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BRIEF RESEARCH REPORT article

Front. Behav. Neurosci.
Sec. Pathological Conditions
Volume 18 - 2024 | doi: 10.3389/fnbeh.2024.1342486
This article is part of the Research Topic Pediatric Autoimmune Neuropsychiatric Syndrome View all 4 articles

Cerebrospinal fluid characteristics of patients presenting for evaluation of pediatric acute-neuropsychiatric syndrome

Provisionally accepted
Rajdeep Pooni Rajdeep Pooni 1*Wynne Zheng Wynne Zheng 2Meiqian Ma Meiqian Ma 3Melissa Silverman Melissa Silverman 4Yuhuan Xie Yuhuan Xie 4Bahare Farhadian Bahare Farhadian 5Margo Thienemann Margo Thienemann 4Elizabeth Mellins Elizabeth Mellins 6Jennifer Frankovich Jennifer Frankovich 3
  • 1 Department of Pediatrics, Division of Allergy Immunology and Rheumatology,, School of Medicine, Stanford University, Stanford, United States
  • 2 Stanford Immune Behavioral Health Clinic and Research Program, School of Medicine, Stanford University, Stanford, California, United States
  • 3 Stanford Immune Behavioral Health Clinic and Research Program, Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, School of Medicine, Stanford University, Stanford, California, United States
  • 4 Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford Immune Behavioral Health Clinic and Research Program, School of Medicine, Stanford University, Stanford, California, United States
  • 5 Stanford Immune Behavioral Health Clinic and Research Program, Stanford Healthcare, Stanford, California, United States
  • 6 Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, School of Medicine, Stanford University, Stanford, California, United States

The final, formatted version of the article will be published soon.

    Objectives: This study characterizes cerebral spinal fluid (CSF) indices including total protein, the albumin quotient, IgG index and oligoclonal bands in patients followed at a single center for pediatric acute-neuropsychiatric syndrome (PANS) and other psychiatric/behavioral deteriorations. Methods: In a retrospective chart review of 471 consecutive subjects evaluated for PANS, navigational keyword search of the electronic medical record was used to identify patients who underwent lumbar puncture (LP). Psychiatric symptom data was ascertained from questionnaires and psychiatric evaluations. Inclusion criteria required that subjects presented with psychiatric deterioration at the time of first clinical visit and had a lumbar puncture. Subjects were categorized into three subgroups by diagnosis: PANS, autoimmune encephalitis (AE), and “other neuropsychiatric deterioration” (subacute onset of severe OCD, eating restriction, behavioral regression, psychosis, etc; not meeting criteria for PANS or AE). Results: 71/471 (15.0 %) of patients underwent LP. At least one CSF abnormality was seen in 29% of patients with PANS, 45% of patients with “other neuropsychiatric deterioration”, and 40% of patients who met criteria for autoimmune encephalitis. The most common findings included elevated CSF protein and/or albumin quotient. Elevated IgG index and IgG oligoclonal bands were rare in all three groups. Conclusion: Elevation of CSF protein and albumin quotient were found in pediatric patients undergoing LP for evaluation of severe psychiatric deteriorations (PANS, AE, and other neuropsychiatric deteriorations). Further studies are warranted to investigate blood brain barrier integrity at the onset of the neuropsychiatric deterioration and explore inflammatory mechanisms.

    Keywords: Pediatric acute-onset neuropsychiatric syndrome (PANS), Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections (PANDAS), blood brain barrier, Obsessive-Compulsive Disorder, neuroimmune, autoimmune encephalitis

    Received: 21 Nov 2023; Accepted: 30 Apr 2024.

    Copyright: © 2024 Pooni, Zheng, Ma, Silverman, Xie, Farhadian, Thienemann, Mellins and Frankovich. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Rajdeep Pooni, Department of Pediatrics, Division of Allergy Immunology and Rheumatology,, School of Medicine, Stanford University, Stanford, United States

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