Medical Progress
Moving from PANDAS to CANS

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The Need to Move beyond PANDAS

The concept of PANDAS has been the topic of intense debate and controversy for many years.2, 3, 4, 5, 6, 7, 8 Historically, several reports, some published under the heading pediatric infection triggered autoimmune neuropsychiatric disorders, suggested that a variety of infectious agents could cause acute neuropsychiatric symptoms, including Borrelia burgdorferi, herpes simplex virus, varicella zoster virus, human immunodeficiency virus, Mycoplasma pneumoniae, and the common cold.9, 10, 11, 12

Prepubertal Disorder

In the hallmark description of PANDAS,1 the prepubertal onset criterion was based empirically on the demographics in that case series. This criterion, however, is not specific because typical tic disorders such as TS or early-onset OCD develop in a large proportion of children within this age range. Additionally, this age limit may arbitrarily exclude some late-onset cases, including adults with the sudden onset of OCD after an infectious disorder.42, 43

Presence of a Tic Disorder, OCD, or Both

The sole focus on tics and OCD as the

CANS

Having identified significant limitations to the PANDAS hypothesis, it is suggested that this diagnosis be eliminated. Recognizing, however, that clinicians will continue to encounter children with the acute onset of tics, OCD, and other neuropsychiatric symptoms, establishing a new broader diagnostic category is essential. Our suggested approach adopts a more encompassing concept of acute fulminant neuropsychiatric symptoms, but requires an active search for a specific etiology. The proposed

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    The authors declare no conflicts of interest.

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