Ocular tics in Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)

Aims/Purpose: Little is known about ocular tics in Paediatric Autoimmune Neuropsychiatric Disorders associated with Streptococcal infections (PANDAS). The purpose of this retrospective study was to assess ocular symptoms in 40 children with PANDAS. Methods: The clinical records of children with PANDAS referred to the Ophthalmology Unit, Azienda Ospedaliero‐Universitaria di Sassari, Sassari, Italy, between 2010 and 2019 were examined. The detection of ocular tics was investigated. Data about plasma antistreptolysin O (ASO) and anti‐DNAse b titres, erythrocyte sedimentation rate (ESR), plasma C‐reactive protein (CRP), and antibiotic use were recorded and statistically analysed. Results: 40 children (34 boys, 6 girls; mean age: 7.6 ± 2.5 years) with PANDAS were identified; 33 (82.5%) showed ocular tics, whereas the remaining 7 (17.5%) had extraocular tics. Children with ocular tics had significantly higher plasma values of anti‐DNAse b antibodies (p = 0.04) and CRP (p = 0.016) than those with extraocular tics. A course of oral antibiotics was given to 25 (76%) out of 33 children with ocular tics. All the treated patients showed marked improvement/complete resolution of symptoms; conversely, no improvement was observed in those untreated. A post‐antibiotic recurrence occurred in 8 (32%) children. Conclusions: Results suggest that higher plasma values of anti‐DNAse b antibodies and CRP may play a role in the pathophysiological mechanisms underlying ocular tics in PANDAS. Oral antibiotics may be beneficial in improving ocular symptoms. Further research is necessary to confirm our findings.