Paula Tran

All Publications

• Prevalence of Neurological Soft Signs at Presentation in Pediatric Acute-Onset Neuropsychiatric Syndrome. medRxiv : the preprint server for health sciences Zebrack, J. E., Gao, J., Verhey, B., Tian, L., Stave, C., Farhadian, B., Ma, M., Silverman, M., Xie, Y., Tran, P., Thienemann, M., Wilson, J. L., Frankovich, J. 2024

  Abstract

  Importance: Studies of brain imaging and movements during REM sleep indicate basal ganglia involvement in pediatric acute-onset neuropsychiatric syndrome (PANS). Characterizing neurological findings commonly present in patients with PANS could improve diagnostic accuracy.Objective: To determine the prevalence of neurological soft signs which may reflect basal ganglia dysfunction (NSS-BG) in youth presenting with PANS and whether clinical characteristics of PANS correlate with NSS-BG. Design, Setting, and Participants: 135 new patients who were evaluated at the Stanford Children's Immune Behavioral Health Clinic between November 1, 2014 and March 1, 2020 and met strict PANS criteria were retrospectively reviewed for study inclusion. 16 patients were excluded because they had no neurological exam within the first three visits and within three months of clinical presentation.Main Outcomes and Measures: The following NSS-BG were recorded from medical record review: 1) glabellar tap reflex, 2) tongue movements, 3) milkmaid's grip, 4) choreiform movements, 5) spooning, and 6) overflow movements. We included data from prospectively collected symptoms and impairment scales.Results: The study included 119 patients: mean age at PANS onset was 8.2 years, mean age at initial presentation was 10.4 years, 55.5% were male, and 73.9% were non-Hispanic White. At least one NSS-BG was observed in 95/119 patients (79.8%). Patients had 2.1 NSS-BG on average. Patients with 4 or more NSS-BG had higher scores of global impairment (p=0.052) and more symptoms (p=0.008) than patients with 0 NSS-BG. There was no significant difference in age at visit or reported caregiver burden. On Poisson and linear regression, the number of NSS-BG was associated with global impairment (2.857, 95% CI: 0.092-5.622, p=0.045) and the number of symptoms (1.049, 95% CI: 1.018-1.082, p=0.002), but not age or duration of PANS at presentation.Conclusions and Relevance: We found a high prevalence of NSS-BG in patients with PANS and an association between NSS-BG and disease severity that is not attributable to younger age. PANS may have a unique NSS-BG profile, suggesting that targeted neurological exams may support PANS diagnosis.Key Points: Question: Do patients with pediatric acute-onset neuropsychiatric syndrome present with neurological soft signs reflective of basal ganglia dysfunction, and are these examination findings associated with disease severity?Findings: In this cohort study of 119 patients with pediatric acute-onset neuropsychiatric syndrome, most patients presented with at least one neurological soft sign pertaining to the basal ganglia. The number of signs was associated with global impairment and the number of PANS symptoms. These findings are consistent with basal ganglia pathology in pediatric acute-onset neuropsychiatric syndrome.Meaning: Targeted neurological exams may help support the diagnosis of pediatric acute-onset neuropsychiatric syndrome.

  View details for DOI 10.1101/2024.04.26.24306193

  View details for PubMedID 38746142

• Development of Autoimmune Diseases Among Children With Pediatric Acute-Onset Neuropsychiatric Syndrome JAMA network open Ma, M., Masterson, E. E., Gao, J., Karpel, H., Chan, A., Pooni, R., Sandberg, J., Rubesova, E., Farhadian, B., Willet, T., Xie, Y., Tran, P., Silverman, M., Thienemann, M., Mellins, E., Frankovich, J. 2024; 7 (7)

  View details for DOI 10.1001/jamanetworkopen.2024.21688

• Sex and Aggression Characteristics in a Cohort of Patients with Pediatric Acute-Onset Neuropsychiatric Syndrome. Journal of child and adolescent psychopharmacology Gao, J., Chan, A., Willett, T., Farhadian, B., Silverman, M., Tran, P., Ahmed, S., Thienemann, M., Frankovich, J. 2022

