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Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science

Specialty

Emergency Medicine

Advisor

Dr. Elyse Watkins, DHSc, PA-C

Abstract

Purpose: The purpose of this article is to discuss current treatment guidelines for PANS and successful remission of the syndrome with NSAIDS versus IVIG.

Method: A PubMed literature search was conducted with search terms Pediatric Acute-onset Neuropsychiatric Syndrome and treatment with filters for the past 5 years and full text being used. Seventeen articles were retrieved and reviewed to find three articles that were pertinent to this clinical review’s topic.

Results: Anti-inflammatories are a very effective treatment for PANS with naproxen being the preferred treatment. The use of IVIG has been shown to be beneficial in patients with IgG deficiencies but discrepancies were noted in people with normal to low normal IgG levels if IVIG is of benefit.

Conclusion: In the treatment of pediatric acute onset neuropsychiatric syndrome (PANS), children experience a variety of cognitive, behavioral, and neurological symptoms. These children typically present very ill with their symptoms. PANS children are most appropriately treated through a three-pronged approach that was established by the PANS/PANDAS Research Consortium. The first is the use of psychiatric medications and behavioral interventions to treat the most distressing symptoms of PANS. The second prong in treatment is utilization of anti-inflammatories and immune modulating therapies. The third prong is the use of treatment with prophylactic antimicrobials. It is shown across the board in all of these studies that antimicrobial therapy and psychological intervention are of benefit. The use of anti-inflammatories and immune modulating therapy is more of a controversial topic with conflicting data. It does appear that anti-inflammatories are a very effective treatment for PANS. The use of IVIG has been shown to be beneficial in patients with IgG deficiencies but usefulness is guarded currently for patients with low to normal IgG levels.

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