BMC Psychiatry (Aug 2022)

Paediatric Acute-onset Neuropsychiatric Syndrome (PANS) and intravenous immunoglobulin (IVIG): comprehensive open-label trial in ten children

  • Parisa Hajjari,
  • Malin Huldt Oldmark,
  • Elisabeth Fernell,
  • Klara Jakobsson,
  • Ingrid Vinsa,
  • Max Thorsson,
  • Mehran Monemi,
  • Lotta Stenlund,
  • Anders Fasth,
  • Catrin Furuhjelm,
  • Jakob Åsberg Johnels,
  • Christopher Gillberg,
  • Mats Johnson

DOI
https://doi.org/10.1186/s12888-022-04181-x
Journal volume & issue
Vol. 22, no. 1
pp. 1 – 13

Abstract

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Abstract Background Treatment with intravenous immunoglobulin (IVIG) in children with Paediatric Acute-onset Neuropsychiatric Syndrome (PANS) has for many years been used on clinical indications, but the research evidence for its efficacy is insufficient. Methods Open-label prospective in-depth trial including ten children (median age 10.3 years) with PANS, who received IVIG treatment 2 g/kg monthly for three months. Primary outcomes were changes in symptom severity and impairment from baseline to first and second follow-up visits one month after first and one month after third treatment, using three investigator-rated scales: Paediatric Acute Neuropsychiatric Symptom (PANS) scale, Clinical Global Impression – Severity and Improvement (CGI-S and CGI-I) scales. Secondary outcomes reported here were changes in Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) scores, and side effects. Results All ten children received three treatments at one-month intervals according to study plan. From baseline to second follow-up marked reductions were seen in mean total PANS scale scores (p = .005), and CGI-S scores (p = .004). CGI-I ratings showed much to very much global improvement (mean CGI-I 1.8). Nine children had clinical response defined as > 30% reduction in PANS Scale scores. Improvements were also noted for CY-BOCS scores (p = .005), and in school attendance. Three children suffered moderate to severe temporary side effects after the first treatment, and the remaining seven had mild to moderate side effects. Side effects were much less severe after second and third treatments. Conclusions Considerable and pervasive improvements in symptoms and clinical impairments were seen in these ten children after three monthly IVIG treatments. Moderate to severe transient side effects occurred in three cases. Trial registration EudraCT no. 2019–004758-27, Clinicaltrials.gov no. NCT04609761, 05/10/2020.

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