Tiffany Haney
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are rare disorders that typically affect children between the ages of 3 and puberty. PANS is caused by various infections, immune system issues, or environmental factors, while PANDAS is specifically associated with streptococcal infections such as strep throat or scarlet fever. Both disorders can cause a range of symptoms, including obsessive-compulsive disorder (OCD), tics, mood changes, and anxiety. While PANS and PANDAS are more common in children, adults can also be diagnosed with these disorders, although it is considered unlikely. Treatment options include antibiotics, intravenous immunoglobulin (IVIG) therapy, plasmapheresis, and cognitive behavioral therapy (CBT).
| Characteristics | Values |
|---|---|
| Can adults get PANS? | Yes, although rare, adults can be diagnosed with PANS. |
| Age of onset | PANS typically first appears in childhood, from age 3 to puberty. |
| Symptoms | Tics, obsessive-compulsive behaviour, anxiety, mood changes, irritability, aggression, depression, deterioration of motor skills, visual or auditory hallucinations, sensitivity to light, sound and touch, sleep disturbances, fatigue, restricted eating habits, bed-wetting, and frequent daytime urination. |
| Diagnosis | There is no lab test to confirm PANS. Diagnosis is based on a thorough evaluation of symptoms, medical history, and laboratory findings. |
| Treatment | There is no cure for PANS, but treatments such as IVIG, plasmapheresis, steroids, antibiotics, and tonsillectomy can help minimise the severity of symptoms. |
| Challenges | Many adults with PANS face challenges in finding specialised care and doctors who are familiar with the condition. |
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What You'll Learn
PANS and PANDAS are rare and lesser-known disorders
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a clinically defined disorder characterized by the sudden onset of obsessive-compulsive symptoms (OCD) or eating restrictions, along with acute behavioural deterioration in at least two designated domains. PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) is a subtype of PANS and was first reported by a team at the National Institute of Mental Health in 1998. While PANS and PANDAS are more prevalent in children, adults can be diagnosed with either disorder.
The exact causes of PANS and PANDAS are not known. PANDAS is specifically associated with an infection from streptococcal (strep) bacteria, such as strep throat or scarlet fever. PANS may be triggered by various infections, immune system issues, or environmental factors. One theory suggests that it is triggered by an immune response that leads to inflammation in the brain. When the immune system mistakenly attacks healthy brain tissue, it can result in sudden and severe symptoms such as obsessive-compulsive behaviours, tics, anxiety, and mood changes.
There is currently no cure for PANS or PANDAS, but treatments such as IVIG, plasmapheresis, antibiotics, and steroids can help minimize the severity of symptoms. However, finding care and support for these disorders can be challenging, especially for adults. Many patients face difficulties in getting a proper diagnosis and accessing effective treatment options.
Raising awareness about PANS and PANDAS is crucial, as it can help improve diagnosis and treatment for both children and adults living with these rare and complex disorders.
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Adults can be diagnosed with PANS or PANDAS
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are rare disorders that are typically associated with children. PANS is the general term for acute neuropsychiatric disorders in children, while PANDAS is a subset of disorders triggered by Group A streptococcal (strep) infections.
However, while PANS and PANDAS usually first appear in childhood, from age 3 to puberty, it is possible for adults to develop these conditions. There are reports of teenagers and adults with symptoms and lab results that support a PANS or PANDAS diagnosis. For example, one person shared their story of being diagnosed with PANDAS at 20 years old, and another shared their experience of struggling to find treatment for PANS as an adult.
The core symptoms of PANS include obsessive-compulsive behaviours (OCD) or restricted eating, along with acute behavioural deterioration in at least two designated domains. PANDAS shares many of the same symptoms as PANS, including tics, OCD behaviours, and other mental and neurological issues. However, to be diagnosed with PANDAS, the symptoms must be associated with a strep infection.
There is currently no cure for PANS or PANDAS, but treatments such as IVIG, plasmapheresis, antibiotics, and cognitive behavioural therapy (CBT) can help minimise the severity of symptoms.
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PANS is triggered by infections, immune system issues, or environmental factors
PANS, or Pediatric Acute-onset Neuropsychiatric Syndrome, 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. While PANS is more prevalent in children, adults can be diagnosed with the disorder.
PANS is believed to be triggered by one or more pathogens, including infections, immune system issues, or environmental factors. Infections that can trigger PANS include strep throat, scarlet fever, influenza, varicella, and mycoplasma pneumoniae. Lyme disease has also been proposed as a trigger for neuropsychiatric symptoms.
Strep infections typically occur in the oropharynx, tonsils, and anus, and each area should be examined and swabbed for culture. While "strep throat" infections are the most common trigger, PANS has also been reported to occur in association with perianal strep infections. Animal research also suggests that strep in the nasal cavity may enter or influence neuroimmune cells along the olfactory nerve, providing access to the brain through the third ventricle.
