Background PANDAS is defined by neuropsychiatric symptoms, mainly obsessive-compulsive disorder (OCD) or tics, temporally associated with group A β-hemolytic Streptococcus (GAS) infections, showing acute prepubertal onset and relapsing/remitting course.
Objectives To describe the clinical features of a cohort of 242 Italian pts with OCD and/or tics related to a previously confirmed GAS infection.
Methods Between May 2009 and January 2015 we recruited 242 pts (185 males, 76.45%) with OCD and/or tics starting before puberty associated with a previous upper airway infection (impetigo in 2 cases). GAS infection was confirmed in all patients. Their mean age at onset was 77.64 months ±30.1 SD.
Results Two hundred and twenty-three children (93.31%) were full-term born after a regular pregnancy, and 52 (37.68%) from Caesarean section (though for 4 adopted children there were no information); 101/236 (42.8%) had familiars with OCD/tics or other neurologic diseases (for 6 patients there were no familial history data). Sport activity was evaluated in only 149 out of 242 patients, and was performed by 122/149 (81.88%). Clinical signs were motor tics in 109/242 (45.04%), vocal tics in 6/242 (2.48%), motor/vocal tics in 28/242 (3.31%), motor/vocal tics and OCD in 18/242 (7.44%), OCD in 16/242 (6.61%), OCD and motor tics in 61/242 (25.21%), OCD and vocal tics in 4/242 (1.65%). At the first evaluation the mean age was 102.70 months ±35.12 SD. Brain MRI was performed resulting within normal limits in 110/242 patients. Pharyngeal swab was positive in 34/242 (14.05%). Anti-streptolysin O titer was <250 IU in 19/242 (7.85%), 250-550 in 66/242 (27.28%), >550 in 129/242 (53.31%), while in the remaining 28/242 (11.57%) this titer was in progress or not evaluated. Anti-DNase B titer was >650 IU/ml in 76/242 (31.4%) and <650 in 42/242 (17.36%); in the remaining 118 (48.76%) this titer was not evaluated. Anti-nuclear antibodies were studied in 142/242 patients, resulting positive in 7/142 (4.93%). All patients received benzathine benzylpenicillin; neuroleptic drugs were used in 27/242 (11.16%). Therapeutic efficacy was null in 5/242 (2.07%), <25% in 7/242 (2.89%), 25-75% in 125/242 (51.65%), >75% in 58/242 (23.97%), and not-valuable in 47/242 (19.42%).
Conclusions Our preliminary data in the largest pediatric population with PANDAS ever studied until now show male predominance and familiar recurrence rate over 40%. Clinical onset occurs at a mean age of 8.5±2.9 years with motor tics in 45% of cases. Increased anti-DNase B titer is found in over 30% of patients. Benzathine benzylpenicillin has resulted effective in 3/4 of cases with complete or partial remission of symptoms.
Disclosure of Interest None declared
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