  Abstract

  Objective: This study describes for the first time the characteristics by sex of patients with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), including clinical phenotype, treatment, and psychosocial aspects of disease. Methods: This cross-sectional study included 205 consecutive community patients evaluated between January 1, 2012 and March 30, 2019 and compared 87 females with 118 males. Our primary hypothesis was that males would display more aggression, as measured by the Modified Overt Aggression Scale (MOAS) and would be treated with immunotherapy earlier than females. The MOAS began to be administered 5 years into the study period, and 57 of the 205 families completed the MOAS for this study. Results: Our analysis revealed that males had a higher median MOAS score in the first year of clinic when compared with females (median 11, interquartile range [IQR] [4-24] vs. median 3, IQR [1-9]; p = 0.03) and a higher median subscore for physical aggression (median 4, IQR [0-12] vs. median 0, IQR [0-8]; p = 0.05). The median time from PANS symptom onset to first administration of immunotherapy, which did not include nonsteroidal anti-inflammatory drugs or short bursts of oral steroids, was 6.9 years for females and 3.7 years for males (p = 0.20). The two groups did not differ significantly in age of PANS onset, time from onset to clinic entry, other psychiatric symptom measures, or laboratory markers of inflammation. Conclusion: Among patients with PANS, males exhibit more aggressive behavior when compared with females, which may advance the decision to treat with immunotherapy. Scores that capture a more global level of functioning show that despite there being a higher level of aggression in males, female patients with PANS have similar levels of overall impairment.

  View details for DOI 10.1089/cap.2021.0084

  View details for PubMedID 35998241

• Children With PANS May Manifest POTS. Frontiers in neurology Chan, A., Gao, J., Houston, M., Willett, T., Farhadian, B., Silverman, M., Tran, P., Jaradeh, S., Thienemann, M., Frankovich, J. 2022; 13: 819636

  Abstract

  Pediatric acute-onset neuropsychiatric syndrome (PANS) is characterized by an abrupt-onset of severe psychiatric symptoms including OCD, anxiety, cognitive difficulties, and sleep issues which is thought to be a post-infection brain inflammatory disorder. We observed postural orthostatic tachycardia syndrome (POTS) which resolved with immunomodulation in a patient with Pediatric acute-onset neuropsychiatric syndrome (PANS). Here, we aim to present a case of POTS and to examine the prevalence of (POTS) in our PANS cohort, and compare the clinical characteristics of patients with and without POTS.We conducted this cohort study of patients meeting PANS criteria who had at least three clinic visits during the study period. We included data from prospectively collected questionnaires and medical record review. We present a case followed by statistical comparisons within our cohort and a Kaplan-Meier analysis to determine the time-dependent risk of a POTS diagnosis.Our study included 204 patients: mean age of PANS onset was 8.6 years, male sex (60%), non-Hispanic White (78%). Evidence of POTS was observed in 19/204 patients (9%) with 5/19 having persistent POTS defined as persistent abnormal orthostatic vitals, persistent POTS symptoms, and/or continued need for pharmacotherapy for POTS symptoms for at least 6 months). In this PANS cohort, patients with POTS were more likely to have comorbid joint hypermobility (63 vs 37%, p = 0.04), chronic fatigue (42 vs 18%, p = 0.03), and a family history of chronic fatigue, POTS, palpitations and syncope. An unadjusted logistic regression model showed that a PANS flare (abrupt neuropsychiatric deterioration) was significantly associated with an exacerbation of POTS symptoms (OR 3.3, 95% CI 1.4-7.6, p < 0.01).Our study describes a high prevalence of POTS in patients with PANS (compared to the general population) and supports an association between POTS presentation and PANS flare within our cohort.

  View details for DOI 10.3389/fneur.2022.819636

  View details for PubMedID 35557616

  View details for PubMedCentralID PMC9086964

• Pediatric Delirium in the Palliative Care Setting Interdisciplinary Pediatric Palliative Care Tran, P., Moss, J., Koh, E., Ort, K., Shaw, R. J., Goldsmith, M. 2021; 2nd: 264–281

  View details for DOI 10.1093/med/9780190090012.003.0020

• Chronic Fatigue Symptoms in Children with Abrupt Early-onset OCD And/or PANS Chan, A., Truong, A., Farhadian, B., Willett, T., Silverman, M., Tran, P., Thienemann, M., Frankovich, J. WILEY. 2020: 252–54

  View details for Web of Science ID 000542687800144

• Familial Clustering of Immune-mediated Diseases in Children with Abrupt-onset OCD Chan, A., Phu, T., Farhadian, B., Willett, T., Silverman, M., Tran, P., Thienemann, M., Frankovich, J. WILEY. 2020: 250–52

  View details for Web of Science ID 000542687800143

• Current Pharmacological Treatments for Childhood-Onset Somatic Symptom and Related Disorders (SSRD) and Functional Gastrointestinal Disorders (FGID) Current Treatment Options in Psychiatry Crawford, J., Tran, P., Shaw, J. S., Shaw, R. J. 2020; 7: 120–143

  View details for DOI 10.1007/s40501-020-00209-9

• Pediatric Inflammatory Brain Disease Complex Disorders in Pediatric Psychiatry Tran, P., Frankovich, J., Van Mater, H., Dale, R. C., Or-Geva, N., McHugh, A., Thienemann, M. 2018: 169-188

  View details for DOI 10.1016/B978-0-323-51147-6.00014-4