pandakal

streptococcal anubaadhakalumaayi (paandakal) bandhapetta pediatric oottoo immyoon neurosychiatric disordezhs ennathu obsessive-compulsive desorder (osidi) allengil tick disordezhs vegathil aarambikkunna kuttikalude oru upavibhaagathin oru vivaada saangalppika roganirnayamaanu. oru streptococcal (gyaas) group kooduthal vyakthamaayi paranjaal, oru beetaa-haemolitic streptococcal (gabs) anubadhayum moolamaanu lakshanagal undaakunnathenn nirddeshikkappedunnu. streptococcal oottoo immyoon prakriyayude falamaayi kuttikalude oru upavibhaagathil osidi, tick disordezhs enniva undaakumenn anumaanikkappedunnu. anubadhayum eee vaikalyangalum thammilulla nirddishta bandham anubaadhayodulla svayam rogaprathirodha prathikaranam adisthaana ganglia pravartthanatthe thadassappeduthunna aantibodikal uthpaadippikkukayum rogalakshanangal vardhippikkukayum cheiyunnu ennathaanu, eee svayam rogaprathirodha prathikaranam vishalamaaya neuro psychiatric lakshanangalkk kaaranamaakunnu.
1998 ll aadyamaayi vivaricha pandas sidhaantham, us naashanal instittyoott oof mental healthile susanne sweedoy mattullavarum nadatthiya klinikkal cases padanangalile nireekshanangale adisthaanamaakkiyullathaanu, thudarnnulla klinikkal pareekshanangalil kuttikalkk naadakeeyavum pettennullathumaya osidi vardhanavum anubaadhayethudarnnulla tick desorders undennu thonni. mattu tick disordezhs allengil oo. sii. dii kesukalil ninnu vyathyasthamaaya oru prathyeka asthithvamaayirunnu pandakal ennathu charcha cheyyappedunnu. pandas sidhaantham sthireekarikkappedaathum daatta pinthunaykkaathathumaayil, 2012 ll sweedoy sahapravarthakarum oru puthiya nirvachanam nirddeshichu. 2012 leeii vishalamaaya pediatric acute-oonsettu neurosychiatric syndrome (paan) koodaathe, mattu rund vibhagangal nirddeshikkappettindu balyakaala acute neurosychiatric lakshanagal (canukal), pediatric anubadha-triggard oottoo immyoon neurosychiatric disordezhs (pittaand). qaan/paan sidhaanthangalil acute-aanset neuro psychiatric avasthakalkku adisthaanamaaya vividha saadhyamaaya samvidaanangal ulppedunnu, pakshe vyakthikalude oru upavibhaagathil vathaka anubaadhaye oru kaaranamaayi ozhivaakkunnilla. pandakal, paanukal, canukal enniva klinikkal, laborattari gaveshanathinte kendrabinduvaanenkilum theliyikkappettittilla.
paandakale krithyamaayi sthireekarikkaan diagnostic parisodhanayilla; diagnostic maanadandangal asamamaayi prayogikkukayum avasthakal amithamaayi nirnnayikkukayum cheyyaam. pandakal undennu samshayikkunna kuttikalkkulla chikitsa saadhaaranayaayi torret syndrome (ts), osidi ennivayude saadhaarana chikilsakalkku thulyamaanu. pareekshanathmaka chikilsakal chilappol upayogikkunnundengil, theliyikkappedaatha chikilsakalil ninnulla prathikoola phalangal pratheekshikkappedunnum chikitsa pinthunaykkunnathinu mathiyaya thelivukaloo samavaayamo illa. thangalude kuttikalkk paandakalo paanukalo undennu vishwasikkunna kudumbangalude budhimuttukalekkurichu reportukalkkoppam maadyamangalum internettum paandakalude vivaadathinu kaaranamaayittund. pothu nayathe swaadheenikkaanulla sramangal advecasy netvarkkukal munnott kondupoyittundu.
savisheshathakal.
