Wikipedia:Articles for deletion/Pediatric acute-onset neuropsychiatric syndrome


 * The following discussion is an archived debate of the proposed deletion of the article below. Please do not modify it. Subsequent comments should be made on the appropriate discussion page (such as the article's talk page or in a deletion review).  No further edits should be made to this page.

The result was   redirect to PANDAS. Anything that editorial consensus finds useful can be merged from the page history.  Sandstein  13:37, 3 March 2012 (UTC)

Pediatric acute-onset neuropsychiatric syndrome

 * – ( View AfD View log )

POV content fork from PANDAS (a highly contentious topic about a hypothesized condition), creating a fork about yet another hypothesized subset of PANDAS. Neither are recognized diagnoses: both are contentious and contested hypotheses. This entire article was based on only one source, a proposal, and the rest of the article uses sources (some primary and not in accordance with WP:MEDRS) that are actually related to PANDAS: that is, most of the article is synthesis, using sources unrelated to the hypothesized PANS condition, and furthering POV by use of primary sources rather than secondary reviews (in the wrong article, noless). I've removed the PANDAS-specific info and what is left is the single source relating to PANS; the PANDAS article might mention that Swedo has put forward a second hypothesis. I have not put up a merge dicussion because the author who created the PANS article previously attempted to create similar at PANDAS, so we need to get community consensus on this. Here are the only two sources mentioning PANS in Google scholar:


 * Google scholar (One an advocacy group, not a MEDRS)

There are no mentions in PubMed of PANS that I can find. This is a content fork created that furthers POV after the primary-sourced text (disagreeing with secondary reviews) was removed from PANDAS. Sandy Georgia (Talk) 19:09, 24 February 2012 (UTC)
 * Update: In spite of my long explanations here and on talk about the incorrect use of primary sources, synthesis, POV, and false info in the article, Buster23 has now reverted to that version. Sandy Georgia  (Talk) 17:56, 25 February 2012 (UTC)


 * Merge/redirect. Merge salvageable sentence or two to PANDAS. Most of what is written here is not about PANS, but PANDAS, is based on primary sources, and the only new info is that Swedo has now proposed PANS as a subset of the hypothesized PANDAS. Sandy Georgia  (Talk) 19:09, 24 February 2012 (UTC)
 * Switch from delete to the more correct merge/redirect, which better addresses this situation. Sandy Georgia  (Talk) 14:23, 26 February 2012 (UTC)


 * Note: This debate has been included in the list of Medicine-related deletion discussions.  • Gene93k (talk) 18:44, 24 February 2012 (UTC)
 * Note: This debate has been included in the list of Behavioural science-related deletion discussions.  • Gene93k (talk) 18:45, 24 February 2012 (UTC)


 * Merge/redirect to PANDAS. I agree that there's no way this merits a content fork at present, and it can be handled with a couple of sentences (at most) in the PANDAS article. I think it can just be redirected without a fuss, although perhaps that's naive. Disclosure: saw notice of this AfD at WT:MED. MastCell Talk 21:39, 24 February 2012 (UTC)


