Современные подходы к диагностике и лечению PANS/PANDAS
Аннотация
PANS — педиатрический острый нейропсихический синдром, который характеризуется внезапным началом обсессивно-компульсивного синдрома, сопровождается тревогой, эмоциональной лабильностью и другими симптомами. PANDAS, или педиатрические аутоиммунные нейропсихические расстройства, ассоциированные со стрептококковой инфекцией, являются подтипом PANS. В статье представлены современные данные об этиологии, патогенезе, диагностике и лечении PANS/PANDAS. Проанализированы варианты выбора противовоспалительной и иммунотропной терапии, включающей применение нестероидных противовоспалительных препаратов, глюкокортикостероидов, внутривенного иммуноглобулина, плазмафереза, ритуксимаба, мофетила микофенолата.
Ключевые слова
дети,
PANDAS,
PANS,
CANS,
PITAND,
обсессивно-компульсивный синдром,
тики,
гиперкинезы,
стрептококк,
этиология,
диагностика,
лечение
Об авторах
И. А. Костик
Детский санаторий — Реабилитационный центр Детские Дюны
Россия
Раскрытие интересов: отсутствие конфликта интересов, о котором необходимо сообщить
Россия
Костик Инна Анатольевна - кандидат медицинских наук, невролог.
197701, Санкт-Петербург, г. Сестрорецк, 37-й км Приморского шоссе, д. 1, тел.: +7 (812) 246-22-88Раскрытие интересов: отсутствие конфликта интересов, о котором необходимо сообщить
М. М. Костик
Санкт-Петербургский государственный педиатрический медицинский университет; Национальный медицинский исследовательский центр им. В.А. Алмазова
Россия
Раскрытие интересов: получение гонораров за чтение лекций от компаний «Пфайзер», «Эббви», «Новартис», «Оанофи»
Россия
Раскрытие интересов: получение гонораров за чтение лекций от компаний «Пфайзер», «Эббви», «Новартис», «Оанофи»
Список литературы
1. Swedo SE, Leonard HL, Garvey M, et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry. 1998; 155(2):264-271. doi: 10.1176/ajp.155.2.264.
2. Allen AJ, Leonard HL, Swedo SE. Case study: a new infection-triggered, autoimmune subtype of pediatric OCD and Tourette's syndrome. J Am Acad Child Adolesc Psychiatry. 1995;34(3):307-311. doi: 10.1097/00004583-199503000-00015.
3. Snider LA, Seligman LD, Ketchen BR, et al. Tics and problem behaviors in schoolchildren: prevalence, characterization, and associations. Pediatrics. 2002;110(2 Pt 1):331-336. doi: 10.1542/peds.110.2.331.
4. Swedo SE, Leckman JF, Rose NR. From research subgroup to clinical syndrome: modifying the PANDAS criteria to describe PANS (pediatric acute-onset neuropsychiatric syndrome). Pediatr Therapeut. 2012;2:113. doi: 10.4172/2161-0665.1000113.
5. Chang K, Frankovich J, Cooperstock M, et al. Clinical evaluation of youth with pediatric acute-onset neuropsychiatric syndrome (PANS): recommendations from the 2013 PANS Consensus Conference. J Child Adolesc Psychopharmacol. 2015;25(1):3-13. doi: 10.1089/cap.2014.0084.
6. Sindler HS, Gilbert DL, Wolf DS, et al. Moving from PANDAS to CANS. J Pediatr. 2012;160(5):725-731. doi: 10.1016/j.jpeds.2011.11.040.
7. Zibordi F, Zorzi G, Carecchio M, Nardocci N. CANS: Childhood acute neuropsychiatric syndromes. Eur J Paediatr Neurol. 2018; 22(2):316-320. doi: 10.1016/j.ejpn.2018.01.011.
8. Hedderly T, Malik O. Childhood Acute Neuropsychiatric Syndromes ... furthering the discussion PANS and PANDAS. Eur J Paediatr Neurol. 2018;22(2):223-224. doi: 10.1016/j.ejpn.2018.01.022.