susanne sweedoy mattullavarum aadyam vivarichathaanu kuttikal. (1998) saadhaaranayaayi motor allengil vokkal tixes, obsessions allengil nirbandhangal ennivayulppede rogalakshanangalude pettennulla thudakkam undaayirunnu. obsessive-compulsive allengil tick desorder roganirnayathinu purame, kuttikalkk vaikarikamaaya lability, enurasis, uthkanda, kaiyaksharatthile thakarcha thudangiya prakopanangalumaayi bandhapetta mattu lakshanangalum undakam. orupakshe, aashvaasam labhikkanulla kaalangal undakam. paandaa maathrkayil, eee pettennulla arambham strep thonda anubaadhaykk munbaanennu karuthappedunnu. paandakalude klinikkal spectrum touret syndrome (torrets disorderinu ts allengil tidi) poleyaanennu thonnunnathinaal, chila gaveshakar paandakalum tss bandhappettirikkamenn anumaanichu; eee ashayam velluvilikkukayum gaveshanathinu shradha kendreekarikkukayum cheiyunnu.
pediatric acute-oonsettu neurosychiatric syndrome (pance) ennathu osidi lakshanangalude pettennulla thudakkamo bhakshana niyanthranangalo, nisithamaaya perumatta takararo urakkam, vaikaarikavum perumattaparavumaaya aswasthathakal, school prakadanatthile regression, allengil motor, censory prasnangal ennivayulppedeyulla gurutharamaaya neurosychiatric lakshanangalumayi sahavarthikkunna oru sidhaanthaparamaaya rogamaanu. pance oru praadhamika maanadandamaayi tick disordezhs illaathaakkukayum streptococcal anubadha ozhikeyulla kaaranagal anuvadikkumbol acute-oonsettu osidiyil kooduthal oonnal nalkukayum cheythu. paanukal paandakalekkaal vishalamaaya oru groupine ulkkollunnathinaal, kuttikale paanukal kondu label cheyyaanum shaasthreeya pinthuna illaatha paandakalkkaayi prothsaahippicha parisodhanayum chikitsa sweekarikkaanum saadhyathayund.
vargeekaranam.
vittumaaraatha tick desorder, osidi, ts thudangiya roganirnayathinu yogyatha nedunnathinu mathiyaya kadinamaaya pettennullatho pettennullatho aaya thudakkathode tixes, obsessions, nirbandhangal, mattu lakshanagal ennivayude variable kompineshan undaakkunna oru svayam rogaprathirodha thakaraaraan paandakal ennu anumaanikkappedunnu. 2021 leeii kanakkanusarichu, paandakalude svayam rogaprathirodha sidhaanthathe thelivukal pinthunaykkunnilla.
paan, canukal, pitaandukal ennivayum svayam rogaprathirodha vaikalyangalayi anumaanikkappedunnu.
kaaranam.
paandakalude roganirnayavum eee upagrooppile rogikalil anubadha moolamaanu lakshanagal undaakunnath enna sidhaanthavum tharkkaparavum sthireekarikkappedaathu. kuttikkaalatthe groupil ninnulla streptococcal (gyaas) anubaadhayude falamaayi undaakunna sidenhams korea (essie) yumayi saamyamullathaan kaaranam, ithu oottoo immyoon desorder roomattik paniyilekku nayikkunnu, athil essie oru prakadanamaanu. ezz. sii. pole, paandakalum thalachorinte basel gangliyayil svayam prathirodhasheshi ulkkollunnathayi karuthappedunnu.
oru takaraar oru svayam rogaprathirodha thakaraaraanennu sthaapikkaan, vaitski maanadandangal aavasyamaanu. 
vaittbskiyude maanadandangal palikkunna oru svayam rogaprathirodha kaaranathekkurichu anweshikkunna padanangalude phalangal asthiravum vivaadaparavum reethishaasthraparamaaya parimithikalkk vidheyavumaan.
oru sookshumaanu oru thakaraarin kaaranamaakunnuvenn kaanikkan, coach posttulettukalkk eee thakaraarinte ellah kesukalilum jeeviyundennu kaanikkendathundu, eee thakararullavaril ninnu jeevi verthirichedukkaanum samskarikkaanum kazhiyumennu kaanikkendathundu, aarogyamulla vishayangalilekku jeevi maattunnath thakaraarin kaaranamaakunnu, koodaathe rogabadhithanaaya kakshiyil ninnu jeevi veendum ottappeduthaam. rogalakshanangal prathyakshappedumbol jeevikal undakaathirikkaam, onniladhikam jeevikal lakshanangalkk kaaranamakaam, rogalakshanangal oru saadhaarana rogakaariyodulla apoorva prathikaranamayirikkaam ennathinaal pakarchavyaadhikku sheshamulla rogaavasthayaaya paandakale sthireekarikkunnathinu coach posttulettukal upayogapradamallennu giavanoni abhipraayappedunnu.
