Understanding PANDAS/PANS
What is PANDAS/PANS?
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) occur after an infection, most commonly a strep infection. Brain inflammation occurs when the body’s immune system mistakenly attacks healthy brain cells, leading to autoimmune processes that affect central nervous system function. An affected child generally has a sudden, dramatic change in personality, displayed as obsessive-compulsive disorder (OCD), anxiety, tics or other abnormal movements, personality changes, decline in math and handwriting abilities, sensory sensitivities, restrictive eating and more. Read our detailed “what is PANDAS” beginners guide to learn more.
The Impact
PANDAS/PANS is increasingly recognized as a form of autoimmune encephalitis (AE)—more specifically post-infectious basal ganglia encephalitis (BGE). There are different types of AE and they should be considered in a differential diagnosis to PANDAS/PANS. Symptoms can cause serious debilitation and extreme neurological changes in AE, including seizures and/or problems with balance, speech or vision. Psychiatric symptoms also occur and can include aggression, inappropriate or compulsive behaviors or fear. In general, testing for clinical features of AE includes testing for autoantibody markers in the cerebral spinal fluid (CSF)—but because this is a new field of treatment, CSF can be negative for aberrant, disease-inducing illness. This is why research is developing rapidly for PANDAS/PANS or BGE and all other forms of AE in major medical centers around the world.
To better understand the spectrum of PANDAS / PANS and autoimmune encephalitis (AE), watch this brief video from psychiatrist Dr. Barbara Hale-Richlen.
Signs and Symptoms of PANDAS/PANS
The severity of symptoms and the onset of PANDAS/PANS can vary from patient to patient, but the symptoms usually present suddenly and intensely. Symptoms can get better and then get worse again, presenting in what’s known as an episodic manner.
Possible PANDAS/PANS symptoms can include:
- Sudden, acute onset of OCD.
- Restrictive eating habits.
- Irritability or aggressive behavior.
- Extreme moodiness or depression.
- Deterioration of motor skills.
- Tics and unusual movements.
- Visual or auditory hallucinations.
- Sensitivity to light, sound, and touch.
- Sleep disturbance or fatigue.
Diagnosing PANDAS/PANS
PANDAS/PANS is a rare and lesser-known disorder, and doctors often mistake it for other conditions. Meeting with a specialist is the best way to get a diagnosis. A clinical diagnosis will be made by a doctor based on testing for active infections, as well as evaluating the signs, symptoms, medical history, and laboratory findings that rule out other known neurological or medical disorders. Providing a thorough medical history and description of symptoms can help aid the diagnosis.
PANS criteria include sudden onset of obsessive-compulsive disorder (OCD) or severely restricted food intake. Two of the following seven criteria are also required to make a diagnosis:
- Anxiety.
- Emotional lability (mood swings) or depression.
- Irritability, aggression or oppositional behavior.
- Behavioral (developmental) regression.
- Sudden deterioration in school performance.
- Motor or sensory abnormalities including tics or involuntary movements.
- Somatic signs and symptoms, like sleep disturbances or bedwetting (enuresis).
PANDAS is a subcategory of PANS. This was an earlier research definition used to explain a Group A strep-related infectious onset. PANDAS has five distinct criteria for diagnosis:
- Abrupt onset of OCD, or dramatic, disabling tics.
- An episodic symptom course, or relapsing-remitting course of severity.
- Pre-pubertal onset.
- Presence of neurologic and neuropsychiatric abnormalities.
- Occurrence of a strep infection before symptom onset.
Treating PANDAS/PANS
When treated in a timely fashion, PANDAS/PANS appears to be stopped and potentially cured with prompt immune modulation interventions. Some children continue to relapse and require additional testing. Research following children over the years into adulthood is underway to ascertain this evidence. It is known that early treatment of PANDAS is important to reduce the duration and intensity of a patient’s symptoms. Untreated, PANDAS/PANS can cause permanent psychological and neurological issues.
When treating PANDAS/PANS, it is important to get rid of strep infection or other infections completely. Exposure to illnesses from family and friends needs to be avoided while the child is healing. Antibiotic treatment can cure a current strep infection and used as prophylaxis can prevent new infections while simultaneously calming the autoimmune processes affecting the brain. Strep or other infections can reoccur while healing, and PANDAS/PANS episodes tend to get longer and worse after each infectious recurrence. Therefore, diligence to prevent infections while healing is important. Once healed and infections eradicated, the child usually develops a normal autoimmune response and no longer has symptom flares.
Methods of treating PANDAS/PANS may include:
- Antibiotics to treat and prevent strep or other bacterial infections
- Antiviral if viral infections are persistent
- Intravenous immunoglobulin treatments
- Plasmapheresis (Apheresis) or Plasma Exchange (PEX), is a process during which harmful autoantibodies are removed from the blood system
- Steroids can reduce the inflammation occurring in the child’s brain
- Tonsillectomy and adenoidectomy where the chronic infection is reoccurring
- Cognitive behavioral therapy and/or exposure and response prevention
Frequently Asked Questions About PANDAS and PANS
Below are the most commonly asked questions about PANDAS and PANS. If you still have questions search our FAQ page to find answers to the most common questions asked by parents, clinicians, and educators.
PANDAS is an autoimmune condition that occurs following infection with Group A Streptococcus (strep). This disease is categorized as Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). Therefore, PANDAS is a type of PANS. In other words, PANDAS without strep is PANS. Other causes of PANS involve other infections such as Borrelia burgdorferi (Lyme disease) and Influenza (Flu).
The symptoms of PANDAS and PANS can last 4-6 weeks assuming the underlying infection is detected and rapidly treated. However, symptoms can reemerge if the child is reinfected.
Currently, there is no cure for PANDAS or PANS. However, there are treatments such as IVIG, plasmapheresis, and antibiotics that can minimize the severity of symptoms.
While PANDAS and PANS are more prevalent in children adults can be diagnosed with PANDAS or PANS.
The Centers for Disease Control and Prevention do not categorize PANDAS or PANS as a disability. In fact, the U.S. regulatory health agencies have not officially recognized PANDAS or PANS as childhood diseases. However, many of the underlying symptoms of PANDAS or PANS are recognized as “child development-specific conditions“, such as anxiety, OCD, and Tourette Syndrome.
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