9. Murphy ML, Pichichero ME. Prospective identification and treatment of children with pediatric autoimmune neuropsychiatric-disorder associated with group A streptococcal infection (PANDAS). Arch Pediatr Adolesc Med. 2002;156(4):356-361. doi: 10.1001/archpedi.156.4.356.
10. Orlovska S, Vestergaard CH, Bech BH, et al. Association of streptococcal throat infection with mental disorders: testing key aspects of the PANDAS hypothesis in a nationwide study. JAMA Psychiatry. 2017;74(7):740-746. doi: 10.1001/jamapsychiatry.2017.0995.
11. Bernstein GA, Victor AM, Pipal AJ, Williams KA. Comparison of clinical characteristics of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and childhood obsessive-compulsive disorder. J Child Adolesc Psychopharmacol. 2010;20(4):333-340. doi: 10.1089/cap.2010.0034.
12. Murphy TK, Storch EA, Lewin AB, et al. Clinical factors associated with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. Journal of Pediatrics. J Pediatr. 2012;160(2):314-319. doi: 10.1016/j.jpeds.2011.07.012.
13. Leckman JF, King RA, Gilbert DL, et al. Streptococcal upper respiratory tract infections and exacerbations of tic and obsessive-compulsive symptoms: a prospective longitudinal study. J Am Acad Child Adolesc Psychiatry. 2011;50(2):108-118.e3. doi: 10.1016/ j.jaac.2010.10.011.
14. Kurlan R, Johnson D, Kaplan EL; Tourette Syndrome Study Group. Streptococcal infection and exacerbations of childhood tics and obsessive-compulsive symptoms: a prospective blinded cohort study. Pediatrics. 2008;121(6):1188-1197. doi: 10.1542/peds.2007-2657.
15. Toufexis MD, Hommer R, Gerardi DM, et al. Disordered eating and food restrictions in children with PANDAS/PANS. J Child Adolesc Psychopharmacol. 2015;25(1):48-56. doi: 10.1089/cap.2014.0063.
16. Ercan TE, Ercan G, Severge B, et al. Mycoplasma pneumoniae infection and obsessive-compulsive disease: a case report. Journal of child neurology. 2008;23(3):338-340. doi: 10.1177/0883073807308714.
17. Caruso JM, Tung GA, Gascon GG, et al. Persistent preceding focal neurologic deficits in children with chronic Epstein-Barr virus encephalitis. J Child Neurol. 2000;15(12):791-796. doi: 10.1177/088307380001501204.
18. Fallon BA, Kochevar JM, Gaito A, Nields JA. The underdiagnosis of neuropsychiatric Lyme disease in children and adults. Psychiatr Clin North Am. 1998;21(3):693-703, viii. doi: 10.1016/s0193-953x(05)70032-0.
19. Cunningham MW. Molecular mimicry, autoimmunity and infection: the cross-reactive antigens of group a streptococci and their sequelae. Microbiol Spectr. 2019;7(4). doi: 10.1128/microbiolspec.GPP3-0045-2018.
20. Белов Б.С. А-стрептококковая инфекция на рубеже веков // Научно-практическая ревматология. — 2002. — № 1. — С. 29-32. [Belov BS. A-streptokokkovaya infektsiya na rubezhe vekov. Nauchno-prakticheskaya revmatologiya. 2002;(1):29-32. (In Russ).]
21. Staali L, Morgelin M, Bjorck L, Tapper H. Streptococcus pyogenes expressing M and M-like surface proteins are phagocytosed but survive inside human neutrophils. Cell Microbiol. 2003;5(4):253-265. doi: 10.1046/j.1462-5822.2003.00272.x.
22. Hertzen E, Johansson L, Kansal R, et al. Intracellular Streptococcus pyogenes in human macrophages display an altered gene expression profile. PLoS One. 2012;7(4):e35218. doi: 10.1371/journal.pone.0035218.
