Therapeutic impact and tolerability of intravenous immunoglobulin in pediatric autoimmune neuropsychiatric syndromes (PANS and PANDAS): an updated systematic review and meta-analysis

Ahlam S. Almuabdi; Juwhra Sadiq AlTurkostani; Marwah Alsulami; Shouq Aljohani; Latifah Alansari; Yousef Magbool; Morooj Mahnashi

doi:10.24911/IJMDC.51-1764006113

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Original Article
Online Published: 01 Jan 2026

IJMDC. 2025; 9(12): 3185-3193

doi: 10.24911/IJMDC.51-1764006113

Therapeutic impact and tolerability of intravenous immunoglobulin in pediatric autoimmune neuropsychiatric syndromes (PANS and PANDAS): an updated systematic review and meta-analysis

Ahlam Saad Almuabdi, Juwhra Sadiq Alturkostani, Marwah Alsulami, Shouq Aljohani, Latifah Alansari, Yousef Magbool, Morooj Mahnashi.

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<0.0001). The pooled prevalence of adverse effects was 0.51 (95% CI: 0.30–0.71; p-value=0.0460). ‏IVIG significantly improves neuropsychiatric symptoms in children with PANS/PANDAS, as evidenced by reductions in validated clinical scales such as the PANS Scale, CY-BOCS, and CGI-S, with mostly mild and transient adverse effects.

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

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Pubmed Style

Almuabdi AS, Alturkostani JS, Alsulami M, Aljohani S, Alansari L, Magbool Y, Mahnashi M. Therapeutic impact and tolerability of intravenous immunoglobulin in pediatric autoimmune neuropsychiatric syndromes (PANS and PANDAS): an updated systematic review and meta-analysis. IJMDC. 2025; 9(12): 3185-3193. doi:10.24911/IJMDC.51-1764006113

Web Style

Almuabdi AS, Alturkostani JS, Alsulami M, Aljohani S, Alansari L, Magbool Y, Mahnashi M. Therapeutic impact and tolerability of intravenous immunoglobulin in pediatric autoimmune neuropsychiatric syndromes (PANS and PANDAS): an updated systematic review and meta-analysis. https://www.ijmdc.com/?mno=299116 [Access: January 16, 2026]. doi:10.24911/IJMDC.51-1764006113

AMA (American Medical Association) Style

Almuabdi AS, Alturkostani JS, Alsulami M, Aljohani S, Alansari L, Magbool Y, Mahnashi M. Therapeutic impact and tolerability of intravenous immunoglobulin in pediatric autoimmune neuropsychiatric syndromes (PANS and PANDAS): an updated systematic review and meta-analysis. IJMDC. 2025; 9(12): 3185-3193. doi:10.24911/IJMDC.51-1764006113

Vancouver/ICMJE Style

Almuabdi AS, Alturkostani JS, Alsulami M, Aljohani S, Alansari L, Magbool Y, Mahnashi M. Therapeutic impact and tolerability of intravenous immunoglobulin in pediatric autoimmune neuropsychiatric syndromes (PANS and PANDAS): an updated systematic review and meta-analysis. IJMDC. (2025), [cited January 16, 2026]; 9(12): 3185-3193. doi:10.24911/IJMDC.51-1764006113

Harvard Style

Almuabdi, A. S., Alturkostani, . J. S., Alsulami, . M., Aljohani, . S., Alansari, . L., Magbool, . Y. & Mahnashi, . M. (2025) Therapeutic impact and tolerability of intravenous immunoglobulin in pediatric autoimmune neuropsychiatric syndromes (PANS and PANDAS): an updated systematic review and meta-analysis. IJMDC, 9 (12), 3185-3193. doi:10.24911/IJMDC.51-1764006113

Turabian Style

Almuabdi, Ahlam Saad, Juwhra Sadiq Alturkostani, Marwah Alsulami, Shouq Aljohani, Latifah Alansari, Yousef Magbool, and Morooj Mahnashi. 2025. Therapeutic impact and tolerability of intravenous immunoglobulin in pediatric autoimmune neuropsychiatric syndromes (PANS and PANDAS): an updated systematic review and meta-analysis. International Journal of Medicine in Developing Countries, 9 (12), 3185-3193. doi:10.24911/IJMDC.51-1764006113

Chicago Style

Almuabdi, Ahlam Saad, Juwhra Sadiq Alturkostani, Marwah Alsulami, Shouq Aljohani, Latifah Alansari, Yousef Magbool, and Morooj Mahnashi. "Therapeutic impact and tolerability of intravenous immunoglobulin in pediatric autoimmune neuropsychiatric syndromes (PANS and PANDAS): an updated systematic review and meta-analysis." International Journal of Medicine in Developing Countries 9 (2025), 3185-3193. doi:10.24911/IJMDC.51-1764006113

MLA (The Modern Language Association) Style

Almuabdi, Ahlam Saad, Juwhra Sadiq Alturkostani, Marwah Alsulami, Shouq Aljohani, Latifah Alansari, Yousef Magbool, and Morooj Mahnashi. "Therapeutic impact and tolerability of intravenous immunoglobulin in pediatric autoimmune neuropsychiatric syndromes (PANS and PANDAS): an updated systematic review and meta-analysis." International Journal of Medicine in Developing Countries 9.12 (2025), 3185-3193. Print. doi:10.24911/IJMDC.51-1764006113

APA (American Psychological Association) Style

Almuabdi, A. S., Alturkostani, . J. S., Alsulami, . M., Aljohani, . S., Alansari, . L., Magbool, . Y. & Mahnashi, . M. (2025) Therapeutic impact and tolerability of intravenous immunoglobulin in pediatric autoimmune neuropsychiatric syndromes (PANS and PANDAS): an updated systematic review and meta-analysis. International Journal of Medicine in Developing Countries, 9 (12), 3185-3193. doi:10.24911/IJMDC.51-1764006113

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