 * Merge/redirect. Does not appear to be of significant material to justify its own article yet. Yobol (talk) 22:55, 24 February 2012 (UTC)
 * Are you basing that on the content of the article at the time it was nominated for deletion, or its content after it had been edited to remove content that the nominator believed was false or otherwise problematic? --Demiurge1000 (talk) 16:40, 25 February 2012 (UTC)
 * I'm not sure what you mean by "false"? The text I removed was 1) text from PANDAS sources with no mention of the newer PANS hypothesis, based on 2) primary sources when multiple secondary sources compliant with WP:MEDRS are available, and 3) POV because it cherry-picked those primary sources to present one side of the argument (not all supported by secondary reviews compliant with WP:MEDRS).  In other words, as well discussed long ago with the creator of this article, there are multiple secondary sources that can be used to write neutral text at PANDAS; he chose instead to create a POV content fork to a new hypothesis PANS, utilizing primary sources in spite of knowing about MEDRS, and based on only two sources available that suggest that the (failed) PANDAS hypothesis might now become PANS instead.  If he had 1) added text based on the multiple secondary reviews available, 2) to the correct article (PANDAS), and 3) mentioned the emerging idea of PANS instead of PANDAS, then 4) should medical consensus or sources emerge over time that support PANS over PANDAS (which could eventually happen, who knows), we would instead be discussing writing the PANS article with PANDAS being a shorter article about a failed hypothesis that points to the new PANS hypothesis.  We aren't yet at that point; even if we were, creating a POV content fork and chocking it full of primary sources that don't even discuss the PANS hypothesis-- after I had educated him about WP:MEDRS and the secondary sources available-- wasn't the best use of his time. Sandy Georgia  (Talk) 17:26, 25 February 2012 (UTC)
 * By "false" I meant the material that you removed or altered with edit summaries such as "false"; and similar. --Demiurge1000 (talk) 17:47, 25 February 2012 (UTC)
 * Ah, ok, yes-- thanks. I did remove some info that was false. For example, there was an infobox attached to the article that was blatantly false and misleading; it used ICD codes etc for OCD, leaving the impression that PANS was a recognized diagnosis.  Sandy Georgia  (Talk) 17:51, 25 February 2012 (UTC)
 * (reply to Demiurge1000) The original version, as far as I can tell, has only one reference that actually speaks to the new diagnosis (PANS); every other one is a discussion of PANDAS or speaks to neither specifically. That out of 43 references only one uses the actual term in the title of the article suggests something is wrong in this situation. Yobol (talk) 18:00, 25 February 2012 (UTC)
 * (reply to SandyGeorgia) PANS is by definition a subset of OCD and therefore the infobox was not false. Buster23 (talk) 18:10, 25 February 2012 (UTC)
 * PANS is not "defined to be" anything until/unless it gets its own ICD code or is added to DSM-5. One paper does not make consensus for recognition of this as a condition. Now given that Swedo (the originator of the PANDAS hypothesis at NIMH) is the head of the DSM-5 committee, that may well happen, but it hasn't yet, and I'm not aware of any move in that direction.  Are you?  The infobox is false and misleading, and you are edit warring to reinstate it.  I have searched DSM5.org (where most proposed changes are well underway and have been for quite some time) and find no mention that PANDAS or PANS are proposed additions to DSM5, and Leckman had a few things to say about that wrt PANDAS (which, again, is not PANS).  Sandy Georgia  (Talk) 18:21, 25 February 2012 (UTC)
 * This discussion is likely better for the PANS talk page than on a discussion of whether the article should be deleted or not. I'm very glad to hear that you are saying PANDAS is not PANS -- that's exactly why the articles shouldn't be merged. Buster23 (talk) 18:29, 25 February 2012 (UTC)
 * Um, no, the discussion is here where others less informed about these highly contentious hypothesized conditions can learn. I'm glad you acknowledge that the new hypothesis PANS is not PANDAS, after building an entire article on PANS using PANDAS sources that don't even mention PANS.  The new hypothesis-- about which only one article has been written to date-- can be mentioned in the article about the old hypothesis it is replacing, until there is some consensus or research.  Any article should use MEDRS-compliant sources correctly.  Sandy Georgia  (Talk) 18:51, 25 February 2012 (UTC)
 * When I say PANDAS is not PANS, I'm highlighting that there are differences between the two that led to the workshop and the concensus position of defining PANS. PANS does not replace PANDAS but is in addition to it.  PANS is focused on sudden onset OCD regardless of etiology.  PANDAS focuses on etiology (i.e., the anitbody response).  I agree with you that the history and context is quite important. I disagree with you about the balance. The recent review by Murphy and Kurlan indicates 72 papers that are PRO pandas and only 17 that are CON.  The CON paper did not look at onset.   Buster23 (talk) 19:13, 25 February 2012 (UTC)
 * More misunderstanding: the Murphy/Kurlan is not a review, it is yet another proposal for a way forward on the failed PANDAS hypothesis, exactly as this one (PNAS) proposal is. Again, until some more literature supports which proposal will take hold, only a brief mention in warranted in the PANDAS article of proposals for how to move forward on that failed hypothesis.  There are no reviews of the PNAS proposal, and the one article about it is not even PubMed indexed at this time.  How many "pro" and "con" sources are included in one paper, that is not a review, and is not even about PNAS, is an irrelevent red herring. Consider that there is less need to cite multiple "con" sources because those that are available are quite well researched and written and enjoy consensus among most researchers outside of the NIMH. Sandy Georgia  (Talk) 15:03, 26 February 2012 (UTC)


