Marianne Martinez
Lyme disease, a tick-borne illness, has been identified as one of the many infections that can trigger Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). However, there is ongoing debate surrounding the causal relationship between tick-borne infections and PANS or its subset, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS). While Lyme disease is a well-known tick-borne illness, the link between ticks and PANS or PANDAS remains a subject of research and controversy.
| Characteristics | Values |
|---|---|
| PANS and PANDAS triggered by | Lyme disease, influenza, streptococcal infections |
| PANS and PANDAS symptoms | Tics, obsessive-compulsive behaviours, anxiety, depression, irritability, aggression, deterioration of motor skills, unusual movements, hallucinations, sensitivity to light, sound and touch, sleep disturbances, fatigue, anorexia, attention deficit disorder, bedwetting, changes in mood or personality, disinterest in food, fidgeting, deterioration in school performance, reduced coordination, separation anxiety, etc. |
| PANS and PANDAS treatment | Cognitive behavioural therapy, exposure and response prevention, steroids, tonsillectomy, adenoidectomy, antibiotic treatment |
| Lyme disease caused by | Tick bites |
| Lyme disease symptoms | Chest pain, inflammation of the brain and spinal cord, sensitivity to light and sound |
| Lyme disease treatment | Antibiotics |
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What You'll Learn
Lyme disease is a tick-borne illness that can cause PANS
PANS is a hypothesized disorder characterized by the sudden onset of obsessive-compulsive disorder (OCD) symptoms, severely restricted food intake, and severe neuropsychiatric symptoms such as anxiety, depression, irritability, aggression, and behavioral regression. PANS is believed to be triggered by infections, including Lyme disease, and is considered an autoimmune condition. This means that the body's immune system struggles to identify infections and ends up attacking healthy cells in the brain, causing inflammation and symptoms.
The link between Lyme disease and PANS has been recognized by organizations such as the Children's Lyme Disease Network (CLDN), which aims to raise awareness about the impact and prevalence of Lyme disease and other tick-borne infections in children. Lyme disease and PANS share similarities in their symptoms, which can include OCD, eating disorders, anxiety, mood swings, and attention deficit disorder. However, differentiating between the two conditions can be challenging due to overlapping symptoms.
While Lyme disease is a well-known tick-borne illness, the connection between tick-borne infections and PANS is still a subject of ongoing research and debate. Some experts argue that there is insufficient data to support a causal relationship between tick-borne infections and PANS or other behavioral disorders. However, cases of PANS triggered by Lyme disease have been reported, and the two conditions share similar characteristics.
The diagnosis of PANS involves ruling out other neurological or medical causes and meeting specific diagnostic criteria. Physicians may look for elevated levels of antineuronal antibodies, which can trigger inflammation in the brain and cause the sudden onset of OCD symptoms. Treatment for PANS aims to address the underlying infection and manage the neuropsychiatric symptoms through immune modulation interventions, cognitive behavioral therapy, and other approaches.
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PANDAS is a subset of PANS
PANDAS, or paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, is a subset of PANS, or paediatric acute-onset neuropsychiatric syndrome. PANDAS was first reported by a team at the National Institute of Mental Health in 1998.
PANDAS is thought to be related to a strep infection, whereas PANS is believed to result from other infections such as Lyme disease, influenza, varicella, or mycoplasma pneumoniae. PANDAS and PANS are triggered primarily by infections like Lyme disease, caused by the B. burgdorferi organism. Lyme disease and PANS share similarities. Although B. burgdorferi and GAβHS (the pathogen that causes strep) are vastly different microorganisms, they can both evade the immune system and invade a wide variety of tissues, including the central nervous system (CNS). Both can cycle between episodes of active disease and periods of remission. Physical, neurological, and cognitive symptoms can occur with each, and clinical presentations are very similar.
PANS is a clinically defined disorder characterised by the sudden onset of obsessive-compulsive symptoms (OCD) or eating restrictions, along with acute behavioural deterioration in at least two designated domains. 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; the presence of neurologic and neuropsychiatric abnormalities; and the occurrence of a strep infection before symptom onset.
PANDAS and PANS are increasingly recognised as a form of autoimmune encephalitis (AE), more specifically post-infectious basal ganglia encephalitis (BGE). Symptoms can cause serious debilitation and extreme neurological changes, including seizures and/or problems with balance, speech or vision. Psychiatric symptoms can also occur, including aggression, inappropriate or compulsive behaviours, or fear.
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PANDAS is thought to be related to a strep infection
PANDAS, or paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, is a subtype of PANS (paediatric acute-onset neuropsychiatric syndrome). PANDAS is believed to be caused by a strep infection, specifically an infection from streptococcal (strep) bacteria, such as strep throat or scarlet fever.