chila padanangal klinikkal nirvachikkapetta paandakalkkidayil streptococcal anubaadhayumaayi bandhapetta theevramaaya vardhanavukale pinthunaykkunnu; mattu padanangal pettennulla thudakkamo anubaadhayumaayi vardhanavo thammil oru bandhavum kandethiyitla. pance sidhaantham, streptococcal anubaadhaykkappuram kaaranagal vikasippikkukayum kaaranam janithakamo upapachayam allengil pakarchavyaadhiyo aakam ennu anumaanikkukayum cheiyunnu.
paanukalo paandakalo ulla kuttikalil, padanangal asthiramaanu, aantibodikal lakshanagal srishtikkunnu enna sidhaantham theliyikkappettittilla; chila padanangal paanukalo paandakalo ulla kuttikalil aantibodikal kaanichu, pakshe aaa phalangal mattu padanangalil aavarthichilla. oru valia multisenter patanam (kuttikalude padanangalil emittiks-europian multisenter tixes) tick vardhanavilekku nayikkunna strep anubaadhayude vittumaaraatha tick disordezhs ulla kuttikalil thelivukalonnum kaanichittilla, allengil tixes ulla kuttikalil nirddishta aantibodikal, koodaathe ts ulla muthirnnavarude cerebrospinal draavakathekkurichulla padanatthil samanamaaya prathyeka aantibodikal kandethiyitla. oru samgham kandethiya aantibodikalkk koottaayi "kanningham paanal" ennu perittu; thudarnnulla swatantra parisodhanayil eee aantibodikalude paanal paanukalullathum illaathathumaaya kuttikal thammil verthirichariyunnillena athinte vishwaasyatha theliyikkappettittille kandethi. britiish pediatric neurology association (bpna) yude oru samavaaya prasthavanayil, "aakasmika anubaadhayekkaal kaarana anubaadhayo koshajwalanamo svayam rogaprathirodha rogamo" sthireekarichittillenum "paandakale krithyamaayi nirnnayikkunnatho mastishka veekkavumaayi vishwasaneeyamaayi bandhappettatho aaya sthiramaaya biomarkerukalonnum kandethiyitla" ennum parayunnu.
samvidaanam.
aantibodikal thalachorine akramikkukayum neuro psychiatric avasthakalkku kaaranamaakukayum cheiyunna streptococcal anubadhakal moolamundaakunna svayam rogaprathirodha thakararaya rheumatic panikk samaanamaan eee samvidaanam ennu anumaanikkappedunnu. molecular mimikri sidhaantham paandakalkkulla oru nirddishta samvidaanamaanaa streptococcal bacteriayude koshabhithiyile aantijanukal hridaya valve, sandhikal allengil thalachorile proteinukalkku oru tharatthil samaanamaan ennathaanu eee sidhaantham. aantibodikal aaa tissuekalkk kedupaadukal varuthunna rogaprathirodha prathikaranam aarambikkunnathinaal, roomattik panii ulla kuttikk sidenhams vikasippikkaan kazhiyum. oru saadhaarana bacteria anubaadhayil, shareeram akramikkunna baakteeriyakkethire aantibodikal uthpaadippikkunnu, koodaathe aantibodikal shareerathil ninnu bakteeriyakale illaathaakkaan sahayikkunnu. chila roomattik panii rogikalil, autoantibodikal hridayakoshangale akramikkukayum carditisilekku nayikkukayum allengil sandhikalumayi cross-riyaakt cheyyukayum sandhivaathathilekku nayikkukayum cheyyum. paandakalil, tixes osidiyum samanamaaya reethiyilaan uthppaadippikkunnathenna vishwasikkappedunnu. paandakalil baadhikkaavunna thalachorinte oru bhagam chalanathinum perumaattatthinum kaaranamaakumenn vishwasikkappedunna basel gaangliyayaanu. sidenhamsinu samaanamaayi, aantibodikal basel gangliayile neuronal braine tissuevumaayi cross-react cheyth paandakale savisheshamaakkunna tixin osidikkum kaaranamaakumenn karuthappedunnu.
ts roganirnayam nadatthiya mattu aalukalil kaanunnathinekkaal vyathyasthamaaya oru samvidaanathiloode (pathophysiology) pandakal roganirnayam nadatthiya rogikalude koottam tixes osidiyum vikasippicheduthittund ennu vyakthamalla. eee sidhaanthathekkurichulla padanangal asthiramaanu 144 kuttikalil (mell thudangiyavar) nadatthiya niyantritha padanatthil ninnaan ettavum sakthamaaya pinthuna nalkunna thelivukal labhikkunnath.2005), ennaal varaanirikkunna deerghakaala padanangal nirnnayaka phalangal nalkiyittilla, mattu padanangal sidhaanthathe pinthunaykkunnilla.
