2020 Guidelines for Autoimmune Encephalitis in Children Including PANS Diagnosis

A subcommittee of the Autoimmune Encephalitis International Working Group developed new guidelines for recognizing autoimmune encephalitis that includes PANS in children.

A subcommittee of the Autoimmune Encephalitis International Working Group developed new guidelines for recognizing autoimmune encephalitis that includes PANS in children.

PANDAS/PANS is a form of Autoimmune Encephalitis (AE), but recognizing the disease in children can be challenging because it can look like other diseases, and behavior changes are harder to distinguish in children.

A subcommittee of the Autoimmune Encephalitis International Working Group refined existing guidelines for adults to be used specifically in children. 

Seizures are the most common feature in AE. Behavioral changes, such as repetitive (called stereotypical) behaviors, irritability, hyperactivity and insomnia, tend to be more common in children versus adults with AE.

Children with AE are more likely to present with several different kinds of symptoms that are outside of typical psychiatric diagnoses, whereas adults generally present with grouped symptoms that more closely align with a single disease. 

Consistently worsening symptoms differentiate AE from PANDAS/PANS, in which symptoms get better and then worse in an episodic pattern over several weeks. AE is also marked by a decrease in cognitive abilities, whereas that’s not consistently true for PANDAS/PANS.

The subcommittee talked about the importance of antibody testing but noted that antibody testing is not perfect and is continuing to be developed. Diagnosis should be based on clinical observations and testing.

Clinical approach to the diagnosis of autoimmune encephalitis in the pediatric patient