 * (reply to SandyGeorgia) The reference to Leckman's commentary on DSM-V is quite good and seems quite balance. In the body he states that "A growing body of evidence supports the existence of the PANDAS subtype.[124]" he also balances this with "However, PANDAS remains a controversial area of science, with a significant fraction of experts doubting its existence.[49,128]."  Leckman continues discussion in "From Reseach Subgroup to Clinical Syndrome" http://intramural.nimh.nih.gov/pdn/PANDAS-to-PANS2012.pdf  highlighting that "The acuity of symptom onset is the hallmark feature of their clinical presentation and the basis for the name proposed for an expanded clinical entity: Pediatric Acute-onset Neuropsychiatric Syndrome (PANS)." and "studies that did not clearly establish acuity of onset for their PANDAS cases found few differences between the cases and non-PANDAS controls."  I appreciate that the discussion here is about PANS and not necessarily PANDAS, but the two are related which is why the context/history is part of the article. Buster23 (talk) 21:40, 25 February 2012 (UTC)
 * You've left out quite a bit, but focusing only on your last sentence, to keep this brief-- you've given another reason why this should be merged to PANDAS until/unless more is written. And you've failed to note (in several places) that PANS is proposed for research purposes, specifically to help clear up the many problems with the PANDAS hypothesis.  It's not ready to stand alone yet; it may be, with more research and more publication, but it's not yet, and I'm concerned that because this is a very difficult topic even for physicians, misinformation about all four conditions (TS, OCD, PANDAS and PANS) is now being spread across multiple articles, based on misreading of sources.  Sandy Georgia  (Talk) 03:34, 26 February 2012 (UTC)
 * So just clarifying, your argument is that until you have more articles referencing the paper, you aren't ready to include it in wikipedia -- despite review by the National Institute of Mental Health (http://intramural.nimh.nih.gov/pdn/web.htm) and the international OCD Foundation (http://ocfoundation.org/PANDAS/)?  How many other reliable sources would be required before it will gain your support for an article? Buster23 (talk) 08:44, 26 February 2012 (UTC)
 * An advocacy organization repeating one paper-- which is a working hypothesis for resolving the problems with the PANDAS hypothesis-- does not notability make, and the requirements for notability have already been explained to you at length on article talk. This is a one-paper proposal, not even PubMed indexed, not yet subject to secondary review.  Yes, on any topic, we need more than one source-- unrelated to the subject-- to establish notability.  Swedo is as related to PANDAS/PNAS as can be, considering she launched the unproven hypothesis.  Leckman is part of a proposal to redefine the unproven PANDAS hypothesis.  Until there is more to go on, that proposal belongs in the PANDAS article.  Sandy Georgia  (Talk) 14:23, 26 February 2012 (UTC)


 * Include. Please read the original article before the severe edits. It is true that the article relies on ( http://dx.doi.org/10.4172/2161-0665.1000113 that can be viewed at http://intramural.nimh.nih.gov/pdn/PANDAS-to-PANS2012.pdf) published in Pediatrics and Therapeutics this month.  This article provides the new name PANS and represents a consensus position of the workshop at the NIH.  This article is noteworthy for its consolidation of clincial assessments.  You may also wish to review the description at the National Institute of Mental Health http://intramural.nimh.nih.gov/pdn/web.htm -- which was used as a secondary reference in compliance with WP:MEDRS. The history that was moved incorrectly moved to the talk page provides the context as PANS is a derivative of the PANDAS critiera providing better specificity to enable epidemiologic studies. Buster23 (talk) 17:31, 25 February 2012 (UTC)
 * — Buster23 (talk • contribs) has made few or no other edits outside this topic.
 * Anything published by the NIMH should be viewed in context: the PANDAS hypothesis originated at the NIMH, with Susan Swedo, and has been forcefully pushed by them in spite of independent medical studies that have never supported it; they are not an independent source on the matter.  That consensus may finally be emerging that they were wrong-- and PANS may be the newer hypothesis-- is well and good, but we still don't write an article using primary sources that don't even mention that subject, based on one legitimate paper that suggests that PANS may be the newer emerging hypothesis.  When you take out all of the incorrectly used primary sources about PANDAS, there is nothing left in this article except one source that proposes that PANDAS becomes PANS.  That can be added to PANDAS, and PANDAS should be written correctly, using the secondary reviews available.  If/when there are more sources to support PANS, that article can be written-- but not using primary sources that don't even mention PANS.  Sandy Georgia  (Talk) 17:38, 25 February 2012 (UTC)
 * Oh goodness. The consensus position (including Dr. Leckman who is an author on the paper) and the content from Dr. Kurlan (who provided content to the paper and reviewed the quote) that "studied that adhered closely to th PANDAS diagnostic criteria produced positive dataa and were seen as supporting a role for GAS in the etiology of neuropsychiatric symptoms".  The specific issue highlighted in that paper was that papers disputing PANDAS did not look at onset. This is specifically why the PANS criteria was create -- to ensure parties are comparing the same sample group. Buster23 (talk) 18:16, 25 February 2012 (UTC)
 * As I said, it is well and good that credible researchers the likes of Jim Leckman are proposing a way forward on the PANDAS notion pushed by Swedo and the NIMH, but one paper does not a diagnosis make. And the single source available is clear that it's not a diagnosis, rather a definition for research purposes. "The goal of the new PANS criteria is to attempt to define the clinical presentation of a relatively narrow group of patients in order to improve the comparability of research samples. ... The proposed criteria should be considered as 'working criteria', which will undergo modifications and refinement as additional clinical and research experience is accrued. ... The draft criteria must now be validated through careful, systematic application in clinical practice and research investigations. ... Research investigations are required to evaluate the validity, reliability and utility of the draft criteria, as well as to evaluate potential etiologic factors and mechanisms of disease that might be common to the disorders subsumed under the PANS clinical description." The article presents this as a diagnosis, based on one source, that postulates a working definition for research purposes.  Sandy Georgia  (Talk) 06:19, 26 February 2012 (UTC)
 * I'd be supportive of changing the word "diagnosis" to "working criteria" Buster23 (talk) 08:44, 26 February 2012 (UTC)
 * That discussion is already on article talk, the numerous errrors in the article and not supported by sources are laid out there, and since you have already breached the WP:BRD cycle by reverting to that incorrect text without discussion, it would behoove you to address those comments on talk by correcting the article yourself, since the errors were re-introduced by you. That, however, has nothing to do with the deletion discussion.  Sandy Georgia  (Talk) 14:26, 26 February 2012 (UTC)