roganirnayam.
diagnostic aandu stattistikkal maanuval oof mental disordezhs" (dii. ezz. emm 5)-nte 2013-leeii anchaam pathippil paandakalo paanukalo roganirnayamaayi pattikappedutthukayo allengil vyathyastha vaikalyangalayi sthireekarikkukayo cheythitilla. 2022 ll praabalyatthil varunna lokaarogya samghadanayude icd-11 ll oottoo immyoon central narvas sisttam disordezhs prakaram paandakale paraamarsikkunnu, ennaal diagnostic maanadandangal nirvachikkappettitla, koodaathe panukalkko paandakalkko prathyeka kodukalonnum nalkiyittilla. torret syndrome (ezz. ezz. tii. ezz) padanathinaayi europian sosaitti vikasippicha 2021 leeii europian klinikkal maargganirddeshangal aii. sii. dii-11-ll chertthavaye pinthunaykkunnilla.
swedo mattullavarum avarude 1998 leeii prabandhatthil paandakalkku anchu diagnostic maanadandangal nirddeshichu. lombroso aandu scahill (2008) anusarichu, aaa maanadandangal ivayaayirunnu "(1) dii. ezz. emm-aii. vii. yumayi poruthappedunna oru tick disorderinteyum/allengil oo. sii. diyudeyum saannidhyam; (2) neuro psychiatric lakshanangalude prepabertal thudakkam; (3) lakshanangalude pettennulla thudakkathinteyum/allengil pettennulla rogalakshanangalude vardhanavinulla oru episodic kozhsinteyum charithram, bhaagikamo poornnamo aaya rogamochana kaalayalavukal; (4) lakshanangalude arambham allengil vardhanavum munkaala streptococcal anubadhayum thammilulla oru thaalkkaalika bandhatthinte thelivu; (5) saahasika chalanagal (udha.jii.rogalakshanangal vardhikkumbol motoric hyper activityum corifom chalanangalum).
nirddishta paan maanadandangal ooo. sii. dii. yude pettennulla thudakkathino (oru dii. ezz. emm roganirnayam urappunalkaan mathiyaya kadinamaaya) allengil niyantritha bhakshana upabhogathino oppam thaazhepparayunna randennam, uthkanda, vaikarikamaaya sthiratha allengil vishaadam, prakopanamo ethir swabhaavamo, vikasana regression, academic thakarcha, censory allengil motor budhimuttukal, allengil urakkam allengil moothrathile thadassangal ennivayil ninnu kadinavum theevravumaaya neuro psychiatric lakshanagal aavashyappedunnu. syndenham korea allengil touret syndrome polulla mattoru takaraar lakshanangale nannayi vishadeekarikkaruthu. paanukal pariganikkunnathin matellaa kaaranangalum ozhivaakkanamenn (ozhivakkal roganirnayam) rachayithakkal prasthaavichu.
paandakale krithyamaayi sthireekarikkaan diagnostic parisodhanayilla. nirddishta ellah avasthakaludeyum (paandakal, pitaandukal, canukal, paankal) roganirnaya maanadandangal svayam rogaprathirodhathinte lakshanangalekkal lakshanangaleyum avatharanatheyum adisthaanamaakkiyullathaanu. aantibodikalude parisodhanaye adisthaanamaakki paandakaleyum paanukaleyum nirnnayikkaan uddeshichulla "kanningham paanal" ennariyappedunna oru vaanijya upakaranam, moleculera laabukal vipananam cheyyukayum swathanthramaayi pareekshikkumbol paanukalullathum illaathathumaaya kuttikal thammil verthirichariyaathirikkum cheythu.
pandakal amithamaayi roganirnayam nadathiyekkaam roganirnaya maanadandangal asamamaayi prayogikkukayum "rogaprathirodha-madhyastha lakshanagal saadhyathayillaatha kuttikalil" oru anumaanikkappedunna roganirnayam nalkukayum cheyyaamennu wilber "thudangiyavar" (2019) parayunnu. community doctormar pandakal roganirnayam nadatthiya mikka rogikalum vidagdhar parishodhichappol maanadandangal paalikkunnillenn soochippikkunnu, pandakal nirnnayaka thelivukalillaathe community doctormar nalkunnathaanu.
