Ella Walter
Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and its subgroup, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS), are complex illnesses that affect up to 1 in 200 children. PANS/PANDAS can cause a range of severe symptoms, including obsessive-compulsive disorder (OCD), anorexia, acute separation anxiety, panic attacks, and various neurological issues. While PANS/PANDAS can be cured, it may require a multi-disciplinary approach and a combination of different treatments. Treatment options include antibiotics, steroids, IVIG therapy, over-the-counter anti-inflammatory drugs, and behavioural therapy, with an emphasis on addressing the underlying causes of the illness.
| Characteristics | Values |
|---|---|
| Curability | Yes, curable with careful management |
| Treatment | Multi-disciplinary approach, including CBT therapy, medication, behavioural therapy, education, psychotherapy |
| Treatment Providers | Licensed healthcare provider, primary care provider, multi-disciplinary team of specialists, PANS/PANDAS specialist, rheumatologist |
| Treatment Considerations | Individualised treatment protocols, start low and go slow with medication, careful management to avoid adverse reactions |
| Relapses | Possible, early treatment can minimise relapses, relapses tend to increase in duration and intensity with each episode |
| Remission | Possible, especially with early and timely treatment, vigilance required for reoccurrence of symptoms |
| Causes | Infection, most commonly strep, other bacterial, viral or environmental irritants, genetic vulnerability, location of infection |
| Symptoms | OCD, anxiety, depression, tics, panic attacks, anorexia, sleep disturbances, somatic symptoms, behavioural regression, emotional lability, irritability, aggression, deterioration in school performance, motor or sensory abnormalities |
| Onset | Acute, sudden and dramatic, abrupt |
| Diagnosis | Meet two of seven criteria, diagnostic criteria for acute onset originally stipulated for research purposes, difficulty receiving diagnosis from neurologist |
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What You'll Learn
- PANS/PANDAS can be cured
- Treatment options include antibiotics, anti-inflammatory drugs, steroids, psychiatric treatment, and CBT
- PANS/PANDAS is caused by an infection, most commonly strep
- Symptoms include OCD, anxiety, depression, tics, and anorexia
- PANS/PANDAS can be relapsing-remitting, chronic-static, or chronic-progressive
PANS/PANDAS can be cured
The first step in treating PANS/PANDAS is to identify and eradicate any underlying infections, most commonly strep infections. Antibiotics are often prescribed to resolve these infections and can lead to significant improvements in neuropsychiatric symptoms. In some cases, a longer course of antibiotics may be necessary, along with other treatments such as anti-inflammatory drugs, steroids, or psychiatric interventions.
Additionally, a three-pronged strategy is often employed to treat PANS/PANDAS symptomatically while addressing inflammation, immune system, and infections. This may include behavioural therapy, psychiatric medications, and educational interventions. It is crucial to individualize treatment plans based on the patient's severity of symptoms, course of illness, lab testing, and physical examination.
Furthermore, caregivers play a crucial role in the treatment process. They are encouraged to seek the help of a CBT therapist to learn techniques for managing OCD rituals, setting limits, and reinforcing good habits. Caregivers can also utilize CBT tools at home to minimize obsessions and compulsions and reduce long-term stress.
While PANS/PANDAS can be cured, it is important to be vigilant for symptom recurrence. Relapses can occur, and early treatment is essential to minimize their impact. Overall, with careful management and a tailored treatment approach, children with PANS/PANDAS can feel better and live full and fulfilling lives.
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Treatment options include antibiotics, anti-inflammatory drugs, steroids, psychiatric treatment, and CBT
PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are severe, acute-onset OCD disorders that can affect children. PANDAS is a subgroup of PANS, and both conditions are caused by infections, most commonly a strep infection. The onset of symptoms is often abrupt and dramatic, and they can include OCD, anxiety, depression, tics, anorexia, and panic attacks.
PANS and PANDAS can be treated and cured, but it may not be simple or straightforward and may require a multi-disciplinary approach. Treatment options include antibiotics, anti-inflammatory drugs, steroids, psychiatric treatment, and CBT. Antibiotics can help control or reduce symptoms of PANS/PANDAS by eradicating the underlying infection, and anti-inflammatory drugs can help control the inflammation caused by the autoimmune response. Steroids have also been used to treat PANS/PANDAS, although there is limited information on their effectiveness.
Psychiatric treatment for PANS/PANDAS may include medications and psychotherapy. Psychiatric medications should be implemented with a "start low and go slow" approach, with beginning doses typically at 1/4 or less of the typical dose. Benzodiazepines are often used as a first psychoactive treatment for PANS/PANDAS to help alleviate agitation, aggression, anxiety, and insomnia. CBT (cognitive-behavioral therapy) can also be an effective treatment for PANS/PANDAS, as it can help caregivers learn techniques to manage OCD rituals and other behaviors, set limits, and reinforce good habits.
Overall, treatment for PANS/PANDAS should be individualized and adjusted based on the patient's symptomology and severity. Early treatment is important to minimize relapses, which can increase in duration and intensity with each episode. With careful management and treatment, children with PANS/PANDAS can feel better and live full and fulfilling lives.
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PANS/PANDAS is caused by an infection, most commonly strep
PANS/PANDAS is caused by an infection, most commonly a strep infection. The infection results in inflammation in the brain. PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. PANS stands for Pediatric Acute-Onset Neuropsychiatric Syndrome. PANS/PANDAS causes a child's immune system to misdirect its response against bacterial, viral, or environmental irritants. This can lead to inflammation in the brain.
PANS/PANDAS is often relapsing-remitting, meaning that symptoms may disappear for extended periods and then reappear, stimulated by later exposure to strep or other bacteria, viruses, or environmental triggers. Symptoms may get increasingly severe with multiple recurrences. PANS/PANDAS can also be chronic-static or chronic-progressive. It is important to eradicate strep infections and other repeat infections, as they can cause serious problems.