In addition to infections, PANS may be triggered by immune system issues. One theory is that PANS is triggered by an immune response that leads to inflammation in the brain. When the immune system mistakenly attacks healthy brain tissue, it can lead to sudden and severe symptoms, such as obsessive-compulsive behaviours, tics, anxiety, and mood changes.
Finally, PANS may be triggered by environmental factors. However, the exact causes of PANS are not yet known, and further research is needed to understand the role of infections, immune system issues, and environmental factors in triggering the disorder.
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PANDAS is a subset of PANS and is associated with strep infections
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a clinically defined disorder characterized by the sudden onset of obsessive-compulsive symptoms (OCD) or eating restrictions, along with acute behavioural deterioration in at least two designated domains. PANDAS is a subset of PANS and is specifically associated with an infection from streptococcal (strep) bacteria, such as strep throat or scarlet fever.
PANS and PANDAS are often overlooked and underdiagnosed medical conditions that can lead to changes in thinking and behaviour. They are neuroimmune conditions that are often not recognized, and it can take multiple doctor visits and years for children to get a proper diagnosis. PANS and PANDAS typically first appear in childhood, from age 3 to puberty, and it is uncommon for an adult to develop these conditions. However, there have been cases of teenagers and adults with symptoms and lab results that support a PANDAS diagnosis.
The symptoms of PANDAS include tics, obsessive-compulsive behaviour, anxiety, mood changes, deterioration of motor skills, visual or auditory hallucinations, sensitivity to light, sound and touch, sleep disturbances, fatigue, and more. The severity of symptoms and their onset can vary from patient to patient, but they usually present suddenly and intensely. Symptoms can improve and then worsen again, presenting in an episodic manner.
There is currently no cure for PANDAS or PANS, but treatments such as IVIG, plasmapheresis, steroids, tonsillectomy, adenoidectomy, and antibiotics can help minimize the severity of symptoms.
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PANS and PANDAS symptoms may disappear and then reappear
PANS and PANDAS are rare disorders that typically first appear in childhood, from age 3 to puberty. However, it is possible for adults to develop these conditions, although such cases are uncommon and not well studied. PANS and PANDAS are characterised by a range of symptoms, including obsessive-compulsive behaviours, tics, anxiety, mood changes, and restricted eating habits.
The symptoms of PANS and PANDAS can vary in severity and onset, but typically present suddenly and intensely. Importantly, these symptoms can be episodic, meaning they may disappear for extended periods and then reappear. This is thought to occur due to the underlying cause of PANS and PANDAS, which is believed to be related to the immune system's response to infections. Specifically, PANDAS is associated with streptococcal infections, such as strep throat or scarlet fever, while PANS can be triggered by various infections or other factors.
In the case of PANDAS, the first signs typically appear in early childhood, as most children develop antibodies to strep by the age of 12. However, strep infections can still occur during and after puberty, and there are reports of teenagers and adults with symptoms and lab results supporting a PANDAS diagnosis. For example, one individual shared their experience of being diagnosed with PANDAS at age 20, highlighting the challenges of finding specialised care for adults with this condition.
The episodic nature of PANS and PANDAS symptoms may be influenced by the recurrence of infections. When an infection reoccurs during the healing process, PANS/PANDAS episodes tend to become longer and more severe. Therefore, preventing infections while healing is crucial to managing these disorders. Once the infection is eradicated, individuals typically develop a normal immune response and experience symptom remission.
While there is currently no cure for PANS or PANDAS, treatments such as IVIG, plasmapheresis, and antibiotics can help minimise symptom severity. Additionally, cognitive behavioural therapy (CBT) and habit reversal training can help manage behavioural problems and reduce the frequency of symptoms.
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Frequently asked questions
Yes, adults can be diagnosed with PANS. While PANS is more prevalent in children, there are reports of teenagers and adults with symptoms and lab results that support a PANS diagnosis.
The core symptoms of PANS are OCD-like behaviours or restricted eating. Other symptoms include tics, anxiety, sensory amplification or motor abnormalities, behavioural regression, deterioration in school performance, mood disorder, urinary symptoms and/or sleep disturbances.
PANS is diagnosed by a healthcare provider using the following criteria: sudden onset of OCD or severely restricted food intake, sudden onset of at least two other neuropsychiatric symptoms, history of a strep infection within 3 months of symptom onset, and physical hyperactivity or unusual, jerky movements.
There is currently no cure for PANS. However, there are treatments such as IVIG, plasmapheresis, and antibiotics that can minimize the severity of symptoms.
PANS is the general term for acute neuropsychiatric disorders in children, while PANDAS is a subtype of PANS specifically associated with an infection from streptococcal (strep) bacteria. PANDAS typically first appears in childhood, from age 3 to puberty, but it is possible for adults to develop this condition.