rogalakshanangal mattu pala maanasika avasthakalumaayum ovarlaappu cheiyunnathinaal, deferential diagnosis velluvili niranjathaanu. tii. esil ninnu paandakale verthirichariyaan niravadhi budhimuttukalundu. iruvarkkum samanamaaya thudakkavum waxing ksheenavum undu, paandakalil anumaanikkappedunna tixile pettennulla thudakkamo vardhanavo tsil asaadhaaranamalla. paandakalulla kuttikalude bandhukkalil oo. sii. dii, tii. ezz ennivayude nirakk kooduthalaanu, koodaathe aaa kuttikalkk palappozhum paanda roganirnayathinu munbu tixes undakam allengil tick disordezhs undakam; gyaas anubadha moolamulla naadakeeyamaaya thudakkamaayi thonnunnathu "tick disordezhsinte swaabhaavika gathiyayirikkaam", yooda black (2021) parayunnu.
chikitsa.
paandakal undennu samshayikkunna kuttikalkkulla chikitsa saadhaaranayaayi ts, osidi ennivayude saadhaarana chikilsakalkku thulyamaanu. cognitive behavioural therapy oo. sii. dii chikilsikkunnathinulla marunnukalaaya selective serotonin reaptake inhibittarukal (ezz. ezz. aarr. aii. ezz), "tixinulla parambaraagatha therapy" ennivayum ithil ulppedunnu.
vyakthikalkk "sthiramo pravartthanarahithamo cheiyunna lakshanagal" undaakumbol, wilber (2019) "mattullavarum" vidagthare sameepikkuka, sthaapitha maarganirddeshangalkkinu thiricharinja acute streptococcal anubaadhakalude chikitsa, klinikkal pareekshanangalil maathram rogaprathirodha chikitsa enniva shupaarsha cheiyunnu.
niyantritha pareekshanangal illaayirunnuvenkilum paan/paandakalkkulla psychotropic marunnukalude upayogam vyaapakamaanu.
pareekshanathmaka.
tixin osidiykkumulla rogaprathirodha antibiotic chikilsakal pareekshanathmakamaanu, avayude upayogam velluviliyaanu; paandakalude amithamaya roganirnayam sajeevamaaya anubaadhayude abhaavathil tixino osidico chikilsikkaan antibioticukalude amita upayogathilekku nayichekkaam. paan, paanda, pittand, canukal ennivaykku antibiotic chikilsaykkulla thelivukal anishchithathvathilaanu. marfi, kurlan, leckman (2010) paranju, "paandakale chikilsikkaan rogaprathirodha antibioticukalude upayogam samoohathil vyaapakamaayitheernniriknu, ennirunnaalum avayude upayogathe pinthunaykkunna thelivukal avyakthamaanu."
paandakal/paankal chikilsikkunnathinu retuximab allengil micophenolate mofettil upayogikkunnathine pinthunaykkunna thelivukalonnumilla.
paanukalkkum paandakalkkumulla immunomodulati theraappikale (intravinus immunoglobulin (aiviji) allengil therapeutic plasma exchange (tpe)) pinthunaykkunna anishchithathvamulla thelivukalundu; mikka padanangalkkum reethishaasthraparamaaya prashnangalund. svayam report cheytha oru survey adisthaanamaakki ivig phalapradamaanennu "kanakkakkappettu". 2009ll kalra sweedoy ezhuthi, "ivig, plasma exchange enniva prathikoola falangalkku ganyamaaya apakadasaadhyatha vahikkunnathinaal, eee reethikalude upayogam prathyekichu gurutharamaaya lakshanangalulla kuttikalkkum vyakthamaaya paandaa avatharanathinum vendi neekkivaykkanam."
paanukalkkum paandakalkkumulla pareekshanathmaka chikilsakalekkurichulla padanangal (ivig, tpe, antibioticukal, tonsilectomy, corticosteroidukal, ensideukal) "kuravaanu, pothuve pakshapaathatthinu mithamaayatho uyarnnatho aaya apakadasaadhyathayund", 2018 ll prasidheekaricha sigra "thudangiyava" avalokanam parayunnu
maargganirddeshangal.