PANS/PANDAS is typically preceded by a strep infection, with \"strep throat\" infections being the most common trigger. However, Strep A may also enter the nasal cavity or influence neuroimmune cells along the olfactory nerve, providing access to the brain. In addition to strep, PANS cases have also been linked to other infections, including Lyme disease, mononucleosis, mycoplasma (walking pneumonia), and the flu (such as H1N1).
The onset of PANS/PANDAS is often sudden and dramatic, with parents reporting that their child woke up a different person. Children with PANS/PANDAS may exhibit behavioral regression, acting much younger than their age, such as reverting to baby talk. They may also experience emotional lability, including severe depression or even suicidal thoughts. Other possible symptoms include irritability, aggression, deterioration in school performance, motor or sensory abnormalities, and somatic symptoms such as sleep disturbances.
Treatment for PANS/PANDAS typically involves a three-pronged strategy of symptom management, treating inflammation, supporting the immune system, and addressing infections. Antibiotics are often prescribed to resolve strep infections and can dramatically improve neuropsychiatric symptoms. Other treatments may include anti-inflammatory drugs, steroids, psychiatric medications, and psychotherapy. It is important to note that PANS/PANDAS treatment should be individualized and may require a multi-disciplinary approach.
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Symptoms include OCD, anxiety, depression, tics, and anorexia
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a childhood condition characterised by the sudden onset of obsessive-compulsive disorder (OCD) symptoms and/or eating restrictions following a bacterial or viral infection, including COVID-19. PANS is often linked to a strep bacterial infection, but it can also be caused by other infections such as Lyme disease, mononucleosis, walking pneumonia, and the flu.
PANS can cause a range of distressing and confusing symptoms in children, including OCD, anxiety, depression, tics, and anorexia. The onset of symptoms is usually abrupt and can include new fears, anxiety, depression, tics, changes in temperament, and sensory sensitivity. Children with PANS may also exhibit signs of psychological distress, such as excessive handwashing, refusal to eat certain foods, and struggling in school.
OCD symptoms in PANS can include severe obsessions, compulsions, or both. Children may experience new and intense fears or concerns about things being clean or dirty. These fears and concerns can be so strong that the child may be hard to comfort. Anxiety symptoms can include excessive worry, irrational fears, separation anxiety, or panic attacks. Depression symptoms can include emotional distress such as suicide ideation, inappropriate emotional reactions, or dramatic mood swings. Tics are also a common symptom of PANS and can be treated with therapy, such as habit reversal therapy.
Anorexia, or eating restrictions, is another possible symptom of PANS. Children with PANS may refuse to eat certain foods or all foods, which can be a cause for concern. It is important for parents to be caring and understanding and not to criticise or blame their child, as this may only lead to increased anxiety and exacerbate OCD symptoms. Instead, parents should try to empathise with their child, reassure them that they will get better, and encourage them to face their fears and deal with their emotions.
Treatment for PANS aims to address the underlying infection, as well as the individual symptoms. Antibiotics may be used to treat the infection, while psychiatric medications and behavioural therapy can help manage symptoms such as OCD, anxiety, and depression. It is important to individualise treatment plans and adjust them as needed, as symptomology and severity differ per child.
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PANS/PANDAS can be relapsing-remitting, chronic-static, or chronic-progressive
PANS/PANDAS can be cured, but it may not be simple or straightforward and may require a multi-disciplinary approach. The condition can be relapsing-remitting, chronic-static, or chronic-progressive.
Relapsing-remitting means that symptoms can worsen and improve over time. Being in remission is not the same as being cured, and parents and medical providers should be vigilant for a reoccurrence of symptoms. This is often referred to as a "flare" by families of those with PANS/PANDAS. To prevent relapses, early treatment is important. Relapses tend to increase in duration and intensity with each episode.
PANS/PANDAS is an episodic disorder, with symptoms disappearing for extended periods and then reappearing, often stimulated by exposure to strep or other bacteria or viruses. Symptoms may become increasingly severe with multiple recurrences. The onset of PANS/PANDAS is often abrupt and dramatic, and symptoms can include acute OCD, eating restrictions, anxiety, depression, tics, and other neurological issues.
Treatment for PANS/PANDAS is a three-pronged strategy, addressing symptoms, inflammation, and the immune system. Treatment must be individualized and will require adjustment based on the specific symptoms and severity of each case. Psychiatric medications should be implemented with a "start low and go slow" approach, with beginning doses typically at 1/4 or less of typical doses. In some cases, behavioural therapy, further education, and pharmacological treatments may be necessary.
It is important to note that PANDAS is a subgroup of PANS, and both conditions are gradually being understood as different variations in severity of a similar autoimmune attack on the brain. PANS/PANDAS occurs after an infection, most commonly a strep infection, but other bacterial, viral, or environmental irritants can also cause or exacerbate symptoms.
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Frequently asked questions
Yes, PANS can be cured. However, it may not be simple or straightforward and may require a multi-disciplinary approach. Treatment for PANS involves three different strategies: addressing inflammatory sources, regulating the immune system, and providing psychological and emotional support.
Treatment options for PANS include antibiotics, steroids, IVIG therapy, over-the-counter anti-inflammatory drugs, and behavioural therapy. It is important to note that PANS patients are more prone to adverse reactions to medications, so a "start low and go slow" approach is generally advised.
Symptoms of PANS vary from child to child but often include acute onset OCD, eating restrictions, behavioural regression, emotional lability, irritability, deterioration in school performance, motor or sensory abnormalities, and somatic symptoms such as sleep disturbances.
