Laudisio, Boscarino, Pedretti, Menoni, Pellino, Tagliani, Bergomi, ANTODARO, Cantù, Bersini, Mari, Mazzini, Biasucci, Suppiej and Esposito. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Susanna M. Esposito, Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126, Parma, Emilia-Romagna, Italy

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