Marianne Martinez
Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is a rare condition that causes a sudden onset of obsessive-compulsive symptoms and/or severe eating restrictions, along with at least two other cognitive, behavioural, or neurological symptoms. PANS is not life-threatening in itself, but some of its comorbidities can cause significant morbidity if not managed. One of the symptoms of PANS is clinical depression, which can become so severe that it is accompanied by suicidal ideation. PANS is believed to be caused by an infection, usually strep, which triggers an immune response that leads to inflammation in the brain.
| Characteristics | Values |
|---|---|
| Definition | Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is characterized by the sudden onset of obsessive-compulsive symptoms and/or severe eating restrictions, along with at least two other cognitive, behavioral, or neurological symptoms. |
| Symptoms | Behavioral regression, emotional lability, irritability, aggression, deterioration in school performance, motor or sensory abnormalities, somatic symptoms, severe OCD, restricted eating, anger, depression, obsessions, compulsions, tics, anxiety, mood changes, physical hyperactivity, or unusual, jerky movements. |
| Causes | PANS may be triggered by various infections, immune system issues, or environmental factors. It is believed that PANS happens because of a problem with the immune system's response to an infection. |
| Diagnosis | PANS is a clinical diagnosis. To diagnose PANS, doctors will take time talking to patients and their families, asking questions about symptoms, performing an exam, and testing for infections. |
| Treatment | Treatment for PANS focuses on addressing the underlying cause, managing symptoms, and supporting the immune system. Treatment includes medicine, therapy, and guidance and support for families. |
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What You'll Learn
PANS and PANDAS are treatable with medicine and therapy
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are severe forms of acute-onset OCD in children. They are characterised by a sudden onset of severe OCD symptoms, including obsessions, compulsions, or both. Children with PANS or PANDAS may experience new and intense fears, concerns, stressful thoughts or images, and ritual behaviours. They may also experience mood changes, such as irritability, sadness, or a tendency to laugh or cry unexpectedly and inappropriately. Other symptoms include the sudden onset of nighttime bed-wetting, frequent daytime urination, and a decline in school performance, particularly in math and handwriting abilities.
PANS and PANDAS are believed to be caused by a problem with the immune system's response to an infection. Instead of attacking the infection, the immune system targets a part of the brain called the basal ganglia, which affects thoughts, feelings, movement, and other behaviours. The most common cause of PANDAS is a streptococcus ("strep") infection, such as strep throat or scarlet fever. PANS is associated with other types of infections, such as the flu, chickenpox, mycoplasma, and Lyme disease.
PANS and PANDAS can be treated with a combination of medicine and therapy. Treatment typically starts with medication to address the underlying infection. Antibiotics may be prescribed to treat strep infections, and steroids can help reduce inflammation in the brain. Intravenous immunoglobulin (IVIG) therapy has been proven to help the majority of children with PANDAS/PANS. Cognitive behavioural therapy (CBT) is also a recommended treatment for OCD, and therapists can work closely with parents to help manage their child's symptoms. Exposure and response prevention therapy can help reduce ritual behaviours, and habit reversal therapy can be effective for children with tics.
It is important to start therapy as soon as possible and to work closely with a healthcare provider to manage PANS or PANDAS. Early intervention can lead to full recovery, while delays in treatment may result in recurring episodes or chronic symptoms. Treatment adjustments may be necessary if symptoms worsen. Families should consult with a healthcare provider before stopping or changing any medication.
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PANS and PANDAS are not contagious
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Acute-onset Neuropsychiatric Disorders Associated with Streptococcus) are conditions that can cause a range of severe symptoms, including suicidal thoughts and behaviours. PANS is a more general term, referring to any infection, while PANDAS specifically refers to a streptococcus infection.
PANS and PANDAS are characterised by the sudden onset of obsessive-compulsive symptoms and/or severe eating restrictions, along with at least two other cognitive, behavioural, or neurological symptoms. These can include:
- Emotional lability: severe mood swings, depression, or irritability
- Aggression and/or severely oppositional behaviours
- Behavioural regression: acting much younger than their age, such as reverting to baby talk
- Deterioration in school performance: a sudden decline in math and reading competence, memory, and concentration
- Motor or sensory abnormalities: deterioration in handwriting and drawing, distress caused by noise or light
- Somatic symptoms: sleep disturbances, bedwetting, and changes in urinary frequency or intensity
The cause of PANS and PANDAS is believed to be related to the immune system's response to an infection. Instead of attacking the infection, the immune system mistakenly targets the basal ganglia region of the brain, leading to inflammation and autoimmune processes that affect the central nervous system. The most common type of infection associated with PANDAS is a streptococcus infection, such as strep throat or scarlet fever. PANS can be triggered by various infections, including the flu, chickenpox, mycoplasma, and Lyme disease, as well as immune system issues or environmental factors.
Diagnosing PANS and PANDAS can be challenging, and healthcare providers must rule out many other conditions first. Treatment typically involves addressing the underlying infection with antibiotics and managing symptoms with cognitive behavioural therapy for OCD.
