Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep (PANDAS) and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) are neuropsychiatric syndromes triggered by a misdirected immune system response.

Patients may experience symptoms after a “strong stimulant” to the immune system, such as strep infection, flu, pneumonia or even the common cold. In patients with PANDAS/PANS, the immune system is thought to mistakenly react and cause an autoimmune reaction that causes inflammation in the part of the brain responsible for motor control, executive functions, behaviors and emotions. This reaction may cause neurological, psychological and cognitive symptoms as a result of neurological inflammation.

PANDAS/PANS can produce sudden, uneven and unusual symptoms in children, typically aged 4 to 10 years. But it can also occur in teens, and new research indicates that it can occur into young adulthood as well. Symptoms may include separation anxiety, obsessions and compulsions, inability to tolerate certain activities, tics, involuntary movements or hyperactivity. Caretakers may also observe changes in handwriting and academic performance, reduced attention span, changes in eating and sleep habits, increased sensory sensitivity and other changes in personality or behavior.

The following treatments can help alleviate PANDAS/PANS symptoms:

• Antibiotics, including penicillin, Augmentin, Cephalosporins and Azithromycin to treat a current infection and prevent recurrent infections.
• IVIG, an intravenous pooled blood product composed of immunoglobulins, that is used to treat immune deficiencies, encephalitis and other medical conditions.
• Plasmapheresis (apheresis) or plasma exchange (PEX), a process during which harmful auto-antibodies are removed from the blood system. 
• Steroids, which likely reduce the inflammation occurring in the child’s brain. 
• Tonsillectomy and adenoidectomy, which should both lower the chances of a person contracting strep and, if there is a latent infection in tonsil crypts, this will also be addressed. These are being studied to possibly calm overactive immune cell production. 
• Cognitive behavioral therapy or exposure and response prevention, which may be beneficial for a recovering PANDAS child.

There is limited research on PANDAS/PANS, and the condition is often misdiagnosed. Additionally, PANDAS/PANS may occur with other autoimmune disorders, immune deficiency or other neurological or psychiatric disorders. This can make treatment and management more complex. PANDAS/PANS are sometimes overlooked by clinicians who assume that there is not an underlying medical cause for the patient’s psychiatric symptoms.