Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS): Current Concepts, Challenges, and Controversies

Abstract

Introduction: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) constitute a controversial pediatric neuropsychiatric syndrome characterized by the acute onset of obsessive–compulsive disorder and/or tic disorders temporally associated with group A β-hemolytic streptococcal infection. Despite increasing clinical and research interest, the diagnosis and management of PANDAS remain challenging due to heterogeneous clinical presentation, absence of specific biomarkers, and lack of universally accepted diagnostic and therapeutic guidelines.

Materials and methods: This narrative review synthesizes current evidence regarding the definition, epidemiology, pathophysiology, clinical manifestations, and treatment strategies of PANDAS. A critical analysis of the literature was conducted to highlight diagnostic frameworks, proposed immune-mediated mechanisms, therapeutic approaches, and areas of ongoing controversy, with particular attention to methodological limitations affecting clinical interpretation.

Conclusions: Available data support the concept of PANDAS as a post-infectious, immune-mediated neuropsychiatric condition involving basal ganglia dysfunction and neuroinflammatory processes; however, evidence remains inconsistent and insufficient to establish standardized diagnostic or treatment algorithms. Therapeutic interventions demonstrate variable efficacy, largely limited by heterogeneous study designs and small sample sizes. Continued interdisciplinary research focusing on refined phenotypic characterization, biomarker identification, and well-designed prospective studies is essential to clarify disease mechanisms and improve clinical management.