Severe Adult Pandas?

- Response from Miroslav Kovacevic, MD FAAP
Cl. Asst.Professor of Pediatrics
Loyola University Stritch School of Medicine
Lecturer
University of Illinois at Chicago College of Medicine

Dr. Murphy,

I'm a 29 yr. male, diagnosed with TS at 16. Initial OCD/TS symptoms at age 16 were acute in onset, although I did have significant obsessional symptoms, as early as 13. I have had a fairly regular occurrence of Strep A infections, since childhood. These were sometimes found, according to my mother, to be asymptomatic.
Predominant concerns have been pronounced anxiety, including debilitating OCD. For about eight months, up until three weeks ago, I was doing well, upon initiation of memantine treatment, receiving ~90% in first year, university biology.

Four weeks ago, however, I got a sore throat. Building up to the third day of throat irritation, my OCD returned in full force. I was treated that day, with Penicillin, which seemed to diminish the symptoms in about four days. I did not manage to complete the full course of treatment. At this time I had heart palpitations, and fainting sensations, that ended in an ER visit. Two weeks, after Penicillin treatment, the sore throat returned, with the TS/OCD and Paranoia. I was promptly treated with a more potent antibiotic, which seemed to clear the sore throat.

At present, two weeks later, the OCD remains. It's tormenting, and incapacitating. Particularily, the compulsion to raise my hands in public to embarass myself. I dread being around people, but feel I will die if I don't force myself to do socially inappropriate things, to show people how depraved I am, for a sense of atonement. Obsessions are religious and symmetrical in nature. Extreme emotional lability; one minute I’m o.k., and the next, quite troubled and depressed.

Reading different lists of PANDAS criteria, I seem to fit the majority of them. Could IVIG treatment be a viable option, in your opinion? I am Canadian, but would go anywhere for treatment.

Thank you




Re: Severe Adult PANDAS case?‏

Even though I am fairly convinced that existence of PANDAS AFTER puberty is VERY likely, there is nothing in medical literature addressing it. However, I have seen several patients AFTER puberty developing anxiety attacks, depressive episodes, extreme moodiness that I was able to connect to Streptococcal autoimmune response. In these patients (I have now a group of FOUR) an excellent response was elicited by use of Augmentin. The problem that I have faced is that I still don't know HOW LONG these patients should remain on Augmentin.