23. Hertzen E, Johansson L, Wallin R, et al. M1 protein-dependent intracellular trafficking promotes persistence and replication of Streptococcus pyogenes in macrophages. J Innate Immun. 2010; 2(6):534-545. doi: 10.1159/000317635.
24. Bombaci M, Grifantini R, Mora M, et al. Protein array profiling of tic patient sera reveals a broad range and enhanced immune response against Group A Streptococcus antigens. PLoS One. 2009; 4(7):e6332. doi: 10.1371/journal.pone.0006332.
25. Swedo SE. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Molecular Psychiatry. 2002;7:S24-S25. doi: 10.1038/sj.mp.4001170.
26. Kirvan CA, Swedo SE, Kurahara D, Cunningham MW. Streptococcal mimicry and antibody-mediated cell signaling in the pathogenesis of Sydenham's chorea. Autoimmunity. 2006;39(1):21-29. doi: 10.1080/08916930500484757.
27. Ben-Pazi H, Stoner JA, Cunningham MW. Dopamine receptor autoantibodies correlate with symptoms in sydenham's chorea. PLoS One. 2013;8(9):e73516. doi: 10.1371/journal.pone.0073516.
28. Cox CJ, Sharma M, Leckman JF, et al. Brain human monoclonal autoantibody from Sydenham chorea targets dopaminergic neurons in transgenic mice and signals dopamine D2 receptor: Implications in human disease. J Immunol. 2013;191(11):5524-5541. doi: 10.4049/jimmunol.1102592.
29. Hoffman KL, Hornig M, Yaddanapudi K, et al. A murine model for neuropsychiatric disorders associated with group A beta-hemolytic streptococcal infection. J Neurosci. 2004;24(7):1780-1791. doi: 10.1523/JNEUR0SCI.0887-03.2004.
30. Frankovich J, Swedo S, Murphy T, et al. Clinical management of pediatric acute-onset neuropsychiatric syndrome: Part II — use of immunomodulatory therapies J Child Adolesc Psychopharmacol. 2017;27(7):574-593. doi: 10.1089/cap.2016.0148.
31. Kawikova I, Leckman JF, Kronig H, et al. Decreased numbers of regulatory T cells suggest impaired immune tolerance in children with tourette syndrome: a preliminary study. Biol Psychiatry. 2007;61(3):273-278. doi: 10.1016/j.biopsych.2006.06.012.
32. Dileepan T, Smith ED, Knowland D, ,et al. Group A Streptococcus intranasal infection promotes CNS infiltration by streptococcal-specific Th17 cells. J Clin Invest. 2016;126(1):303-317. doi: 10.1172/JCI80792.
33. Krause D, Matz J, Weidinger E, et al. Association between intracellular infectious agents and Tourette's syndrome. Eur Arch Psychiatry Clin Neurosci. 2010;260(4):359-363. doi: 10.1007/s00406-009-0084-3.
34. Muller N, Riedel M, Blendinger C, et al. Mycoplasma pneumoniae infection and Tourette's syndrome. Psychiatry Res. 2004; 129(2):119-125. doi: 10.1016/j.psychres.2004.04.009.
35. Aron AR, Behrens TE, Smith S, et al. Triangulating a cognitive control network using diffusion-weighted magnetic resonance imaging (MRI) and functional MRI. J Neurosci. 2007;27(14): 3743-3752. doi: 10.1523/JNEUR0SCI.0519-07.2007.
36. Graybiel AM. Habits, rituals, and the evaluative brain. Annu Rev Neurosci. 2008;31:359-387. doi: 10.1146/annurev.neuro.29.051605.112851.
37. Hampson M, Tokoglu F, King RA, et al. Brain areas coactivating with motor cortex during chronic motor tics and intentional movements. Biol Psychiatry. 2009;65(7):594-599. doi: 10.1016/j.biopsych.2008.11.012.
