Selecting a Treatment Regimen
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS)
PANDAS is defined as the abrupt onset or exacerbation of a tic or obsessive- compulsive disorder (OCD) in prepubertal children, considered to be triggered by a Group A β-hemolytic streptococcal infection, but there is controversy in the medical community regarding this syndrome as a disease entity.
ÎThere is insufficient evidence to support or refute the use of plasmapheresis in the treatment of acute OCD and tic symptoms in the setting of PANDAS (Level U).
Sydenham Chorea
ÎThere is insufficient evidence to support or refute the use of plasmapheresis in the treatment of Sydenham chorea (Level U).
Table 1. Summary of Evidence Disease
Acute Inflammatory Demyelinating Polyneuropathy/Guillain-Barré Syndrome
Chronic Inflammatory Demyelinating Polyneuropathy, short-term treatment
Conclusion Established effective Established effective
Probably effective Probably ineffective
Quality Class I
Class I
Polyneuropathy with monoclonal gammopathies of undetermined significance IgA/IgG IgM
Class I Class I
Myasthenia Gravis Pre-op Preparation Crisis
Fulminant Demyelinating CNS Disease Chronic Progressive MS Relapses in MS
Sydenham Chorea Acute OCD and Tics in PANDAS
Insufficient evidence Class III Insufficient evidence Class III Possibly effective
Class II
Established ineffective Class I Probably effective
Class I
Insufficient evidence Class III Insufficient evidence Class III
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