 * P.A.N.D.A.S. was first identified in the late 20th century. The literature internationally has grown exponentially over the past decade. This is a formally acknowledged disorder in virtually every country with modern medicine, from Finland to New Zealand, Japan, Western Europe, South America, you name it. It remains "controversial" in the United States for political reasons. The two primary political reasons are firstly that the crowd at Harvard and Johns Hopkins bristle at the notion that someone other than they discovered something in vigorously denied the existence of this until about 2006 when Harvard tried to claim that they discovered it to the vast amusement of the world medical community. Secondly, the NIH has been slow to formally acknowledge it and continues to keep it "under investigation" because of pressure from the insurance industry. The PANS article on Wikipedia was a much better article on these conditions.  It had more up to date information and did a better job of explaining the condition to someone who might be looking up this type of condition on Wikipedia.  It seems that it has now been edited to reduce its usefulness ...for what reason I can only speculate.  Maybe someone associated with Harvard or the insurance industry...  — Preceding unsigned comment added by Werelived (talk • contribs) 20:27, 25 February 2012 (UTC)  — Werelived (talk&#32;• contribs) has made few or no other edits outside this topic.
 * This page is not a forum to discuss PANDAS or PANS in general but is a discussion on whether the PANS page meets notability guidelines or not. Please refrain from conspiracy minded digressions and focus on the point of this discussion. Yobol (talk) 20:34, 25 February 2012 (UTC)
 * Not to mention that most of what Werelived (another SPA) wrote above is utter and complete bunk (history is wrong, mention of Harvard is from left field, they were never major players in the PANDAS issue, the NIH statements are wrong, and the insurance issue is a red herring. And no one working on the PANDAS articles on Wikipedia is from Harvard or works in the insurance industry-- Tim Vickers CV is well known and documented on Wikipedia).  I should mention that there are now at least three internet support groups for parents supporting PANDAS (which in some cases, translates roughly to-- I insist that antibiotics will cure my child's neurobiological, genetic condition, and I want insurance to pay for unlimited antibiotics even when my child has no active strep infection), so we should expect more PANDAS SPAs to show up, and likewise refuse to engage WP:MEDRS. Oh, I guess I'm now associated with Harvard or the insurance industry.  Sorry to disappoint, Stanford SAHM.  Sandy Georgia  (Talk) 15:07, 26 February 2012 (UTC)


 * RESOLUTION?

It looks like we may have resolution here. I see that Sandy has changed her position to merge/redirect rather than delete. I can support that position and work on appropriate text on the PANDAS article until such time as there are more articles on PANS and PITAND. By the way, when there are position changes, don't we normally strike the old comment through and replace with new text per WP:REDACT. Just trying to follow the rules here. Buster23 (talk) 17:59, 26 February 2012 (UTC)
 * I'm not experienced at AFD-- it wasn't my intent to change my position (you'll see that I mentioned a "merge" proposal in my nomination blurb), but I misstated what should happen here. A Delete makes it harder to recreate the article should the situation change (that is, should PANS gain consensus, more sources, etc).  Considering that PANS may advance as an accepted hypothesis, and additional sources may eventually be available, a merge/redirect for now allows us to recreate the article if warranted at a later date subject to developing consensus to do so.  So I misstated what should have been merge and redirect all along: I'm sorry for any confusion created. We merge correct text to PANDAS, from whence the PANS hypothesis developed, and should literature eventually support it, we can discuss then whether to write a new PANS article-- with correct sourcing.  Sandy Georgia  (Talk) 22:17, 29 February 2012 (UTC)
 * It sounds like there's general agreement on a merge/redirect, then? Absent any objection, I'd propose just redirecting the article and closing this AfD. Relevant text can be merged from the page history. MastCell Talk 22:50, 29 February 2012 (UTC)
 * The above discussion is preserved as an archive of the debate. Please do not modify it. Subsequent comments should be made on the appropriate discussion page (such as the article's talk page or in a deletion review). No further edits should be made to this page.