2014ll amerikkayil nadanna sweedoyudeyum stanford sarvakalaashaalayile doctormaarudeyum yogathethudarnnu 2017ll paanukalkkum paandakalkkumulla chikitsa maargganirddeshangal moonnu bhagangalaayi prasidheekarichu. prasidheekarichu maarganirddeshangalekku maarganirddeshangalekku oru avalokanathil, sigra mattullavarum chikilsayude samavayam illennum phalangal anishchithathvathilaanennum paranju. pandakal/paan ulla kuttikalude chikilsaykkulla thelivukalude abhaavamundennum chikilsaykku sheshamulla lakshanangalile rogamochana nirakk "yadhaartha chikitsa falathekkaal [pandakal allatha pediatric osidi] kesukalude swaabhaavika charithrathe prathinidheekarikkaamennum wilber" mattullavarum "2019 leeii oru avalokanam paranju. wilber 'ettu alle' 2019 avalokanathil tonsilectomy allengil rogaprathirodha antibioticukale pinthunaykkunnathinu thelivukalonnum kandethiyilla, oo. sii. dick phalapradamaanennu ariyappedunna staanderd amgeekritha chikilsakal shupaarsha cheyyukayum klinikkal pareekshanangalilozhike immunomodulati chikilsakalkkethire munnariyipp nalkukayum cheythu. gilbert (2019) prasthaavichu "chikitsa padanangal paandakalkkulla antibiotic allengil immunomodulati edapedalukale pinthunaykkunnillenna samshayavaadikal nigamanam cheythittundu. iruvareyum pinthunaykkunna chikitsa maargganirddeshangal abhibhaashakar prasidheekarichu."gilbert athu kootticherkkunnu... paan/paandakal sarikkum saadhaaranamaanenkil, ettavum mikacha sameepanam valuthum kramarahitavum placibo niyantrithavumaaya pareekshanangalayirikkanam. koodaathe, kapadashaasthraparamaaya sameepanagal ozhivaakkukayum kyash-payy klinikkukal, internettu diagnosisukal, vidagdha saakshikalude saakshyam thudangiya labham thedunna perumattangal vilikkukayum cheyyumbol, nalla shaasthravum mikachathumaaya rogaparicharanam pinthudarunnathil sahakarikkanum samshayavaadikalum vadakarum uchithamayirikkum."
yukeyile maarganirddesha nila samaanamaan. pandas aandu pance physicians network 2018 ll iii-hospital enna swakaarya aarogya samrakshana plaattphomil maargganirddeshangal prasidheekarichu. 2021 eprilil britiish pediatric neurology association (bii. pii. enn. eiii) royal koleju oof cycatristukalude child aandu kaumaara saikyatri faakkalttiyumaayi oru samavaaya prasthavana purappeduvichu, rogaprathirodha modulatory allengil rogaprathirodha antibiotic chikilsakal shupaarsha cheiyunnathinu thelivukalude abhaavamundennu prasthaavichu. oru saadhaarana maargganirddesham vikasippikkunnathin mathiyaya thelivukalillennu rachayithakkal prasthaavichathinaal oru maargganirddeshathinu pakaram eee samavaaya prasthavana purappeduvichu. naashanal instittyoott phoor health aandu cair exalance (naise) ulppede yukeyile audyogika sthaapanangal paandakalkkayulla muun maargganirddeshangal nilavilundo amgeekarikkukayo cheythitillennum pandakal/pance yuke chaarity websaittilum swakaarya platfomilum (iii-hospital) labhyamaya 2018 maargganirddeshangal bpnal ninnu swathanthramaayi vikasippicheduthittundum athil paraamarshichu.
athupole, nordic rajyangalkkulla (denmark, norway, sweeden, yuke) 2021 epril chikitsa maargganirddeshangal oru specialist krameekaranatthinu purathulla tonsillectomy, antibiotic prophylaxis allengil pareekshanathmaka immunomodulati theraappikal shupaarsha cheiyunnilla. antibioticukal, aanti-inflammatory marunnukal allengil immunomodulati ejantukal enniva upayogichu paanukalude gaveshana nirvachanam palikkunna vyakthikale chikilsikkunnathinu prathikoola falangalkkulla mithamaaya saadhyathayum "prayojanakaramaaya phalangalude thelivukalude valare kuranja urappum" 2021 ll prasidheekaricha oru sweedish avalokanam kandethi. amerikkayile chila gaveshakar, oru adisthaana neuro inflammation anumaanathinte adisthaanathil, eee rogikalude klinikkal maanejmentil aanti-inflammatory marunnukal, antibioticukal, immunomodulati chikitsa enniva shupaarsha cheiyunnu, sweedish deseeya maargganirddeshangal soochippikkunnathu eee chikilsakal gaveshanathinteyum vikasanathinteyum chattakkoodinullil maathrame nalkoo" ennaanu.
