1014 The PANDA Monster Under the Bed

Abstract Introduction Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) is an acute-onset constellation of symptoms including obsessive-compulsive disorder and concurrent neuropsychiatric anxiety, emotional lability, behavioral regression. Sleep disturbances are common in PANDAS, suspected post-infectious inflammation that can decrease serotonin, increase dopamine, prevent the production melatonin. OCD fears rituals create may impede sleep onset impair maintenance. Abnormal motor manifestations during include restlessness, stereotypies, paroxysms or periodic limb movements sleep. This case report highlights clinical time course disorders found chronic refractory to immunomodulatory interventions. Report case(s) We present 11-year-old male who presented insomnia childhood sleep-onset association type setting personality changes deterioration school performance coinciding streptococcus infection two months earlier. The patient was supported prophylaxis antistreptococcal therapy as well Omega-3 fatty acids. Parents noted heightened anxiety day, fear obsessive intrusive thoughts about becoming sick, social seclusion but refusal alone be away from home. He also diagnosed a tic disorder, migraine, postural orthostatic tachycardia syndrome (POTS), which likely exacerbated insomnia. referred for Cognitive behavior utilizing exposure/response prevention ERP modality psychoeducation. However, it not until clonidine introduced demonstrated significant response. Clonidine initiated at 50ug increased 100ug QHS. It promotes sedation by decreasing norepinephrine release via negative feedback agonism α2-adrenergic receptors level locus coeruleus. Conclusion PANDAS remain elusive challenging manage due lack well-developed pharmacologic guidelines treat children. Our illustrates importance integration treatments augment strategies promote better outcomes. More studies needed investigate management ­disorders children general, appraise safety efficacy specific medications such, clonidine, particular. Support (if any)