Dr. Kumar’s Take:
This observational study from the Stanford PANS Clinic looked at how children with PANS or PANDAS did when their flares were treated with oral corticosteroids. Treated flares were shorter than untreated ones, the advantage held after the authors controlled for a long list of confounders, and starting steroids earlier in a flare was associated with shorter flares. Longer courses were associated with a more enduring period of symptom improvement. This is observational data, not a trial, so I read it as a reason to have the conversation with your child’s clinician rather than proof of efficacy. The authors themselves say a double-blind placebo-controlled trial is warranted, and I agree.
Key Takeaways:
✔ Flares treated with oral corticosteroids were shorter than untreated flares.
✔ Earlier use of corticosteroids was associated with shorter flare durations.
✔ Longer courses were associated with a more enduring impact on symptom improvement.
✔ This is an observational study, so it shows association, not proven efficacy.
Actionable tip:
If your child is in a severe PANS flare, ask the treating clinician whether a course of oral corticosteroids fits the situation. In this study, the timing mattered: steroids given earlier in a flare were associated with shorter flares.
Brief Summary:
This observational study from the Stanford PANS Clinic followed 98 children who met PANS or PANDAS criteria and had either a single episode or a relapsing/remitting course. Those children collectively experienced 403 flares. Eighty-five of those flares were treated with a total of 102 courses of oral corticosteroids, either short (4 to 5 days) or long (5 days to 8 weeks). Flares treated with corticosteroids were shorter than flares that were not treated, and the difference persisted after the authors controlled for a range of confounding variables.
Study Design:
- Type: Observational study of consecutive patients
- Setting: Stanford PANS Clinic and Research Program, Lucile Packard Children’s Hospital
- Screening: Of the consecutive patients seen, 98 met PANS or PANDAS criteria with a single episode or relapsing/remitting course
- Data: 403 flares total; 85 flares treated with 102 oral corticosteroid courses
- Course length: Short bursts of 4 to 5 days, long bursts of 5 days to 8 weeks
- Outcome assessment: Within 14 days of starting a short burst and at the end of a long burst, based on clinician documentation and patient questionnaires
- Time Frame: September 1, 2012 to January 15, 2016
- Analysis: Multilevel random-effects models
Results:
- Shorter flares: Flares treated with oral corticosteroids lasted 6.4 ± 5.0 weeks versus 11.4 ± 8.6 weeks when untreated (p < 0.001)
- Held after adjustment: The difference remained after controlling for age at flare, weeks since onset of PANS illness, sex, antibiotic treatment, prophylactic antibiotics, previous immunomodulatory treatment, maintenance anti-inflammatory therapy, psychiatric medications, and cognitive behavioral therapy (p < 0.01)
- First episode: When corticosteroids were given for the initial PANS episode, flares tended to be shorter, 10.3 ± 5.7 weeks versus 16.5 ± 9.6 weeks (p = 0.06), and the difference was statistically significant after controlling for the same confounders (p < 0.01)
- Timing: Earlier use of corticosteroids was associated with shorter flare durations (p < 0.001)
- Course length: Longer courses were associated with a more enduring impact on the duration of neuropsychiatric symptom improvement (p = 0.014)
How Corticosteroids Might Help in PANS
The working model behind this treatment is immunologic. The authors describe an abnormal immune response to infection, with subsequent neuroinflammation, as the postulated etiologic mechanism in PANS. Corticosteroids act broadly against inflammation and dampen immune activation, which is the rationale for using them during a flare. This study tested the clinical result, shorter flares, rather than the mechanism itself.
Related Studies and Research
Tonsillectomy as a Treatment for PANDAS: Reviews the potential role of tonsil removal in reducing symptoms.
Azithromycin for PANS-Related OCD: Evaluates the role of azithromycin in treating obsessive-compulsive symptoms.
IVIG for PANDAS: Pediatric OCD Trial: Reviews IVIG’s effectiveness in a randomized trial.
Podcast: Could Your Child’s Behavior Changes Be Cured with an Antibiotic?: A deep dive into the link between strep infections and dramatic neuropsychiatric symptoms.
Frequently Asked Questions
What is PANS?
PANS stands for Pediatric Acute-Onset Neuropsychiatric Syndrome. It is defined by sudden-onset severe obsessive-compulsive symptoms and/or severely restrictive food intake, along with at least two coinciding, similarly debilitating neuropsychiatric symptoms.
Is this the same as PANDAS?
PANDAS is the label used when the syndrome is associated with group A Streptococcus: pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections.
Are steroids safe for kids with PANS?
That decision belongs with an experienced clinician who can weigh your child’s history against the known risks of corticosteroids. This study was designed to measure flare duration and symptom improvement, and the authors call for a double-blind placebo-controlled trial to formally assess treatment efficacy.
When is the best time to start steroids?
Earlier appears to be better. In this study, earlier use of corticosteroids during a flare was associated with shorter flare durations.
Are steroids a cure for PANS?
No. Most patients in this population have a relapsing-remitting course. The authors frame corticosteroids as a treatment that may hasten symptom improvement or resolution during a flare, not as a cure.
Conclusion
This Stanford study offers observational evidence that oral corticosteroids may be a helpful intervention in new-onset and relapsing/remitting PANS and PANDAS, hastening symptom improvement or resolution. Giving them earlier in a flare was associated with faster improvement and earlier clinical remission, and longer courses were associated with more durable remissions.
I would treat this as a reason for families and clinicians to discuss the option carefully, not as settled evidence. The authors’ own conclusion is that a double-blind placebo-controlled clinical trial of corticosteroids in PANS is warranted to formally assess treatment efficacy.
