{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T22:38:17Z","timestamp":1793659097931,"version":"4.5.1"},"reference-count":60,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>The hypothesis that Group A beta-haemolytic Streptococcus (GAS) triggers an autoimmune cascade targeting basal ganglia dopaminergic circuits\u2014producing obsessive\u2013compulsive disorder (OCD), tic disorders, or chorea depending on the receptor subtype involved\u2014is biologically compelling and supported by emerging molecular evidence. Yet PANDAS has remained a diagnostic conundrum since its original description in 1998, with ongoing uncertainty surrounding diagnostic criteria, the interpretation of streptococcal serology, and the distinction from primary neurodevelopmental disorders. This study aimed to review the diagnostic challenges of PANDAS, with focus on streptococcal serology interpretation, advances in dopamine receptor autoantibody biology, the genetic epidemiology of primary tic disorders, and the differential diagnosis of acute neuropsychiatric presentations in children. A structured narrative review was conducted using PubMed, MEDLINE, EMBASE, and the Cochrane Library for publications from 1998 to early 2025 addressing PANDAS, PANS, streptococcal antibodies, childhood movement disorders, autoimmune encephalitis, and the genetics of tic disorders. No currently available biomarker\u2014including ASO, anti-DNase B, anti-basal-ganglia antibodies, or the Cunningham Panel\u2014has demonstrated adequate individual-level diagnostic accuracy for PANDAS. Emerging molecular evidence identifies anti-D1R autoantibodies, acting via G protein-and beta-arrestin-mediated signalling, as candidate biomarkers for PANDAS\/PANS neuropsychiatric phenotypes, and anti-D2R autoantibodies for Sydenham chorea movement phenotypes; independent replication in unselected populations is required. Primary tic disorders carry heritability estimates of 50\u201380% and first-degree familial risk ratios of approximately 18-fold in large population-based cohorts. Prospective blinded studies have not demonstrated a consistent population-level association between GAS infections and tic or OCD exacerbations: PANDAS and PANS remain diagnoses of exclusion. The high background prevalence of both GAS exposure and primary neurodevelopmental disorders in overlapping paediatric age ranges creates conditions for incidental temporal co-occurrence. In the absence of validated molecular biomarkers, diagnostic imprecision carries direct clinical consequences: children may be exposed to treatments with significant risk profiles\u2014including IVIG, plasma exchange, and prolonged antibiotic prophylaxis\u2014while evidence-based therapies are delayed. A stepwise diagnostic approach incorporating the full differential diagnosis is both an epistemological and a patient safety imperative.<\/jats:p>","DOI":"10.3390\/ijms27104612","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T12:06:07Z","timestamp":1779365167000},"page":"4612","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["PANDAS Syndrome: A Narrative Review of the Diagnostic Conundrum in Children with Acute Neuropsychiatric Symptoms"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0092-5604","authenticated-orcid":false,"given":"Carlo Alberto","family":"Cesaroni","sequence":"first","affiliation":[{"name":"Child Neurology and Psychiatry Unit, Mother and Child Department Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"},{"name":"Pediatric Neurophysiology Laboratory, Mother and Child Department, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2730-2791","authenticated-orcid":false,"given":"Giulia","family":"Pisan\u00f2","sequence":"additional","affiliation":[{"name":"Child Neurology and Psychiatry Unit, Mother and Child Department Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8856-9722","authenticated-orcid":false,"given":"Susanna","family":"Rizzi","sequence":"additional","affiliation":[{"name":"Child Neurology and Psychiatry Unit, Mother and Child Department Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1501-0146","authenticated-orcid":false,"given":"Agnese","family":"Pantani","sequence":"additional","affiliation":[{"name":"Child Neurology and Psychiatry Unit, Mother and Child Department Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Frattini","sequence":"additional","affiliation":[{"name":"Child Neurology and Psychiatry Unit, Mother and Child Department Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9321-0952","authenticated-orcid":false,"given":"Carlo","family":"Fusco","sequence":"additional","affiliation":[{"name":"Child Neurology and Psychiatry Unit, Mother and Child Department Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"},{"name":"Pediatric Neurophysiology Laboratory, Mother and Child Department, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/S1473-3099(05)70267-X","article-title":"The Global Burden of Group A Streptococcal Diseases","volume":"5","author":"Carapetis","year":"2005","journal-title":"Lancet Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/B978-0-444-52014-2.00014-8","article-title":"Sydenham\u2019s Chorea","volume":"Volume 100","author":"Cardoso","year":"2011","journal-title":"Handbook of Clinical Neurology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1038\/nm892","article-title":"Mimicry and Autoantibody-Mediated Neuronal Cell Signaling in Sydenham Chorea","volume":"9","author":"Kirvan","year":"2003","journal-title":"Nat. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"7412","DOI":"10.4049\/jimmunol.178.11.7412","article-title":"Tubulin Is a Neuronal Target of Autoantibodies in Sydenham\u2019s Chorea","volume":"178","author":"Kirvan","year":"2007","journal-title":"J. Immunol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1176\/ajp.155.2.264","article-title":"Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections: Clinical Description of the First 50 Cases","volume":"155","author":"Swedo","year":"1998","journal-title":"Am. J. Psychiatry"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1017\/S1461145701002371","article-title":"Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS)","volume":"4","author":"Leonard","year":"2001","journal-title":"Int. J. Neuropsychopharmacol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/j.jpeds.2011.11.040","article-title":"Moving from PANDAS to CANS","volume":"160","author":"Singer","year":"2012","journal-title":"J. Pediatr."},{"key":"ref_8","first-page":"tre-03-167-4158-7","article-title":"Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS): An Evolving Concept","volume":"3","author":"Macerollo","year":"2013","journal-title":"Tremor Other Hyperkinet. Mov."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1542\/peds.2007-2657","article-title":"Streptococcal Infection and Exacerbations of Childhood Tics and Obsessive-Compulsive Symptoms: A Prospective Blinded Cohort Study","volume":"121","author":"Kurlan","year":"2008","journal-title":"Pediatrics"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.jaac.2010.10.011","article-title":"Streptococcal Upper Respiratory Tract Infections and Exacerbations of Tic and Obsessive-Compulsive Symptoms: A Prospective Longitudinal Study","volume":"50","author":"Leckman","year":"2011","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1002\/mds.20052","article-title":"Anti-Basal Ganglia Antibodies in PANDAS","volume":"19","author":"Singer","year":"2004","journal-title":"Mov. Disord."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.jneuroim.2017.09.002","article-title":"Biomarkers for Diagnosis of Pediatric Acute Neuropsychiatric Syndrome (PANS): Sensitivity and Specificity of the Cunningham Panel","volume":"312","author":"Hesselmark","year":"2017","journal-title":"J. Neuroimmunol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1176\/appi.ajp.157.2.281","article-title":"MRI Assessment of Children with Obsessive-Compulsive Disorder or Tics Associated with Streptococcal Infection","volume":"157","author":"Giedd","year":"2000","journal-title":"Am. J. Psychiatry"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"113","DOI":"10.4172\/2161-0665.1000113","article-title":"From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS","volume":"2","author":"Swedo","year":"2012","journal-title":"Pediatr. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1542\/peds.113.4.883","article-title":"The Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS) Etiology for Tics and Obsessive-Compulsive Symptoms: Hypothesis or Entity? Practical Considerations for the Clinician","volume":"113","author":"Kurlan","year":"2004","journal-title":"Pediatrics"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Board of Directors (2025). Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Clinical Report. Pediatrics, 155, e2024070334.","DOI":"10.1542\/peds.2024-070334"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1089\/cap.2014.0084","article-title":"Clinical Evaluation of Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Recommendations from the 2013 PANS Consensus Conference","volume":"25","author":"Chang","year":"2015","journal-title":"J. Child Adolesc. Psychopharmacol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.pediatrneurol.2012.05.002","article-title":"Prevalence of Tic Disorders: A Systematic Review and Meta-Analysis","volume":"47","author":"Knight","year":"2012","journal-title":"Pediatr. Neurol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.jpeds.2018.04.035","article-title":"A Pediatric Neurology Perspective on Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection and Pediatric Acute-Onset Neuropsychiatric Syndrome","volume":"199","author":"Gilbert","year":"2018","journal-title":"J. Pediatr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S0140-6736(03)12162-9","article-title":"The Common Cold","volume":"361","author":"Heikkinen","year":"2003","journal-title":"Lancet"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1128\/CMR.00101-13","article-title":"Disease Manifestations and Pathogenic Mechanisms of Group A Streptococcus","volume":"27","author":"Walker","year":"2014","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1161\/CIRCULATIONAHA.109.191959","article-title":"Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis","volume":"119","author":"Gerber","year":"2009","journal-title":"Circulation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1542\/peds.101.1.86","article-title":"Antistreptolysin O and Anti-Deoxyribonuclease B Titers: Normal Values for Children Ages 2 to 12 in the United