Pediatric autoimmune neuropsychiatric disorders associated with group A streptococcal infections (PANDAS) is a sudden-onset or worsening episodic pediatric neurological disorder characterized by tics (vocal or motor) or obsessive-compulsive (OCD) behaviors following group A beta-hemolytic streptococcal infection. PANDAS is considered a subtype of pediatric acute-onset neuropsychiatric syndrome (PANS). Other signs and symptoms may include anxiety, agitation, irritability, hyperactivity, mood changes, sleep disturbance, arthralgia, urinary frequency, and nocturnal enuresis. This disorder is thought to be rare by most experts, but some consider it more common. The existence and diagnosis of this disorder is still the subject of controversy. National Institutes of Health (NIH) working diagnostic criteria include:

1. Abrupt onset or worsening of OCD or tics over a 1-3-day period that is severe enough to interfere with normal functioning. Symptoms may then follow a relapsing / remitting, saw-toothed course over several weeks to a few months.

2. Onset from age 3 years through the beginning of puberty.

3. Temporal association between onset or worsening of symptoms with a group A streptococcal (GAS) infection determined by positive culture, rapid antigen test, or a clinically significant rise in anti-streptococcal antibody titers.

4. Neurologic abnormalities, including choreiform-like movements, motor hyperactivity, or vocal / motor tics, are present during exacerbations.

Researchers suggest an underlying autoimmune process by which antibodies against GAS effect changes in the basal ganglia.