March 17th, 2010, 10:47 pm #1 2010-03-18T02:47

At the 2008 Child Neurology Society meeting in San Jose, California, I presented six children with a unique syndrome I called "Exorcist Syndrome"


1. Hyperacute onset - parents point to hour of change

2. Ballistic tics - forceful, unrestrained, violent - can put holes in walls, etc.

3. Disinhibition - expletives, capable of serious physical harm to self or others

4. "Falsetto" vocal change - voice is clear, no aphasia but change in quality of voice - gruff/demonic, Bugs Bunny, infantile

5. Symptoms seem to turn on and off like a switch. At times appear completely normal, then symptoms above suddenly rage.


These previously normal children acquire this illness suddenly and appear to be demonically possessed. It is not an encephalitis or encephalopathy as the sensorium remains clear, there is no significant cognitive dysfunction.


Every one of these children was fully alert, could recall the episode entirely. Video EEG normal in all.

MRI was not done in all, but where done show significant reversible basal ganglia swelling

LP was not done in all, but where done was normal.

No antibiotics or meds (such as neuroleptics) helped significantly. IVIG works - but loses effect in 2-3 weeks. Only PEX produces lasting changes

So the lowdown is don't putz around with antibiotics or drugs, go straight to the big immunosuppressive guns.


What causes it? You guessed it ....

Every one of these kids have SKY HIGH strep markers, ASO 800-1000 range, anti-DNAase B >1:2720. At this time, I wasn't thinking about other PANDAS triggers .... these children were never tested for Mycoplasma or other triggers


In my view, this is the most severe PANDAS variant and is a neuropsychiatric quasi-emergency due to the risk of violence. It's a central catecholaminergic storm ...


We never measured Cunnigham panel on these kids, but I'll bet they show anti-neurotransmitter receptor antibodies.


If left alone, it resolves spontaneously in months-years. Resolution is often sudden.


Amazingly, outcome is excellent. Cognitive ability is preserved. This is one of the reasons why I believe the outcome in PANDAS, long-term, is good.