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Pediatric acute-onset neuropsychiatric syndrome

Last reviewed: 12 Oct 2024
Last updated: 10 Nov 2023

Summary

Definition

History and exam

Key diagnostic factors

  • acute-onset (<72 hours) obsessive-compulsive disorder (OCD)
  • acute-onset (<72 hours) severely restricted food intake
  • acute-onset (<72 hours) concurrent neuropsychiatric symptoms
  • relapsing-remitting course
Full details

Other diagnostic factors

  • current or past group A streptococcus (GAS) infection
  • motor signs associated with basal ganglia dysfunction
  • sinusitis, otitis media, and other sinopulmonary infections
  • systemic inflammation/immune dysregulation
  • enuresis
  • frequent urination
  • sleep disturbances
  • dehydration
  • palatal petechiae
  • low body mass index (BMI)
  • vital sign instability
Full details

Risk factors

  • prepubescent onset
  • family history of psychiatric disorder
  • family history of autoimmunity
  • history of developmental disorder
  • immune dysfunction
  • male sex
  • history of infection
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
  • throat culture for group A streptococcus (GAS)
  • polymerase chain reaction (PCR) for group A streptococcus (GAS)
  • rapid antigen detection test (RADT) for group A streptococcus (GAS)
  • antistreptococcal serology
  • CBC with differential
  • C-reactive protein (CRP)
  • erythrocyte sedimentation rate (ESR)
  • comprehensive metabolic panel
  • antinuclear antibodies (ANA)
  • immunoglobulins (IgG, IgA, IgM, IgE) with IgG subclasses
  • ferritin (iron) and transferrin saturation
Full details

Tests to consider

  • urinalysis
  • brain MRI
  • electroencephalogram (EEG)
  • lumbar puncture
  • polysomnogram
  • musculoskeletal imaging (MRI or ultrasound)
  • swallowing studies
Full details

Treatment algorithm

ACUTE

new-onset or new flare: mild impairment

new-onset or new flare: moderate to severe impairment

new-onset or new flare: extreme or life-threatening impairment

ONGOING

chronic symptoms

Contributors

Authors

Jennifer Frankovich, MD, MS

Professor Pediatrics - Allergy, Immunology, Rheumatology

Co-Director, Stanford Children’s Immune Behavioral Health Clinic

Director, Stanford Immune Behavioral Health Research Program

Stanford University School of Medicine

Stanford

CA

Disclosures

JF declares that she has no competing interests.

Yuhuan Xie, MD

Clinical Assistant Professor

Psychiatry and Behavioral Sciences - Child & Adolescent Psychiatry and Child Development

Stanford University School of Medicine

Stanford

CA

Disclosures

YX declares that she has no competing interests.

Peer reviewers

Juliette C. Madan, MD, MS

Associate Professor Pediatrics, Psychiatry & Epidemiology

Clinical Director of the Children's Environmental Health and Disease Prevention Research Center

Geisel School of Medicine at Dartmouth

Dartmouth Hitchcock Medical Center

Hanover

NH

Disclosures

JCM declares that she has no competing interests.

  • Differentials

    • Obsessive-compulsive disorder (OCD)
    • Anorexia nervosa
    • Avoidant-restrictive food intake disorder (ARFID)
    More Differentials
  • Guidelines

    • Clinical guidance for diagnosis and management of suspected pediatric acute-onset neuropsychiatric syndrome in the Nordic countries
    • Clinical evaluation of youth with pediatric acute-onset neuropsychiatric syndrome (PANS): recommendations from the 2013 PANS Consensus Conference
    More Guidelines
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