Steroid treatment response to post SARS-CoV-2 PANS symptoms: Case series

Stefano Berloffa; Andrea Salvati; Gloria Pantalone; Ludovica Falcioni; Micaela M Rizzi; Francesca Naldini; Gabriele Masi; Antonella Gagliano

doi:10.3389/fneur.2023.1085948

Steroid treatment response to post SARS-CoV-2 PANS symptoms: Case series

Front Neurol. 2023 Feb 14:14:1085948. doi: 10.3389/fneur.2023.1085948. eCollection 2023.

Authors

Stefano Berloffa¹, Andrea Salvati², Gloria Pantalone², Ludovica Falcioni³, Micaela M Rizzi³, Francesca Naldini³, Gabriele Masi¹, Antonella Gagliano^{3

4}

Affiliations

¹ IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy.
² Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
³ Child and Adolescent Neuropsychiatry Unit, Department of Biomedical Science, University of Cagliari & "A. Cao" Pediatric Hospital, Brotzu Hospital Trust, Cagliari, Italy.
⁴ Neurology Unit, Department of Neurology of Health Science, Magna Graecia University of Catanzaro, Catanzaro, Italy.

Abstract

Background: Pediatric acute-onset neuropsychiatric syndrome (PANS) is characterized by a wide spectrum of symptoms, including the onset of obsessive-compulsive disorder and/or severely restricted food intake, associated with emotional symptoms, behavioral symptoms, developmental regression, and somatic symptoms. Among the possible triggering agents, infectious agents have been extensively explored. More recently, sporadic case reports describe a possible association between PANS and SARS-CoV-2 infection but data on clinical presentation and treatment are still scarce.

Methods: We describe a case series (10 children) with acute onset or relapse of PANS symptoms after SARS-CoV-2 infection. Standardized measures (CBCL, CPRS, C-GAS, CGI-S, Y-BOCS, PANSS, and YGTSS) were used to describe the clinical picture. The efficacy of a pulse treatment with steroids for three consecutive months was assessed.

Results: Our data suggest that the clinical presentation of the COVID-19-triggered PANS is largely similar to that reported in typical PANS, including acute onset, with OCD and/or eating disorders, and associated symptoms. Our data suggest that treatment with corticosteroids may be beneficial for both global clinical severity and global functioning. No serious adverse effects were observed. Both OCD symptoms and tics consistently improved. Among psychiatric symptoms, affective and oppositional symptoms appeared more sensitive to the steroid treatment than the other symptoms.

Conclusion: Our study confirms that COVID-19 infection in children and adolescents could trigger acute-onset neuropsychiatric symptoms. Thus, in children and adolescents with COVID-19, a specific neuropsychiatric follow-up should be routinely included. Even if a small sample size and a follow-up with only two points (baseline and endpoint, after 8 weeks) limit the conclusions, it seems that steroid treatment in the acute phase may be beneficial and well tolerated.

Keywords: SARS-CoV-2; TIC; neuropsychiatric disorder; pediatric acute-onset neuropsychiatric syndrome (PANS); steroid.

Grants and funding

This work has been partially supported by a grant from the IRCCS Fondazione Stella Maris (Ricerca Corrente, and the “5 × 1000” voluntary contributions, Italian Ministry of Health).