The sudden onset of severe behavioral and neuropsychiatric symptoms in children is a frightening and potentially life-changing situation. The pediatric health care providers and clinicians to whom families turn need guidance on how to accurately diagnose and treat new-onset neuropsychiatric symptoms in children. They need expert guidance about whether these symptoms indicate a diagnosis compatible with pediatric acute-onset neuropsychiatric syndrome (PANS). The cause of PANS is unknown, but it is theorized to be triggered, in some cases, by a recent infection and/or autoimmunity issues (similar to Sydenham chorea, autoimmune encephalitis [AE], and Guillain-Barré syndrome). The condition is challenging from a clinical perspective, because it lacks disease-specific biomarkers, strong evidence for pathogenic causes, and consensus on treatment of clinical symptoms. Further, the evidence base for PANS encompasses multiple subspecialties, including child and adolescent psychiatry, pediatric rheumatology, pediatric neurology, pediatric infectious diseases, pediatric immunology, and developmental-behavioral pediatrics.Given this complexity, there is a clear need for guidance and advice for pediatric clinicians and the families they serve and support. To that end, with the encouragement of the Board of Directors, the American Academy of Pediatrics (AAP) has developed this clinical report. It focuses primarily on PANS, an umbrella condition that encompasses pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Although PANDAS is, by definition, associated with streptococcal infection,1 it is now considered by many to represent a subset of the larger spectrum of infection-induced acute-onset neuropsychiatric symptoms.2,3 This clinical report was developed after a comprehensive literature review and analysis of the findings. Because they are limited by the present level of evidence on the topic, the findings are presented as a report rather than a clinical practice guideline. The contents are intended to aid the pediatric health care provider in evaluating, diagnosing, and treating sudden-onset and severe behavioral changes in children that could indicate potential PANS and in supporting these children and their families.

中文翻译：

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儿科急性发作神经精神综合征 （PANS）：临床报告。


儿童突然出现严重的行为和神经精神症状是一种可怕的情况，并且可能会改变生活。家庭求助的儿科医疗保健提供者和临床医生需要有关如何准确诊断和治疗儿童新发神经精神症状的指导。他们需要专家指导，了解这些症状是否表明诊断与小儿急性发作神经精神综合征 （PANS） 相符。PANS 的病因尚不清楚，但理论上在某些情况下，它是由近期感染和/或自身免疫问题（类似于 Sydenham 舞蹈病、自身免疫性脑炎 [AE] 和格林-巴利综合征）触发的。从临床角度来看，这种情况具有挑战性，因为它缺乏疾病特异性生物标志物、致病原因的有力证据以及临床症状治疗的共识。此外，PANS 的证据基础包括多个亚专科，包括儿童和青少年精神病学、儿科风湿病学、儿科神经病学、儿科传染病、儿科免疫学和发育行为儿科。鉴于这种复杂性，显然需要为儿科临床医生及其服务和支持的家庭提供指导和建议。为此，在董事会的鼓励下，美国儿科学会 （AAP） 编写了这份临床报告。它主要关注 PANS，这是一种总括病症，包括与链球菌感染 （PANDAS） 相关的儿科自身免疫性神经精神疾病。尽管根据定义，PANDAS 与链球菌感染有关，1 但现在许多人认为它代表了感染诱导的急性发作神经精神症状的一个子集。2,3 本临床报告是在对结果进行全面的文献回顾和分析后制定的。由于它们受到当前关于该主题的证据水平的限制，因此研究结果以报告而不是临床实践指南的形式呈现。这些内容旨在帮助儿科医疗保健提供者评估、诊断和治疗可能表明潜在 PANS 的儿童突然发作和严重行为变化，并支持这些儿童及其家庭。