It may be that these children were already genetically prone to OCD or tic disorders. It seems to occur more in children before puberty. Characteristically, there is a sudden, “overnight” onset of symptoms. Besides classic obsessive-compulsive behaviors or tics, children with PANDAS may exhibit choreiform movements, irritability, hyperactivity, severe nightmares, separation anxiety, daytime urinary urgency without associated UTI signs, and age regression.

The mechanism of action is unknown but may be related to autoimmune antibodies or a toxin affecting the basal ganglia. Treatment of the GABHS infection seems to result in a decrease or resolution of symptoms for most. Exacerbations of symptoms may be from re-infections with GABHS (which can be subclinical).

I could not find any good data about the incidence/prevalence of PANDAS.

On February 19th, the U.S. Food and Drug Administration “approved a humanitarian device exemption for the first implantable device that delivers intermittent electrical therapy deep within the brain to suppress the symptoms associated with severe obsessive-compulsive disorder (OCD).”

Essentially, it is a pacemaker-like device that is implanted under the skin with four electrodes leading into areas of the brain. Such treatment has been used for movement disorders and likely modulates neural circuits that are hyperactive. This would be the first device for OCD. It is made by Medtronic, Inc. and is called the Reclaim Deep Brain Stimulator.

This type of treatment will likely be reserved for a small group of treatment-resistant individuals. According to Dr. Daniel Schultz, Director of the Center for Devices and Radiological Health, “Deep brain stimulation using the Reclaim system may provide some relief to certain patients with severe obsessive compulsive disorder who have not responded to conventional therapy. However, Reclaim is not a cure for OCD. Individual results will vary and patients implanted with the device are likely to continue to have some mild to moderate impairment in functioning and continue to require medications.”

Hopefully, this will prove to be more effective than the Vagus Nerve Stimulator treatment for depression.

We live in fascinating times.