A full agreement on the hierarchy of each therapeutical intervention is missing owing to the limited number of randomized controlled trials. Our review highlights the need for a comprehensive algorithm to help both patients during their acute distressing phase and physicians during their treatment decision. Interestingly, differentiating PANS from either autoimmune encephalitides and Sydenham’s chorea or from alleged “pure” psychiatric disorders (OCD, tics, Tourette’s syndrome), reveals several overlaps and more analogies than differences. Expert opinions are converging on PANS as the effect of post-infectious events or stressors leading to “brain inflammation”, as it is well-established for anti-neuronal psychosis. Among a total of 1005 articles, 205 were pertinent to study inclusion. Relevant literature was obtained from PubMed database which included only English-written, full-text clinical studies, case reports, and reviews. We also summarized recent points to facilitate practitioners with the disease management. This narrative review focused on recent clinical (ie, diagnostic criteria, pre-existing neurodevelopmental disorders, neuroimaging) and pathophysiological (ie, CSF, serum, genetic and autoimmune findings) aspects of PANS. An immune-mediated etiology is advocated in which the CNS is hit by different pathogen-driven (auto)immune responses. Pediatric acute-onset neuropsychiatric syndrome (PANS) features a heterogeneous constellation of acute obsessive-compulsive disorder (OCD), eating restriction, cognitive, behavioral and/or affective symptoms, often followed by a chronic course with cognitive deterioration.
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