OBJECTIVES: 'Pediatric Autoimmune Neuropsychiatric Disorders Associated with 
Streptococcal Infections' (PANDAS) identified a unique subgroup of patients with 
abrupt onset of obsessive compulsive disorder (OCD) symptoms clinically related 
to Streptococcus infection and accompanied by neuropsychological and motor 
symptoms. After almost 20 years, PANDAS has not been accepted as distinct 
disorder and new criteria for paediatric acute-onset neuropsychiatric syndrome 
(PANS) have been replaced it, highlighting the fact that several agents rather 
than only Streptococcus might be involved.
METHODS: Extensive review of the PANDAS/PANS literature was performed on PubMed.
RESULTS: Although antibiotics have been reported to be effective for acute and 
prophylactic phases in several uncontrolled studies and non-steroidal 
anti-inflammatory drugs (NSAID) are used during exacerbations, clinical 
multicenter trials are still missing. Selective serotonin reuptake inhibitors 
(SSRIs) and cognitive behavioural therapy (CBT) are still the first line of 
recommendation for acute onset OCD spectrum. Immunological therapies should be 
restricted to a few cases.
CONCLUSIONS: While PANDAS has found no confirmation as a distinct syndrome, and 
it is not presented in DSM-5, patients with acute onset OCD spectrum, 
neurocognitive and motor symptoms should be evaluated for inflammatory, 
infective, immunological and metabolic abnormalities with a comprehensive 
diagnostic algorithm.