38. Peterson B, Riddle MA, Cohen DJ, et al. Reduced basal ganglia volumes in Tourette's syndrome using three-dimensional reconstruction techniques from magnetic resonance images. Neurology. 1993;43(5):941-949. doi: 10.1212/wnl.43.5.941.
39. Bloch MH, Leckman JF, Zhu H, Peterson BS. Caudate volumes in childhood predict symptom severity in adults with Tourette syndrome. Neurology. 2005;65(8):1253-1258. doi: 10.1212/01.wnl.0000180957.98702.69.
40. Sowell ER, Kan E, Yoshii J, et al. Thinning of sensorimotor cortices in children with Tourette syndrome. Nat Neurosci. 2008; 11(6):637-639. doi: 10.1038/nn.2121.
41. Lin H, Williams KA, Katsovich L, et al. Streptococcal upper respiratory tract infections and psychosocial stress predict future tic and obsessive-compulsive symptom severity in children and adolescents with Tourette syndrome and obsessive-compulsive disorder. Biol Psychiatry. 2010;67(7):684-691. doi: 10.1016/j.biopsych.2009.08.020.
42. Orefici G, Cardona F, Cox CJ, Cunnin MW. Pediatric autoimmune neuropsychiatrie disorders associated with streptococcal infections (PANDAS). In: Ferretti JJ, Stevens DL, Fischetti VA, ed. Streptococcus pyogenes: basic biology to clinical manifestations [Internet]. ResearchGate; 2016.
43. Rosario-Campos MC, Leckman JF, Mercadante MT, et al. Adults with early-onset obsessive-compulsive disorder. Am J Psychiatry. 2001;158(11):1899-1903. DOI: 10.1176/appi.ajp.158.11.1899.
44. Geller D.A. Obsessive-compulsive and spectrum disorders in children and adolescents. Psychiatr Clin North Am. 2006;29(2): 353-370. doi: 10.1016/j.psc.2006.02.012.
45. Lanzi G, Zambrino CA, Termine C, et al. Prevalence of tic disorders among primary school students in the city of Pavia, Italy. Arch Dis Child. 2004;89(1):45-47.
46. Kurlan R, Como PG, Miller B, et al. The behavioral spectrum of tic disorders: a community-based study. Neurology. 2002;59(3): 414-420. doi: 10.1212/wnl.59.3.414.
47. Cubo E, Gabriel y Galan JM, Villaverde VA, et al. Prevalence of tics in schoolchildren in central Spain: a population-based study. Pediatr Neurol. 2011;45(2):100-108. doi: 10.1016/j.pediatrneu-rol.2011.03.003.
48. Kurlan R, McDermott MP Deeley C, et al. Prevalence of tics in schoolchildren and association with placement in special education. Neurology. 2001;57(8):1383-1388. doi: 10.1212/wnl.57.8.1383.
49. Gadow KD, Nolan EE, Sprafkin J, Schwartz J. Tics and psychiatric comorbidity in children and adolescents. Dev Med Child Neurol. 2002;44(5):330-338. doi: 10.1017/s0012162201002444.
50. Martino D, Cavanna AE, Robertson MM, Orth M. Prevalence and phenomenology of eye tics in Gilles de la Tourette syndrome. J Neurol. 2012;259(10):2137-2140. doi: 10.1007/s00415-012-6470-1.
51. Murphy TK, Lewin AB, Storch EA, Stock S; American Academy of child and adolescent Psychiatry Committee on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with tic disorders. J Am Acad Child Adolesc Psychiatry. 2013;52(12):1341-1359. doi: 10.1016/j.jaac.2013.09.015.
52. Frankovich J, Thienemann M, Pearlstein J, et al. Multidisciplinary clinic dedicated to treating youth with pediatric acute-onset neuropsychiatric syndrome: presenting characteristics of the first 47 consecutive patients. J Child Adolesc Psychopharmacol. 2015;25(1): 38-47. doi: 10.1089/cap.2014.0081.
