Objective: Individuals with Pediatric Acute Onset Neuropsychiatric Syndrome (PANS) experience neuropsychiatric symptoms following an infection or other trigger. Although PANS is typically described as relapsing-remitting, a large community-based 2017 study revealed a range of courses. The present study examined clinical predictors of symptom persistence, measured as % days symptom-free, in this same sample. Methods: A 146-question online survey gathered histories (infections and other triggers, medical and developmental comorbidities), symptomatology, interventions, and outcomes (including school functioning) of PANS patients. Multivariate analyses were applied to examine associations between these variables and % days symptom-free across the disease course. Results: Among the 646 subjects included, significant relationships were found between greater symptom persistence and higher rates of medical comorbidities (especially rashes, headaches, chronic sinusitis, frequent diarrhea, and immune deficiencies), developmental diagnoses, and respondent-perceived developmental lags. Subjects with greater symptom persistence were significantly more likely to report PANS exacerbations associated with infections in close contacts, vaccinations, environmental triggers, and exacerbations of comorbidities and were more likely to report PANS recurrences triggered by Epstein Barr Virus, mycoplasma, and sinus infections. More persistent PANS was also associated with significantly higher frequencies of certain symptoms (sleep disturbance, urinary incontinence, muscle pain, brain fog, sensory defensiveness, irritability, and aggression-related symptoms), less effectiveness of intravenous immunoglobulin in combating symptoms, and more difficulty attending school. Conclusions: Our results suggest high symptom persistence in PANS to be associated with more pervasive medical and neuropsychiatric symptoms. Differences in symptom persistence are associated with both intrinsic (e.g., immune competence) and extrinsic (e.g., infections, treatment) factors. Because extrinsic factors are potentially modifiable, it is critical that providers be aware of current guidelines on PANS evaluation and treatment.

中文翻译：

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与 PANS 症状持续存在相关的因素：第二部分-呈现特征、医疗合并症和 IVIG 治疗史。

目的：患有小儿急性发作神经精神综合征 (PANS) 的个体在感染或其他触发因素后会出现神经精神症状。尽管 PANS 通常被描述为复发缓解型，但 2017 年一项基于社区的大型研究揭示了一系列的过程。本研究在同一样本中检查了症状持续性的临床预测因素，以无症状天数的百分比来衡量。方法：一项包含 146 个问题的在线调查收集了 PANS 患者的病史（感染和其他诱因、医疗和发育合并症）、症状、干预措施和结果（包括学校功能）。应用多变量分析来检查这些变量与整个病程中无症状天数％之间的关联。结果：在纳入的 646 名受试者中，发现症状持续时间较长与合并症（尤其是皮疹、头痛、慢性鼻窦炎、频繁腹泻和免疫缺陷）、发育诊断和受访者感知的发育滞后发生率较高之间存在显着关系。症状持续时间较长的受试者明显更有可能报告与密切接触者感染、疫苗接种、环境触发因素和合并症恶化相关的 PANS 恶化，并且更有可能报告由 Epstein Barr 病毒、支原体和鼻窦感染引发的 PANS 复发。更持久的 PANS 还与某些症状（睡眠障碍、尿失禁、肌肉疼痛、脑雾、感觉防御、易怒和攻击性相关症状）的出现频率显着升高相关，静脉注射免疫球蛋白对抗症状的效果较差，并且难度更大。上学。结论：我们的结果表明 PANS 的高症状持续性与更普遍的医学和神经精神症状相关。症状持续时间的差异与内在因素（例如免疫能力）和外在因素（例如感染、治疗）有关。由于外在因素可能是可以改变的，因此提供者了解有关 PANS 评估和治疗的现行指南至关重要。