الفهرس | Only 14 pages are availabe for public view |
Abstract Streptococcal infection in children is usually benign and selflimited, however, in a small percentage of children, prominent neurologic and/or psychiatric sequelae can occur. PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection) is a well-defined syndrome in which tics (motor and/or vocal) and/or OCD consistently exacerbate in temporal correlation to a GABHS infection. The proposed pathophysiology of PANDAS begins with GABHS infecting a susceptible host. An autoimmune reaction occurs, resulting in production of brain tissue specific antistreptococcal antibodies, which triggers an inflammatory response. The autoantibodies react with basal ganglia proteins, particularly in the caudate nucleus and putamen. Obsessions, compulsions, tics and other neuropsychiatric symptoms, arise from interaction between these antibodies and neurons in the basal ganglia via an unknown mechanism. Egyptian children suffering from RF (with or without chorea) are susceptible for PANDAS. Incidence of PANDAS is more in resistant chorea patients (33%), with females being more affected. The most common neuropsychiatric manifestations in this subgroup includes OCD associated with ADHD, followed by OCD + tics + ADHD, then tics + ADHD, and finally OCD + tics. Swedo et al., 1998 proposed five diagnostic criteria: 1. The presence of OCD or a tic disorder or both. 2. Pediatric onset. 3. Episodic course of symptom severity with abrupt onset or dramatic symptom exacerbations. 4. Temporal association with GABHS infection. 5. Association with neurological abnormalities during symptom exacerbations. |