A CASE REPORT OF TOURETTE'S DISORDER WITH ADHD SYMPTOMS PANDAS VARIANT

PANDAS is an acronym for Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection in which Group-A beta hemolytic Streptococci infection (GABHS) triggers the abrupt onset or exacerbation of tics (tourette's disorder), obsessive-compulsive behavior, hyperactivity, impulsivity or inattentivity. Pathophysiologically, by molecular mimicry, a postulated autoimmune mechanism, anti-bodies are formed against the inciting agent and subsequently attack neurons because of some structural similarity. Longitudinal studies suggest that a recent exposure to GABHS might be a risk factor for the onset of tics and OCD and(or) ADHD symptoms. Specific diagnostic criteria for PANDAS has been described, including the presence of tics and(or) OCD symptoms with pre-pubertal onset, episodic course with sudden or explosive onset and(or) exacerbation and remission, and a temporal relationship of GABHS infection and neuropsychiatric symptoms.