PANDAS Plus Autism: Treatment with IVIg

Abstract

Bouboulis and Mast (1) note sustained benefit of anti-infective therapy followed by intravenous immune globulin (IVIg) when the latter is administered for several months to a year or more in their review of a cohort of six patients with PANDAS and humoral immunodeficiency, including two children with autism. Despite past controversy in the epidemiologic rigor surrounding PANDAS, there has been progress in the understanding of this post-infectious autoimmune disorder that led up to the present therapeutic approach employing immune modulatory therapy. Early serologic investigations (2-4) suggested a causal relation of Group A b-hemolytic streptococcus (GABHS) infection to PANDAS, however it was a fortuitous leap of faith that the insult would be immune-mediated similar to Sydenham chorea (SC). Anti-streptolysin (ASO) antibodies distinguished cases of PANDAS versus non-cases providing evidence of antecedent streptococcal infection with higher sustained titers and slower rates of decline in the antibody rise due to the more potent immune response that was noted to be associated with repeated GABHS infection.