Abstract

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS) are marked by the sudden onset of obsessive-compulsive behaviors, tics, anxiety, and cognitive or behavioral changes. PANDAS is linked to streptococcal infections, while PANS involves a broader range of immune or infectious triggers. Intravenous immunoglobulin (IVIG), with immunomodulatory and anti-inflammatory effects, has been studied as a potential treatment to reduce symptoms and improve functioning in affected children. This systematic review aimed to evaluate the effectiveness and safety of IVIG in treating neuropsychiatric symptoms in children with PANDAS or PANS. This review followed PRISMA 2020 guidelines. A comprehensive search of PubMed, Web of Science, Google Scholar, and Ovid (CENTRAL) covered October 1999–October 2024. Eligible studies included randomized controlled trials and cohort studies of pediatric patients (0–18 years) diagnosed with PANDAS or PANS receiving IVIG as the primary intervention. Studies evaluating IVIG in PANS/PANDAS showed significant improvement in symptom severity. The pooled mean difference in CY-BOCS scores was -10.91 (95% CI: -15.47 to -6.34; p-value=0.0001). CGI-S improved by -2.35 (95% CI: -2.73 to -1.97; p-value=0.0421), and CGI-I by -1.04 (95% CI: -2.31 to 0.23; p

Key words: Therapeutic impact, tolerability, intravenous immunoglobulin, pediatric autoimmune neuropsychiatric syndromes, systematic review, meta-analysis.