53. Cooperstock MS, Swedo SE, Pasternack MS, Murphy TK; PANS/ PANDAS Consortium. Clinical management of pediatric acute-onset neuropsychiatric syndrome: Part III — Treatment and Prevention of Infections. J Child Adolescent Psychopharmacol. 2017;27(7): 594-606. doi.org/10.1089/cap.2016.0151.
54. Белов В.А. Современные методы микробиологической диагностики при острых тонзиллитах и обострении хронических тонзиллитов у детей // Вопросы современной педиатрии. — 2012. — Т. 11. — № 2. — С. 68-71. doi: 10.15690/vsp.v11i2.225.
55. Cardona F, Orefici G. Group A streptococcal infections and tic disorders in an Italian pediatric population. J Pediatr. 2001;138(1): 71-75. doi: 10.1067/mpd.2001.110325.
56. Johnson DR, Kurlan R, Leckman J, Kaplan EL. The human immune response to streptococcal extracellular antigens: clinical, diagnostic, and potential pathogenetic implications. Clin Infect Dis. 2010;50(4):481-490. doi: 10.1086/650167.
57. Singer HS, Mascaro-Blanco A, Alvarez K, et al. Neuronal antibody biomarkers for Sydenham's chorea identify a new group of children with chronic recurrent episodic acute exacerbations of tic and obsessive compulsive symptoms following a streptococcal infection. PLoS One. 2015;10(3):e0120499. doi: 10.1371/journal.pone.0120499.
58. Morris CM, Pardo-Villamizar C, Gause CD, Singer HS. Serum autoantibodies measured by immunofluorescence confirm a failure to differentiate PANDAS and Tourette syndrome from controls. J Neurol Sci. 2009;276(1-2):45-48. doi: 10.1016/j.jns.2008.08.032.
59. Hesselmark E, Bejerot S. Biomarkers for diagnosis of Pediatric Acute Neuropsychiatric Syndrome (PANS) — Sensitivity and specificity of the Cunningham Panel. J Neuroimmunol. 2017;312:31-37. doi: 10.1016/j.jneuroim.2017.09.002.
60. Snider LA, Swedo SE. PANDAS: current status and directions for research. Mol Psychiatry. 2004;9(10):900-907. DOI: 10.1038/sj.mp.4001542.
61. Snider LA, Sachdev V, MacKaronis JE, et al. Echocardiographic findings in the PANDAS subgroup. Pediatrics. 2004;114(6): e748-e751. doi: 10.1542/peds.2004-0308.
62. Frankovich J, Thienemann M, Rana S, et al. Five youth with pediatric acute-onset neuropsychiatric syndrome of differing etiologies. J Child Adolesc Psychopharmacol. 2015;25(1):31-37. doi: 10.1089/cap.2014.0056.
63. Latimer ME, L'Etoile N, Seidlitz J, et al. Therapeutic plasma apheresis as a treatment for 35 severely ill children and adolescents with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. J Child Adolesc Psychopharmacol. 2015;25(1):70-75. doi: 10.1089/cap.2014.0080.
64. Perlmutter SJ, Leitman SF, Garvey MA, et al. Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood. Lancet. 1999;354(9185):1153-1158. doi: 10.1016/S0140-6736(98)12297-3.
65. Thienemann M, Murphy T, Leckman J, et al. Clinical management of pediatric acute-onset neuropsychiatric syndrome: part I — Psychiatric and behavioral interventions J Child Adolesc Psychopharmacol. 2017;27(7):566-573. doi: 10.1089/cap.2016.0145.
66. Sigra S, Hesselmark E, Bejerot S. Treatment of PANDAS and PANS: a systematic review. Neurosci Biobehav Rev. 2018;86:51-65. doi: 10.1016/j.neubiorev.2018.01.001.
