Evidence Based Treatment

There are many different types and combinations of treatments available for children with PANDAS. In general, antibiotics such as penicillin or amoxicillin that are commonly used to treat GABHS infection result in a marked decrease of OCD and tic behavior associated with PANDAS. Antibiotic treatment often leads to remission of psychiatric symptoms within 14 days, with restoration of the premorbid functional state (Murphy and Pichichero 2002).

In instances in which antibiotic treatment does not relieve the psychiatric symptoms associated with PANDAS, psychotropic medicines and psychological interventions are additional treatments to consider using when OCD and tic symptoms persist or are debilitating. Selective serotonin reuptake inhibitors (SSRIs), which are used as standard treatment for OCD, are used in the treatment of OCD symptoms associated with PANDAS. SSRIs such as clomi-pramine, fluvoxamine, and sertraline result in reduction of OCD and tic behavior (Moretti et al. 2008). Cognitive-behavioral therapy (CBT) has been shown to decrease OCD and tic behavior, but in follow-up studies many of these symptoms return once the CBT is stopped. As with OCD in the general pediat-ric population, the greatest treatment efficacy occurs when SSRIs are used in conjunction with CBT.

Immunomodulatory interventions such as intravenous immunoglobulin or plasma exchange are more invasive treatments that are used as a last resort when symptoms are severely incapacitating and do not respond to the interventions mentioned earlier. Perlmutter et al. (1999) assessed the effectiveness of plasma exchange treatment and intravenous immunoglobulin as compared with placebo/sham (saline solution) in 29 children ages 5-14 years diagnosed with severe infection-triggered exacerbations of PANDAS. At 1-month follow-up, it was found that children in both the plasma exchange and intravenous immunoglobulin groups had marked symptom improvement compared with children in the placebo group. Psychiatric symptoms remained dramatically improved 1 year after treatment; 82% of children in the experimental groups had symptom improvement from baseline (Perlmutter et al. 1999).

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