Benefits of IVIG in Pediatric Acute-Onset Neuropsychiatric Syndrome (2411)
Citation Manager Formats
Make Comment
See Comments

Abstract
Objective: To test the hypothesis that pediatric acute-onset neuropsychiatric syndrome (PANS) is related to an autoimmune dysfunction, a multi-site study explored intravenous immunoglobulin (IVIG)[Octagam 5%] for treatment.
Background: PANS is a clinical diagnosis in children who have an acute manifestation of varied neuropsychiatric symptoms, including obsessive compulsive disorder (OCD), eating disorders, tics, anxiety, irritability, and problems with attention/concentration. PANS may develop as a result of a post-infectious syndrome. Our hypothesis is that PANS may represent a new form of post-infectious autoimmunity, through molecular mimicry, suggesting a potential mechanism by which the disorder evolves.
Design/Methods: The primary endpoint was evaluation of IVIG efficacy over a period of 6 months/infusions based on mean changes in psychological evaluation scores using 6 validated assessments including the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Secondary endpoints included evaluation of presenting immune/autoimmune panels and key potential biomarkers.
Results: The final cohort consisted of 21 subjects (7 per site) with moderate to severe PANS. The mean age was 10.86 years (range: 4–16 years). Results demonstrated statistically significant reductions in symptoms from baseline to end of treatment (infusion 6) in all 6 assessments measured. CY-BOCS results demonstrated statistically significant reductions in obsessive compulsive symptoms, resulting in > 50% improvement sustained for at least 8 weeks after the final infusion and up to 46 weeks in a subset of subjects.
Conclusions: In PANS, which may be associated with an underlying immune dysregulation, IVIG [Octagam 5%] successfully ameliorated psychological symptoms and dysfunction, with sustained benefits for at least 8 weeks, and up to 46 weeks, following the final infusion. In addition, baseline immune and autoimmune profiles demonstrated significant elevations in a majority of subjects, which requires further evaluation, characterization, and study to clarify the potential immune dysfunction by which PANS manifests and progresses.
Disclosure: Dr. Melamed has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Octapharma, IMMUNOe. Dr. Melamed has received research support from Octapharma, Pharming Group. Dr. Kobayashi has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Octapharma, Shire/Takeda, UCLA. Dr. O’Connor has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Octapharma, Allergy, Asthma & Immunology Relief. Dr. O’Connor has received research support from Octapharma. Dr. Kobayashi has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Octapharma, Midlands Pediatrics. Dr. Kobayashi has received research support from Octapharma. Dr. Schechterman has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Colorado Neurogeriatrics. Dr. Heffron has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with IMMUNOe. Dr. Canterberry has nothing to disclose. Dr. Miranda has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with IMMUNOe. Dr. Rashid has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Dunwoody Consulting.
Letters: Rapid online correspondence
REQUIREMENTS
If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Hemiplegic Migraine Associated With PRRT2 Variations A Clinical and Genetic Study
Dr. Robert Shapiro and Dr. Amynah Pradhan
Related Articles
- No related articles found.