67. Calaprice D, Tona J, Murphy TK. Treatment of pediatric acute-onset neuropsychiatric disorder in a large survey population. J Child Adolesc Psychopharmacol. 2018;28(2):92-103. doi: 10.1089/cap.2017.0101.
68. Shulman ST, Bisno AL, Clegg HW, et al. Executive summary: clinical practice guideline for the diagnosis and management of group a streptococcal pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2012;55(10): 1279-1282. doi: 10.1093/cid/cis847.
69. Snider LA, Lougee L, Slattery M, et al. Antibiotic prophylaxis with azithromycin or penicillin for childhood-onset neuropsychiatric disorders. Biol Psychiatry. 2005 Apr 1;57(7):788-792. doi: 10.1016/j.biopsych.2004.12.035.
70. Garvey MA, Perlmutter SJ, Allen AJ, et al. A pilot study of penicillin prophylaxis for neuropsychiatric exacerbations triggered by streptococcal infections. Biol Psychiatry. 1999;45(12):1564-1571. doi: 10.1016/s0006-3223(99)00020-7.
71. Murphy TK, Brennan EM, Johnco C, et al. A double-blind randomized placebo-controlled pilot study of azithromycin in youth with acute-onset obsessive-compulsive disorder. J Child Adolesc Psychopharmacol. 2017;27(7):640-651. doi: 10.1089/cap.2016.0190.
72. Lotan D, Cunningham M, Joel D. Antibiotic treatment attenuates behavioral and neurochemical changes induced by exposure of rats to group a streptococcal antigen. PLoS One. 2014;9(6):e101257. doi: 10.1371/journal.pone.0101257.
73. Gerber MA, Baltimore RS, Eaton CB, et al. Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis. Circulation. 2009;119(11):1541-1551. doi: 10.1161/CIRCULATIONAHA.109.191959.
74. Nicolson R, Swedo SE, Lenane M, et al. An open trial of plasma exchange in childhood-onset obsessive-compulsive disorder without poststreptococcal exacerbations. J Am Acad Child Adolesc Psychiatry. 2000;39(10):1313-1315. doi: 10.1097/00004583-200010000-00020.
75. Williams KA, Swedo SE, Farmer CA, et al. Randomized, controlled trial of intravenous immunoglobulin for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. J Am Acad Child Adolesc Psychiatry. 2016;55(10):860-867.e2. doi: 10.1016/j.jaac.2016.06.017.
76. Hoekstra PJ, Minderaa RB, Kallenberg CG. Lack of effect of intravenous immunoglobulins on tics: a double-blind placebo-controlled study. J Clin Psychiatry. 2004;65(4):537-542. doi: 10.4088/jcp.v65n0413.
77. Brown KD, Farmer C, Freeman GM, et al. Effect of early and prophylactic nonsteroidal anti-inflammatory drugs on flare duration in pediatric acute-onset neuropsychiatric syndrome: an observational study of patients followed by an academic community-based pediatric acute-onset neuropsychiatric syndrome clinic. J Child Adolesc Psychopharmacol. 2017;27(7):619-628. doi: 10.1089/cap.2016.0193.
78. Brown K, Farmer C, Farhadian B, et al. Pediatric acute-onset neuropsychiatric syndrome response to Oral corticosteroid bursts: an observational study of patients in an academic community-based PANS clinic. J Child Adolesc Psychopharmacol. 2017;27(7): 629-639. doi: 10.1089/cap.2016.0139.
79. Murphy TK, Lewin AB, Parker-Athill EC, et al. Tonsillectomies and adenoidectomies do not prevent the onset of pediatric autoimmune neuropsychiatric disorder associated with group A streptococcus. Pediatr Infect Dis J. 2013;32(8):834-838. doi: 10.1097/INF.0b013e31829062e2.
80. Pavone P Rapisarda V, Serra A, et al. Pediatric autoimmune neuropsychiatric disorder associated with group a streptococcal infection: the role of surgical treatment. Int J Immunopathol Pharmacol. 2014;27(3):371-378. doi: 10.1177/039463201402700307.
