Michael Daines, MD, discusses pediatric acute-onset neuropsychiatric syndrome
Michael O. Daines, MD, outlines key diagnostic criteria and treatment challenges for pediatric acute-onset neuropsychiatric syndrome (PANS), emphasizing the need for multidisciplinary care and improved treatment access.
Primary care providers may be the first line of defense for children with pediatric acute-onset neuropsychiatric syndrome (PANS), but diagnosing and managing the condition can present significant challenges, according to Michael O. Daines, MD, division chief of Pediatric Allergy and Immunology at the University of Arizona College of Medicine.
“I think there are 3 main hurdles that people in primary care hit with this disease,” Daines said. “The first is recognition,and if you can't find it, you can't treat it.”
PANS is a clinical diagnosis characterized by a sudden onset of obsessive-compulsive disorder (OCD) or severe food restriction, accompanied by at least 2 additional neuropsychiatric symptoms, according to Daines. These can include anxiety, mood changes, regression of skills, sleep disturbances, urinary symptoms, and movement or sensory issues.
“All of these things can be normal or caused by other things in children,” Daines explained. “So it is also essentially a diagnosis of exclusion, where you have to rule out other medical conditions before you go forward. The second threshold you really hit is trying to find a treatment team that is willing to take care of these kids,” he said. “They have a bio-behavioral background, so there are very few doctors that are good at treating both the immunology and the behavioral components.”
Successful management of PANS typically requires a multidisciplinary approach that incorporates both medical and behavioral therapies. In Daines’ clinic, this includes outreach to community pediatricians to help guide treatment for milder cases.
“A lot of the milder cases can be treated with other anti-inflammatories—things like naproxen—and treatment of infections that may be triggering the illness,” he said.
Ultimately, Daines encouraged general pediatricians to remain alert to sudden behavioral or psychiatric shifts in patients and to feel confident initiating a workup.
“Ideally, this is going to be taken care of in a multidisciplinary manner,” he said. “But there’s a lot that primary care can do to identify and support these patients early.”