american akkadami oof neurology 2011 maargganirddeshangal parayunnath "plaasmaaferisisinte falaprapti nirnnayikkaan aparyapthamaaya daatta", paandakalude krameekaranatthil osidi, tixes enniva chikilsikkunnathinu "plaasmaaferisisinte upayogathe pinthunaykkunnathino nishedhikkunnathino mathiyaya thelivukal illa" ennaanu. touret syndrome associationte (ippol amerikkayude touret association) medical advisory board 2006 ll parayukayum 2021 ll aavarthikkukayum cheythu american hart associationte 2009 leeii maargganirddeshangal "eee thakaraarinte vardhanavinu vaathakam nirnnayikkunnathinulla pathiv laborattari parisodhana, deerghakaala antistreptocalcal prophylaxis thadayal, allengil immunoregulati therapy (intravinus immunoglobulin, plasma exchange polullava) enniva shupaarsha cheiyunnillennu" parayunnu.
samoohavum samskaaravum.
paandakalude sidhaanthathe chuttipattiyulla charchakalkku saamoohika prathyaaghaathangalundu; paandakalude vivaadathil maadyamangalum internettum oru punk vahichittundu. thangalude kuttikalkk paandakalo paanukalo undennu vishwasikkunna kudumbangalude budhimuttukal vaarthakalum mattu maadyamangalum report cheiyunnu. america aasthaanamaayulla pandas shringhala, canadian pandshelp thudangiya abhibhaashaka shringalakal pothu nayathe swaadheenikkaanulla sramangal munnott kondupoyittundu.
swerdlo (2005) sidhaanthathinte saamoohika prathyaaghaathangalum paanda sidhaanthathe chuttipattiyulla charchayil internettinte pankum sangrahichu
... orupakshe ettavum vivaadaparamaaya ts trigger streptococcal anubaadhakalumaayi sanbarkkam pulartthunnu. strep thondayude sarvvyaapithvam, amita chikilsayude valia saamoohika prathyaaghaathangal (udha.jii.antibiotic prathirodham allengil rogaprathirodha paarshwafalangal) koodaathe chikilsayude medical prathyaaghaathangal (udha.jii., thirichedukkaan kazhiyaatha svayam rogaprathirodha neurological parikk) gurutharamaaya kaaryangalaan. internettu aayudhadhaarikalaaya maathaapithaakkalkkidayil niraashayude thoth ullathinaal, eee vivaadam vivaadaparamaaya abhipraayavyathyaasangalkka kaaranamaayi, palappozhum vasthunishtathayum nagarikathayum illa.
marfi, kurlan, leckman (2010) ennivar maadhyamangaludeyum internettinteyum swaadheenathekkurichu oru prabandhatthil charcha cheythu, athu "paandakal ennu koottaayi visheshippikkappedunna vaikalyangalude koottavumaayi" oru "munnottulla vazhi" nirddeshichu aashankaajanakamaayi, pothujana avabodham nammude shaasthreeya vijnjaana aditharaye marikadannu, onniladhikam maasikakalum pathra lekhanangalum internettu chaatt roomukalum eee prashnathe pothujanangalude shradhayilppeduthi. medlinil listtucheythirikkunna ~ 200 reportukalumaayi thaarathamyappeduthumbol-palathum orotta rogi ulppedunnavayum mattullavar ore rogikale vyathyastha pepparukalil report cheiyunnavayum, ivayil bhooribhaagavum nilavile paandaa maanadandangal paalikkaatha vishayangalekkurich report cheiyunnavayum-saadhyamaaya "streptococcus"-osidi-tidi bandham charcha cheiyunna 100,000-ladhikam sittukal internettilundu. paandakalodulla pothuthaalpparyavum eee bandhathe pinthunaykkunna nirnnayaka thelivukalum thammilulla eee vidavu vaathakavum osidi/tixes thammilulla bandhatthilekku kooduthal shaasthreeya shradha aavashyappedunnu, prathyekichu adisthaana sellular, rogaprathirodha samvidaanangal parishodhikkunnu.
charithram.