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PANS and PANDAS are rare
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are rare. PANS is a more general term that does not specify the type of infection that triggers the symptoms. PANDAS is a subset of PANS and was first reported in 1998. It is the only subtype of PANS that requires that symptoms be associated with a strep infection.
PANS and PANDAS are characterised by the sudden onset of severe obsessive-compulsive symptoms and/or severe eating restrictions, along with at least two other cognitive, behavioural, or neurological symptoms. The conditions can present with a range of symptoms, and the severity can vary widely between individuals. Some of the symptoms include:
- Severe Obsessive-Compulsive Disorder (OCD): This may manifest as intense obsessions, fears, or compulsions that can be extremely disruptive to a child's life.
- Extreme Food Restriction: This can lead to significant weight loss, malnutrition, and in severe cases, life-threatening complications.
- Cognitive Changes: Including a noticeable drop in school performance, particularly in math and handwriting abilities, problems with memory, and difficulties with concentration.
- Motor or sensory abnormalities: Their handwriting and drawing deteriorate, and they may be distressed by noise or light.
- Somatic symptoms: These include sleep disturbances, bedwetting, and other changes in urinary frequency or intensity.
- Aggression, irritability, inappropriate or compulsive behaviours or fear.
PANS and PANDAS are not contagious, and they are not life-threatening. However, some of their comorbidities can cause significant morbidity if not managed. Treatment for PANS and PANDAS includes antibiotics for active infections, cognitive behavioural therapy, and habit reversal training for tics and OCD. Intravenous immunoglobulin (IVIG) therapy has also been proven to help most children with PANS and PANDAS.
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PANS is a more general term than PANDAS
PANS (pediatric acute-onset neuropsychiatric syndrome) is a more general term than PANDAS, as it does not specify the type of infection that triggers the symptoms. PANS is characterized by the sudden onset of obsessive-compulsive symptoms and/or severe eating restrictions, along with at least two other cognitive, behavioural, or neurological symptoms. The condition can vary widely in severity between individuals.
PANDAS, on the other hand, is a subtype of PANS that specifically refers to cases where the triggering infection is streptococcus (strep). PANDAS stands for "pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections". It has five distinct criteria for diagnosis, including abrupt "overnight" OCD or dramatic, disabling tics, a relapsing-remitting episodic symptom course, young age at onset, presence of neurologic abnormalities, and temporal association between symptom onset and Group A strep (GAS) infection.
Both PANS and PANDAS are rare conditions that can cause severe and acute-onset OCD in children, along with other disturbing symptoms such as anxiety, tics, personality changes, deterioration in school performance, sensory abnormalities, and somatic symptoms like sleep disturbances. These conditions are believed to occur when the immune system mistakenly attacks healthy brain cells, leading to inflammation and autoimmune processes that affect the central nervous system.
While PANS and PANDAS are not life-threatening in themselves, some of their comorbidities can cause significant problems if not managed properly. Treatment for both conditions typically involves medication to address the infection, along with cognitive behavioural therapy to address the OCD symptoms.
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PANS and PANDAS can cause abrupt onset of clinical depression
PANS (pediatric acute-onset neuropsychiatric syndrome) and PANDAS (pediatric acute-onset neuropsychiatric disorders associated with streptococcus) are conditions that a child can develop following an infection, usually streptococcal (strep). PANDAS is a subtype of PANS and is specifically associated with a strep infection. PANS is a more general term that does not specify the type of infection thought to trigger the symptoms.
PANS and PANDAS can cause abrupt-onset clinical depression. Children with PANS or PANDAS may experience mood changes, such as irritability, sadness, or a tendency to laugh or cry unexpectedly and inappropriately. They can also experience emotional lability, which can make them severely depressed and even suicidal. Self-injurious behaviours and suicidal ideation are common and of particular concern among children with concomitant impulsivity and behavioural regression.
PANS and PANDAS are characterised by the sudden onset of obsessive-compulsive symptoms and/or severe eating restrictions, along with at least two other cognitive, behavioural, or neurological symptoms. The symptoms 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).
PANS and PANDAS are not contagious, and they are considered rare. If you think your child may have PANS or PANDAS, contact your child's doctor right away. It's best to start therapy as soon as possible. Treatment for PANS or PANDAS focuses on addressing the underlying cause, managing symptoms, and supporting the immune system.
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Frequently asked questions
Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is characterized by the sudden onset of obsessive-compulsive symptoms and/or severe eating restrictions, along with at least two other cognitive, behavioral, or neurological symptoms.
PANS can cause emotional lability, which can lead to severe depression and suicidal ideation. Self-injurious behaviors and suicidal thoughts are common and of particular concern among children with concomitant impulsivity and behavioral regression.
Treatment for PANS focuses on addressing the underlying cause, managing symptoms, and supporting the immune system. Treatment includes medication to take care of the infection, and cognitive behavioral therapy for OCD.