81. Demesh D, Virbalas JM, Bent JP. The role of tonsillectomy in the treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). JAMA Otolaryngol Head Neck Surg. 2015;141(3):272-275. doi: 10.1001/jamaoto.2014.3407.
82. Nadeau JM, Jordan C, Selles RR, et al. A pilot trial of cognitive-behavioral therapy augmentation of antibiotic treatment in youth with pediatric acute-onset neuropsychiatric syndrome-related obsessive-compulsive disorder. J Child Adolesc Psychopharmacol. 2015; 25(4):337-343. doi: 10.1089/cap.2014.0149.
83. Tellier S, Dallocchio A, Guigonis V, et al. Harambat mycophe-nolic acid pharmacokinetics and relapse in children with steroid-dependent idiopathic nephrotic syndrome. Clin J Am Soc Nephrol. 2016;11(10):1777-1782. doi: 10.2215/CJN.00320116.
84. Woillard JB, Bader-Meunier B, Salomon R, et al. Pharmacokinetics of mycophenolate mofetil in children with lupus and clinical findings in favour of therapeutic drug monitoring. Br J Clin Pharmacol. 2014; 78(4):867-876. doi: 10.1111/bcp.12392.
85. Spartz E, Freeman GM, Brown KD, et al. Course of neuropsychiatric symptoms after introduction or removal of non-steroidal anti-inflammatory drugs: A pediatric observational study. J Child Adolesc Psychopharmacol. 2017;27(7):652-659. doi: 10.1089/cap.2016.0179.
86. Neuwelt CM: The role of plasmapheresis in the treatment of severe central nervous system neuropsychiatric systemic lupus erythematosus. Ther Apher Dial. 2003;7(2):173-182. doi: 10.1046/j.1526-0968.2003.00032.x.
87. Hesselmark E, Bejerot S. Clinical features of paediatric acute-onset neuropsychiatric syndrome: findings from a case-control study. BJPsych Open. 2019;5(2):e25. doi: 10.1192/bjo.2019.10.
88. Perrin EM, Murphy ML, Casey JR, et al. Does group A beta-hemolytic streptococcal infection increase risk for behavioral and neuropsychiatric symptoms in children? Arch Pediatr Adolesc Med. 2004;158(9):848-856. doi: 10.1001/archpedi.158.9.848.
89. Kurlan R, Johnson D, Kaplan EL; Tourette Syndrome Study Group. Streptococcal infection and exacerbations of childhood tics and obsessive-compulsive symptoms: a prospective blinded cohort study. Pediatrics. 2008;121(6):1188-1197. doi: 10.1542/peds.2007-2657.
90. Tromba V, Spalice A, Tancredi G, et al. Restless legs syndrome as an atypical case of PANDAS? Austin J Clin Med. 2017; 4(1):1030.
91. DiFazio MP Morales J, Davis R. Acute myoclonus secondary to group A beta-hemolytic streptococcus infection: a PANDAS variant. J Child Neurol. 1998;13(10):516-518. doi: 10.1177/088307389801301010.
92. Gilbert DL, Mink JW, Singer HS. A Pediatric neurology perspective on pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection and pediatric acute-onset neuropsychiatric syndrome. J Pediatr. 2018;199:243-251. doi: 10.1016/j.jpeds.2018.04.035.
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Для цитирования:
Костик И.А., Костик М.М. Современные подходы к диагностике и лечению PANS/PANDAS. Вопросы современной педиатрии. 2019;18(5):324-338. https://doi.org/10.15690/vsp.v18i5.2055
For citation:
Kostik I.A., Kostik M.M. Current Approaches to PANS/PANDAS Diagnostics and Management. Current Pediatrics. 2019;18(5):324-338. (In Russ.) https://doi.org/10.15690/vsp.v18i5.2055
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