1998ll susanne sweedoy yuu. ezz. naashanal instittyoott oof mental healthile (nihile oru shaakha) oru koottam gaveshakarum chernnaanu paandakale aadyamaayi vivarichathu. paandakalude sweedo "mattullavarum" maanadandangal palikkunna, ennaal vaathakam ozhikeyulla anubadha moolamundaakunna lakshanangalulla pittaandukalkk (pediatric anubadha-trigger cheytha oottoo immyoon neuro psychiatric disordezhs) samanamaaya oru klinikkal chithram nirddeshikkappettu.
paandakale oru roga vargeekaranamaayi saadhookarikkaathathinu niravadhi kaaranagal maikkal pichichero (2009) choondikkaatti. mattu neurological lakshanangalumayi vaathakathinte saadhyamaaya bandhathekkurichu chittayaya padanangalonnumillaathe, gaveshana padanangalkkaayi thiranjeduttha oru prathyeka koottam rogikale athinte nirddishta arambha praayavum klinikkal savisheshathakalum prathiphalippichu. corifom chalanangalude lakshnam ezz. siyude samanamaaya chalanangalil ninnu vyathyasthamaano ennathinekkurichu tharkkamundaayirunnu. pettennulla thudakkathinte reethi paandakalkku maathramullathaano ennu ariyilla. oduvil, vathaka anubadhayum paandayude lakshanangalum thammil oru thaalkkaalika bandham nilavilundo ennathinekkurichu vivaadam undaayi.
eee sidhaanthathinu oru adisthaanam sthaapikkunnathile vivaadangalude velichathil, "oru vazhi" ennu vilikkunna 2010 leeii oru prabandhatthil marfi, kurlan, leckman ennivar paranju "deseeya aarogya sthaapanangalum abhibhaashakarum professional samghadanakalum samyojippichu, nilavile daatta charcha cheiyunnathinalla, marichu munnottulla oru vazhi thayyarakkan vidagtharude oru paanal vilikkenda samayamaanith. thalkkalam ooo. sii. dii, tixes enniva chikilsikkunnathil njangalude staanderd theraappikal maathrame nalkendathulloo, pakshe oru divasam njangalude ayudhappurayil antibioticukalo mattu rogaprathirodha nirddishta chikilsakalo cherkkaan anuvadikkunna thelivukal njangalude pakkalundakaam."2011-ll gaayakan ezhuthiya oru prabandhatthil kuttikkaalatthe acute neuro psychiatric lakshanagal-anukoolamaayatho acute-oonsettu maathram aavasyamullatho aaya oru puthiya" "vishalamaaya ashayam" "-nirddeshichu". gyaas anubaadhayude aavasyakatha illaathaakkunna canukal onniladhikam kaaranangalkk kaaranamaakunnu, paandakalkk "anishchithathvavum vairudhyavumulla shaasthreeya pinthunayum" kaaranam gaayakan nirddeshicha "gaabhukalkk oru pradhana punk illennu soochippikkunna sakthamaaya thelivukal, prasidheekaricha [paandakal] maanadandangal prayogikkunnathil parajayam, nirddishta chikilsakalkku shaasthreeya pinthunayude abhavam" enniva ulppede.
2012 aayappozhekkum, pandas sidhaanthathinte parimithikal prasidheekarichathode, vishalamaaya pediatric acute-oonsettu neurosychiatric syndrome (paan) nirddeshikkappettu (oru konfaransinetthudarnnu sweedoy sahapravarthakarum koodi) "gaveshana aavasyangalkkaayi" oru mikacha nirvachikkapetta avastha srishtikkunnathinaayi. mattu neuro psychiatric lakshanangalkoppam bhakshana vaikalyangalo oo. sii. dii. yude druthagathiyilulla thudakkamo ulla vyakthikale ithu vivarikkunnu, koodaathe kaaranagal vaathakam ozhikeyullavayaayirikkamena anumaanikkunnu. konfaransil vivaricha chila kesukalil kaumaarakkaar ulppettathinaal "kuttikkalam" ennathinekkaal "pediatric" enna padam thiranjedutthu. pance sidhaantham oru prathyeka asthithvathe nirvachikkunnundo ennu vyakthamalla.
sweedo 2019 ll nihayil ninnu viramichuvenkilum pandas physician netvarkkinte shaasthreeya upadeshaka samithiyil sevanamanushtikkunnu. 2020 leeii kanakkanusarichu, nih information pejukal (sweedo ezhuthaan sahaayichath) pandas sidhaanthathe pinthunaykkaattha padanangalekkurichu paraamarsikkunnilla.

