Improvement in Cognitive Assessment, Processing Speed, and Visual Acuity in a 10-Year-Old with Pediatric Autoimmune Neuropsychiatric Disorder After Streptococcus Infection (PANDAS)

Matthew M. Antonucci1, 2, 3*, Derek A. Barton2, 3, Paul E. Link2, 3 and Frederick R. Carrick1, 4

1 Carrick Institute, Clinical Neuroscience, United States

2 Plasticity Brain Centers, Neurorehabilitation, United States

3 NeuroSynergy Associates, PA, Neurorehabilitation, United States

4 Harvard Medical School and Harvard-Macy MGH Institute of Health Professions, Medical Education, United States


Background: A 10-year-old, male, student-athlete, presented with symptoms of repetitive movements that he can suppress, recent difficulties reading in school, and understanding/comprehending story lines, and motion sickness. His condition began abruptly after a series of (unconfirmed) streptococcus infections in one year, and have persisted for a 4 years since. Upon examination, his Trails A (TA) and Trails B (TB) times were 30.8 and 67.1 respectively. His Processing Speed (PS) coding score was 43 correctly matched symbols in 2 minutes. His Visual Acuity (VA) line difference was 2.4.

Methods: A five-day, multimodal program of receptor-based neurological rehabilitation was administered three times per day, one hour per session. Each session consisted of electrical somatosensory stimulation, neuromuscular reeducation exercises, vestibular rehabilitation exercises, hand-eye coordination exercises, vision therapy exercises, and off-vertical axis rotations.

Results: At the end of five days of treatment there were improvements in TA (-22.8%), TB (-8.2%), PS (+21.8%), and VA (-50%). There was also complete resolution of the repetitive movements, motion sickness, and reading comprehension challenges.

Conclusion: Short duration, multimodal, intensive programs of receptor based neurological rehabilitation may be a viable method to improve neurological integrity and performance in individuals with PANDAS. The authors suggest further investigation into short duration, multi-modal, intensive approaches to restoring neurological function in individuals suffering from PANDAS.

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