PANDAS is thought to occur when a child's immune system produces antibodies to fight the bacteria that caused the strep infection. However, these antibodies may also mistakenly attack healthy cells in other tissues because they mimic those of the strep infection. This is known as an autoimmune response, which results in a broad range of neuropsychiatric symptoms. These symptoms can include tics, obsessions, compulsions, and other symptoms with a sudden or abrupt onset that may be severe enough to qualify for diagnoses such as chronic tic disorder, OCD, and TS.
The symptoms of PANDAS are usually intense, occur quickly and unexpectedly, and may come and go over time. They can include compulsions (repetitive behaviours a person feels the urge to do) and obsessions (uncontrollable and recurring thoughts). The symptoms are thought to start suddenly and occur in episodes, lasting for a few days or weeks, then disappearing and returning. Psychological symptoms that have been reported to occur with PANDAS include anxiety or depression, bedwetting, changes in mood or personality, difficulty sleeping, disinterest in food, fidgeting, and symptoms similar to attention-deficit/hyperactivity disorder (ADHD).
PANDAS is primarily triggered by strep infections, whereas PANS is thought to result from other infections such as Lyme disease or influenza. Lyme disease is caused by the microorganism Borrelia burgdorferi, which is transmitted by the deer tick. However, it is important to note that experts from medical societies, including the AAN and the American College of Rheumatology, agree that there is no data to support a causal relationship between tick-borne infections and childhood developmental delay or behavioural disorders such as PANDAS.
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PANDAS and PANS are autoimmune disorders
PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) is an autoimmune disorder that occurs following an infection with Group A Streptococcus (strep). It is a subset of PANS. The symptoms of PANDAS include tics, obsessions, compulsions, and other symptoms with a sudden or abrupt onset, which may be severe enough to qualify for diagnoses such as chronic tic disorder, OCD, and TS.
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a hypothesized disorder characterized by the sudden onset of OCD symptoms or eating restrictions, concomitant with acute behavioural deterioration or severe neuropsychiatric symptoms. Lyme disease, a tick-borne illness, is one of several infections that can trigger PANS. PANS can also be triggered by Borrelia burgdorferi, the causative agent of Lyme disease.
PANDAS and PANS are increasingly recognized as forms of autoimmune encephalitis (AE), specifically post-infectious basal ganglia encephalitis (BGE). In PANS patients, antibodies attack healthy cells in the basal ganglia section of the brain, causing inflammation and symptoms.
The symptoms of PANDAS and PANS can last 4-6 weeks, assuming the underlying infection is detected and rapidly treated. However, if left untreated, PANDAS/PANS can cause permanent psychological and neurological issues.
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PANDAS and PANS can be treated with antibiotics
PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) and PANS (Paediatric Acute-onset Neuropsychiatric Syndrome) are thought to be triggered primarily by infections like Lyme disease. However, experts from medical societies, including the AAN, American College of Rheumatology, Infectious Diseases Society of America, and American Academy of Pediatrics, have stated that there is no evidence to support a causal relationship between tick-borne infections and childhood developmental delay or behavioural disorders such as ADHD, PANDAS, learning disabilities, or psychiatric disorders.
PANDAS is a subset of PANS and is characterised by the sudden onset of OCD symptoms, eating restrictions, and acute behavioural deterioration or severe neuropsychiatric symptoms. PANS, on the other hand, eliminated tic disorders as a primary criterion and placed more emphasis on acute-onset OCD, allowing for causes other than streptococcal infection.
In addition to antibiotics, other treatments for PANDAS and PANS include cognitive-behavioural therapy (CBT), plasmapheresis, and intravenous immunoglobulin (IVIG) therapy. CBT can help children better manage the mental and emotional difficulties associated with PANDAS and PANS. Plasmapheresis is an invasive procedure with associated risks, so it should only be performed in paediatric apheresis centres. However, it may be the preferred method of treatment for severe or life-threatening symptoms due to its quick response rate. IVIG therapy addresses the underlying infection and autoimmune reaction that causes PANDAS.
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Frequently asked questions
PANDAS stands for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. It describes a group of conditions thought to affect children with strep infections, such as strep throat or scarlet fever. Symptoms include tics, obsessive-compulsive behaviour, and other mental and neurological symptoms.
There is no evidence to support a causal relationship between tick-borne infections and PANDAS. Lyme disease, the most prevalent tick-borne disease, has been claimed by some to cause PANDAS, but this is contrary to the evidence.
Lyme disease is one of several infections that can cause PANS. Lyme disease is a bacterial infection caused by the tick-borne bacteria Borrelia burgdorferi.
The symptoms of PANDAS vary from child to child and can include a combination of psychological and neurological conditions. Psychological symptoms include anxiety, depression, bedwetting, changes in mood or personality, difficulty sleeping, disinterest in food, fidgeting, and separation anxiety. Neurological symptoms include tics, problems with handwriting, difficulty concentrating or learning, poor performance in school, reduced coordination, and sensitivity to light and sound.
Treatment for PANDAS generally follows the standard treatments for Tourette syndrome (TS) and OCD. This includes cognitive behavioural therapy (CBT) and antibiotic treatment for active strep infections.