States","volume":"101","author":"Kaplan","year":"1998","journal-title":"Pediatrics"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1111\/j.1440-1754.2005.00726.x","article-title":"New Normal Ranges of Antistreptolysin O and Anti-Deoxyribonuclease B Titres for Australian Children","volume":"41","author":"Danchin","year":"2005","journal-title":"J. Paediatr. Child Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1542\/peds.2007-2658","article-title":"Serial Immune Markers Do Not Correlate with Clinical Exacerbations in Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections","volume":"121","author":"Singer","year":"2008","journal-title":"Pediatrics"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1136\/adc.2003.031856","article-title":"Dyskinesias and Associated Psychiatric Disorders Following Streptococcal Infections","volume":"89","author":"Dale","year":"2004","journal-title":"Arch. Dis. Child."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Ben-Pazi, H., Stoner, J.A., and Cunningham, M.W. (2013). Dopamine Receptor Autoantibodies Correlate with Symptoms in Sydenham\u2019s Chorea. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0073516"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e164762","DOI":"10.1172\/jci.insight.164762","article-title":"Dopamine Receptor Autoantibody Signaling in Infectious Sequelae Differentiates Movement versus Neuropsychiatric Disorders","volume":"9","author":"Menendez","year":"2024","journal-title":"JCI Insight"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Chain, J.L., Alvarez, K., Mascaro-Blanco, A., Reim, S., Bentley, R., Hommer, R., Grant, P., Leckman, J.F., Kawikova, I., and Williams, K. (2020). Autoantibody Biomarkers for Basal Ganglia Encephalitis in Sydenham Chorea and Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections. Front. Psychiatry, 11.","DOI":"10.3389\/fpsyt.2020.00564"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.bbi.2024.07.044","article-title":"Elevated Antibody Binding to Striatal Cholinergic Interneurons in Patients with Pediatric Acute-Onset Neuropsychiatric Syndrome","volume":"122","author":"Xu","year":"2024","journal-title":"Brain Behav. Immun."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1038\/s41398-019-0562-y","article-title":"The Cunningham Panel: Concerns Remain","volume":"9","author":"Bejerot","year":"2019","journal-title":"Transl. Psychiatry"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"577138","DOI":"10.1016\/j.jneuroim.2019.577138","article-title":"Evaluation of the Cunningham Panel\u2122 in Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection (PANDAS) and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Changes in Antineuronal Antibody Titers Parallel Changes in Patient Symptoms","volume":"339","author":"Shimasaki","year":"2020","journal-title":"J. Neuroimmunol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1001\/archpsyc.60.4.415","article-title":"Basal Ganglia Volumes in Patients with Gilles de la Tourette Syndrome","volume":"60","author":"Peterson","year":"2003","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1097\/WCO.0000000000000443","article-title":"Autoimmune Encephalitis in Children: Clinical Phenomenology, Therapeutics, and Emerging Challenges","volume":"30","author":"Dale","year":"2017","journal-title":"Curr. Opin. Neurol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/S1474-4422(15)00401-9","article-title":"A Clinical Approach to Diagnosis of Autoimmune Encephalitis","volume":"15","author":"Graus","year":"2016","journal-title":"Lancet Neurol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1007\/978-1-4939-9554-7_32","article-title":"Genetic Studies of Tic Disorders and Tourette Syndrome","volume":"Volume 2011","author":"Qi","year":"2019","journal-title":"Psychiatric Disorders. Methods in Molecular Biology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1001\/jamapsychiatry.2015.0627","article-title":"Familial Risks of Tourette Syndrome and Chronic Tic Disorders: A Population-Based Cohort Study","volume":"72","author":"Isomura","year":"2015","journal-title":"JAMA Psychiatry"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1001\/jamapsychiatry.2014.2656","article-title":"Familial Clustering of Tic Disorders and Obsessive-Compulsive Disorder","volume":"72","author":"Browne","year":"2015","journal-title":"JAMA Psychiatry"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1038\/s41380-019-0532-z","article-title":"A Population-Based Family Clustering Study of Tic-Related Obsessive-Compulsive Disorder","volume":"26","author":"Brander","year":"2021","journal-title":"Mol. Psychiatry"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1806","DOI":"10.1161\/CIR.0000000000000205","article-title":"Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Doppler Echocardiography: A Scientific Statement from the American Heart Association","volume":"131","author":"Gewitz","year":"2015","journal-title":"Circulation"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1007\/s11940-008-0025-x","article-title":"Sydenham\u2019s Chorea","volume":"10","author":"Cardoso","year":"2008","journal-title":"Curr. Treat. Options Neurol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.ejpn.2011.12.005","article-title":"Acute and Chronic Corticosteroid Treatment of Ten