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. 2019 Oct 1;7:395. doi: 10.3389/fped.2019.00395

Figure 2.

Figure 2

Map of the 20 Italian regions with number of patients per region (zero where not indicated). In accordance with the diagnostic criteria for PANDAS established by Swedo et al. (2), we selected children with the following characteristics:
  • - Presence of OCD and tics according to the diagnostic criteria for tics and OCD of the DSM-IV and DSM-V;
  • - Onset in childhood (from 3 years to puberty);
  • - Sudden onset and cyclic exacerbation of more severe symptoms, as the patient's parents consult doctors when the child begins to show tics, OCD and other pathological behaviors, or a return of past neuropsychiatric symptoms;
  • - Temporal connection between symptom onset and GAS infection [positive pharyngeal swab, high anti-streptolysin O titer; ASLOT (2)], as sometimes the infection has progressed by the time of disease onset (also 6–9 months), although most children experience symptom onset at 6 weeks;
  • - A connection with neurological abnormalities, including cognitive difficulties, worsening academic performance, dysgraphia, ADHD, depression, separation anxiety, irritability, emotional lability, oppositive behavior, sleeping difficulties, choreiform movements, and Romberg test abnormalities.