Paediatric acute-onset neuropsychiatric syndrome

Children who are diagnosed early with identified treatable triggers tend to have a good prognosis. One study showed that although full remission was rare, the majority of children with PANS symptoms had significantly improved with treatment.[5]Gromark C, Hesselmark E, Djupedal IG, et al. A two-to-five year follow-up of a pediatric acute-onset neuropsychiatric syndrome cohort. Child Psychiatry Hum Dev. 2022 Apr;53(2):354-64. https://link.springer.com/article/10.1007/s10578-021-01135-4 http://www.ncbi.nlm.nih.gov/pubmed/33559023?tool=bestpractice.com These patients responded quickly and returned to their pre-PANS baseline of normal function and minimal to no psychiatric symptoms. In the experience of the authors of this topic, the last 5% to 10% of baseline functioning may take time to resolve (up to 3-12 months) and may include memory problems, difficulty with maths and reading, dysgraphia, ongoing but minimally intrusive thoughts, low grade anxiety, sleep dysfunction, and eating restriction. Pain amplification following a resolved PANS episode can occur but if addressed quickly with physiotherapy typically resolves quickly. Fatigue and brain fog following PANS flares may also occur and may be more common in patients treated with corticosteroids, although the mechanism is unclear. The exception to this rule includes patients with elevated mycoplasma titres and patients with vasculitis signs (i.e., elevated von Willebrand factor antigen, etc.) as these patients may have a more refractory course.

Based on the experience of the authors of this topic, patients with PANS and pre-existing attention deficit hyperactivity disorder, autism, or other neurodevelopmental conditions tend to have a more challenging clinical course.