Doctors Diagnose Girl Who Sneezes 12,000 Times

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Lauren Johnson, the 12-year old Virginia girl who sneezes 12,000 times a day has finally gotten an official diagnosis from her doctors. The condition is called Pediatric Neuropsychiatric Disorder Associated with Streptococcus, abbreviated as PANDAS.

PANDAS is a term that describes a subset of children who have obsessive compulsive disorder (OCD) or tic disorders such as Tourette’s syndrome. The symptoms worsen immediately following an infection from the bacteria streptococcus.

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Researchers first described the condition in the American Journal of Psychiatry in 1998.

Symptoms of the condition include motor or vocal tics, obsessions, and/or compulsive behavior. Children may also become irritable, have sleep disturbances, separation anxiety and fine and gross motor changes, such as changes in handwriting. The mechanism of onset is unclear, but researchers at NIMH are pursuing a theory that it is similar to that of Rheumatic Fever, an autoimmune disorder also triggered by strep. Instead of producing antibodies to combat an incoming pathogen, the body mistakenly attacks other body functions such as certain parts of the brain, setting off abnormal movements and actions.

The diagnosis was difficult for doctors because there is currently not a lab test for PANDAS. Physicians use a set of five clinical diagnostic criteria to make the diagnosis, which include presence of OCD or tic disorder, pediatric onset of symptoms, episodic course of symptom severity (meaning symptoms are consistent and do not come and go), association with group A Beta-hemolytic streptococcal infection (GABHS), and association with neurological abnormalities, such as motoric hyperactivity.

Treatment for children with PANDAS is the same as for other OCD or tic disorders. They benefit from cognitive behavioral therapy and anti-obsessional medications, such as an SSRI. Antibiotics may treat the bacterial infection, but are not helpful in treating the PANDAS symptoms.

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