Treatment for children suspected of<unk>  is generally the same as the standard treatments for TS and OCD. These include cognitive behavioral therapy and medications to treat OCD such as selective serotonin reuptake inhibitors (SSRIs); and "conventional therapy for tics". When individuals have "persistent or disabling symptoms", Wilbur (2019) et al recommend referral to specialists, treatment of identified acute streptococcal infections according to established guidelines, and immunotherapy only in clinical trials. The use of psychotropic medications for PANS/PANDAS is widespread, although controlled trials were lacking as of 2019. Experimental Prophylactic antibiotic treatments for tics and OCD are experimental and their use is challenged; overdiagnosis of<unk>  may have led to overuse of antibiotics to treat tics or OCD in the absence of active infection. Evidence for antibiotic treatment is inconclusive for PANS,<unk> , PITAND and CANS. Murphy, Kurlan and Leckman (2010) said, "The use of prophylactic antibiotics to treat<unk>  has become widespread in the community, although the evidence supporting their use is equivocal." As of 2019, there is no evidence supporting the use rituximab or mycophenolate mofetil for treating<unk> /PANS. There is inconclusive evidence supporting immunomodulatory therapies (intravenous immunoglobulin (IVIG) or therapeutic plasma exchange (TPE)) for PANS and<unk> ; most studies have methodological issues. IVIG was perceived as effective based on a self-reported survey. Kalra and Swedo wrote in 2009, "Because IVIG and plasma exchange both carry a substantial risk of adverse effects, use of these modalities should be reserved for children with particularly severe symptoms and a clear-cut<unk>  presentation." Studies of experimental treatments for PANS and<unk>  (IVIG, TPE, antibiotics, tonsillectomy, corticosteroids and NSAIDs) are "few and in general have moderate or high risk of bias", according to a Sigra et al review published in 2018, which states: Guidelines Following a 2014 meeting in the US of Swedo and physicians from Stanford University, treatment guidelines for PANS and<unk>  were published in 2017, in three parts. In a 2018 review, Sigra et al said of the 2017 guidelines that treatment consensus was lacking and that results were inconclusive. A 2019 review by Wilbur et al said that evidence for treatment of children with<unk> /PANS is lacking, and remission rates in symptoms after treatment "may represent the natural history of non-PANDAS pediatric OCD cases rather than true treatment effect". The Wilbur et al 2019 review found no evidence to support tonsillectomy or prophylactic antibiotics, recommended standard approved therapies known to be effective for OCD, and cautioned against immunomodulatory therapies except in clinical trials. Gilbert (2019) stated: "Skeptics have concluded that treatment studies do not support antibiotic or immunomodulatory interventions for<unk> . Advocates published treatment guidelines supporting both." The guideline status in the UK is similar. The<unk>  and PANS Physicians Network published guidelines in 2018 on a private healthcare platform, e-hospital. In April 2021, the British Paediatric Neurology Association (BPNA) issued a consensus statement with the Child and Adolescent Psychiatry Faculty of the Royal College of Psychiatrists stating that there is an absence of evidence for recommending immunomodulatory or prophylactic antibiotic treatments. This consensus statement was issued in place of a guideline as the authors stated that there was insufficient evidence for developing a typical guideline. It noted no previous guidelines for<unk>  existed or had been endorsed by official bodies in the UK, including the National Institute for Health and Care Excellence (NICE), and that the 2018 guidelines available at a<unk> /PANS UK charity website and the private platform (e-hospital) had been developed independently of the BPNA. Similarly, the April 2021 treatment guidelines for Nordic countries (Denmark, Norway, Sweden and the UK) do not recommend tonsillectomy, antibiotic prophylaxis, or experimental immunomodulatory therapies outside of a specialist setting. A Swedish review published in 2021 found a moderate potential for adverse effects, and a "very low certainty of evidence of beneficial effects", for treating individuals meeting the research definition of PANS with antibiotics, anti-inflammatory medications, or immunomodulatory agents. The Swedish review states that, "some researchers in the United States, on the basis of an assumption of an underlying neuroinflammation, recommend anti-inflammatory drugs, antibiotics and immunomodulatory treatment in the clinical management of these patients, Swedish national guidelines imply that these treatments shall only be provided within the framework of research and development". The American Academy of Neurology 2011 guidelines say there are "inadequate data to determine the efficacy of plasmapheresis" and "insufficient evidence to support or refute the use of plasmapheresis", for treating OCD and tics "in the setting of<unk> ". The Medical Advisory Board of the Tourette Syndrome Association (now the Tourette Association of America) said in 2006, and reiterated in 2021: The American Heart Association's 2009 guidelines state that they do "not recommend routine laboratory testing for GAS to diagnose, long-term antistreptococcal prophylaxis to prevent, or immunoregulatory therapy (such as intravenous immunoglobulin, plasma exchange) to treat exacerbations of this disorder".
PANDAS
DRACO
THIRRA
SCAN
OCRL
OHVIRA
DEBRA
CoWIN