Male1: The term we use in pediatric is occasionally PANDAS?
Male2: Yes, PANDAS is a disorder that is related to streptococcal diseases that causes psychiatric problems and tics or chorea tic-like things and it is a little bit related to what we talked about at the beginning in terms of chorea with strep.
The problem with PANDAS is that I think it is pretty clear or at least I believe that strep infections can aggravate tics. Whether you have the predisposition to tics before or not is unclear. I think you already do and it has nothing really to do with it.
Whether PANDAS is a real disease, it is still unclear.
Male1: Some people actually treat this?
Male2: Right and it really should not--
Male1: With high dose steroids, I heard.
Male2: There are a lot of treatments for it and a lot of people are treating it with steroids and gamma globulins, chronic penicillin.
Male1: Do they work?
Male2: Well, one we still do not really know if it exists as a disorder and two, there is absolutely no evidence to treat it because we do not even know if it exists. And there is a study that is being done now and the results are not out even to determine whether it actually exist, whether that will be successful or not to tell us is unclear. That study started about five years ago, so we should be getting some results relatively, so—
Male1: Do patient sometimes get better by themselves?
Male2: Well, if there is such a thing—
Male1: If it is, they get better and it is made under the therapy that is working out?
Male2: Well, first of all, we are not sure it is a real disease and let us say it is a real disease. Let us say it is a real constellation of symptoms that happen after strep. We do not know what the course of it is, but as I said, we are not even sure it is a real disease, so I think treatment is a step. It is kind of a—
Male1: There is even some indication by some people, I think someone in Rhode Island thought that strep causes some cases of OCD, is that true?
Male2: Well, that is the whole part of PANDAS that some people think that OCD and tics are actually triggered by the strep infection and I do not think there is a whole lot of evidence for it, so that is why people are looking into this right now.
I think the reality of it is, we do not know if these are real disease entities. There is very little evidence right now that tells us for sure that it is, and so what we are left with is if a child has tics, if they need treatment, we treat them. If a child has severe OCD that requires treatment, we treat that, and I do not think there is any real reason to call it a certain disease. It is really not treated as a disease right now from what we know. That is a step that is really ongoing.
Male1: So, it is an ongoing evolution to either it is going to be or not to be, but you are certainly trying to help whatever the symptoms are.
Male2: I treat the symptoms because we do not know. To label something we do not even know if it exists as a disease I think is a stretch and then to treat a disease that we do not really know is a disease is a stretch too, and we are going to—think people will find out whether PANDAS really exist or not, I think, maybe not. It may be hard to figure that out and so I think until we really know and if we do not know, is we treat the symptoms.
Male1: Because if you do an internet search, you will find so much stuff on this and then if you really look at very carefully, the people are saying it are not even experts.
Male2: Correct, and I think one has to be very wary about treating something that we are not sure is even a disease.
Male1: But like anything, you have to trust who you are going to, I hope you get it evaluated by an expert in neurology or some related field, is that true?
Male2: I think, it is, PANDAS—you see what happens is, children that have things like PANDAS or part of the symptom complex, they are very vague and they can have other things and sometimes, parents are desperate because their child may not be functioning well in school or doing well and they will go find someone and they will say, listen, I think this is PANDAS and I will give you this and so it is something compelling, but one has to be very careful about this—
Male1: You should be very careful about using psychotropic drugs?
Male2: Right, I think if one uses psychotropic drugs, one has to be sure that you are using it for a real reason. And there has to be a diagnosis—it cannot be PANDAS. It has to be—if one says that if a child has OCD to the point where it is so severe that the child does not function, they are so obsessive compulsive and behavioral and psychiatric intervention does not work, there is a role for medication, so you treat those symptoms. You do not treat PANDAS.
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