PANDAS IN AUTISTIC PATIENTS

Objectives: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection (PANDAS) are a group of disorders in which there is an acute onset of motor and/or vocal tics and obsessive-compulsive behaviors in temporal correlation with a Group A b-hemolytic streptococcal (GABHS) infection. PANDAS was initially described in children who were otherwise neurologically normal. We now describe observations on a cohort of six patients with severe autistic spectrum disorder (CARS scale >30).

Methods: All six patients were male, aged 6–11 years, and lacked functional speech. Following documented GABHS infection (positive pharyngeal cultures), a marked increase of self-stimulatory behaviors occurred, as documented by changes in Yale Brown OCD Scale (YBOCS) scores. All six patients were treated with standard dose of Azithromycin. YBOCS scores were documented post treatment.

Results: Azithromycin treatment resulted in rapid improvement in self-stimulatory behavior as documented by the post-treatment YBOCS scores.

Conclusions: These results suggest that longer-term fluctuations in self-stimulatory behavior in autistic patient could potentially be a consequence of acute or chronic GABHS infection. This observation of PANDAS like symptoms/behavior in patients with autistic spectrum disorder and response to Azithromycin treatment needs to be further studied.