Patients with Paralytic Form of Sydenham\u2019s Chorea","volume":"16","author":"Fusco","year":"2012","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1002\/ana.21050","article-title":"Paraneoplastic Anti-N-Methyl-D-Aspartate Receptor Encephalitis Associated with Ovarian Teratoma","volume":"61","author":"Dalmau","year":"2007","journal-title":"Ann. Neurol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/S1474-4422(10)70253-2","article-title":"Clinical Experience and Laboratory Investigations in Patients with Anti-NMDAR Encephalitis","volume":"10","author":"Dalmau","year":"2011","journal-title":"Lancet Neurol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1136\/pgmj.2004.019356","article-title":"Chorea and Related Disorders","volume":"80","author":"Bhidayasiri","year":"2004","journal-title":"Postgrad. Med. J."},{"key":"ref_46","unstructured":"Fernandez-Alvarez, E., and Aicardi, J. (2001). Movement Disorders in Children, Mac Keith Press."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.parkreldis.2017.05.004","article-title":"ADCY5-Related Movement Disorders: Frequency, Disease Course and Phenotypic Variability in a Cohort of Paediatric Patients","volume":"41","author":"Carecchio","year":"2017","journal-title":"Park. Relat. Disord."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.braindev.2013.09.001","article-title":"Novel Phenotype in a Family with Infantile Convulsions and Paroxysmal Choreoathetosis Syndrome and PRRT2 Gene Mutation","volume":"36","author":"Fusco","year":"2014","journal-title":"Brain Dev."},{"key":"ref_49","first-page":"411","article-title":"Growth Hormone Deficiency in a Child with Benign Hereditary Chorea Caused by a De Novo Mutation of the TITF1\/NKX2-1 Gene","volume":"35","author":"Trevisani","year":"2022","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/S1056-4993(18)30163-9","article-title":"The Epidemiology of Obsessive-Compulsive Disorder in Children and Adolescents","volume":"8","author":"Zohar","year":"1999","journal-title":"Child Adolesc. Psychiatr. Clin. N. Am."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1001\/archpedi.158.9.848","article-title":"Does Group A Beta-Hemolytic Streptococcal Infection Increase Risk for Behavioral and Neuropsychiatric Symptoms in Children?","volume":"158","author":"Perrin","year":"2004","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1097\/MOP.0b013e32831db2c4","article-title":"Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococci (PANDAS): Update","volume":"21","author":"Shulman","year":"2009","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1542\/peds.2007-1307","article-title":"Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus: Comparison of Diagnosis and Treatment in the Community and at a Specialty Clinic","volume":"122","author":"Gabbay","year":"2008","journal-title":"Pediatrics"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2076","DOI":"10.1038\/npp.2012.56","article-title":"Behavioral, Pharmacological, and Immunological Abnormalities after Streptococcal Exposure: A Novel Rat Model of Sydenham Chorea and Related Neuropsychiatric Disorders","volume":"37","author":"Brimberg","year":"2012","journal-title":"Neuropsychopharmacology"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1176\/ajp.154.1.110","article-title":"Identification of Children with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections by a Marker Associated with Rheumatic Fever","volume":"154","author":"Swedo","year":"1997","journal-title":"Am. J. Psychiatry"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.jneuroim.2010.08.017","article-title":"Maternal History of Autoimmune Disease in Children Presenting with Tics and\/or Obsessive-Compulsive Disorder","volume":"229","author":"Murphy","year":"2010","journal-title":"J. Neuroimmunol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.neubiorev.2018.01.001","article-title":"Treatment of PANDAS and PANS: A Systematic Review","volume":"86","author":"Sigra","year":"2018","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/j.biopsych.2004.12.035","article-title":"Antibiotic Prophylaxis with Azithromycin or Penicillin for Childhood-Onset Neuropsychiatric Disorders","volume":"57","author":"Snider","year":"2005","journal-title":"Biol. Psychiatry"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1016\/S0140-6736(98)12297-3","article-title":"Therapeutic Plasma Exchange and Intravenous Immunoglobulin for Obsessive-Compulsive Disorder and Tic Disorders in Childhood","volume":"354","author":"Perlmutter","year":"1999","journal-title":"Lancet"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1089\/cap.2017.0042","article-title":"Overview of Treatment of Pediatric Acute-Onset Neuropsychiatric Syndrome","volume":"27","author":"Swedo","year":"2017","journal-title":"J. Child Adolesc. Psychopharmacol."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/10\/4612\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T12:11:06Z","timestamp":1779365466000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/10\/4612"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,21]]},"references-count":60,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["ijms27104612"],"URL":"https:\/\/doi.org\/10.3390\/ijms27104612","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,21]]}}}