Cody Casey
PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections) are neuroimmune conditions that can cause a range of psychiatric and neurological symptoms, including obsessive-compulsive disorder (OCD), tics, abnormal movements, personality changes, and restrictive eating. While PANS and PANDAS are more commonly recognized in children, they can also affect teenagers and adults. The symptoms can vary in severity and can present suddenly and intensely, often requiring medical treatment. Many adults with PANS or PANDAS struggle to find proper care and treatment, as many medical professionals are not aware of these conditions or how to diagnose them.
| Characteristics | Values |
|---|---|
| Affects Adults | Yes |
| Affects Children | Yes |
| Treatable | Yes |
| Curable | No |
| Affects Neurodivergent Individuals | Yes |
| Affects Non-Neurodivergent Individuals | Yes |
| Symptoms | OCD, tics, depression, hallucinations, seizures, rage, anxiety, eating disorders, sensory issues, deterioration in handwriting, etc. |
| Cause | Linked to autoimmune response to Strep A |
| Diagnosis | Often misdiagnosed as psychiatric disorders |
| Treatment | IVIG, steroids, antibiotics, plasmapheresis, immunomodulation |
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What You'll Learn
PANS/PANDAS is an autoimmune disorder
PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are indeed autoimmune disorders. They are infection-triggered neuroimmune conditions that can lead to changes in thinking and behaviour.
PANS is the general term for acute neuropsychiatric disorders in children, whereas PANDAS is a subset of disorders triggered by Group A streptococcal infections. Children with PANDAS typically have a history of strep throat or a positive strep test. However, future flare-ups of symptoms can be due to other causes, including viral illnesses, sinusitis, and non-infectious triggers. While PANDAS is usually associated with strep infections, PANS is thought to result from other infections such as Lyme disease or influenza.
PANS and PANDAS are often misdiagnosed as psychiatric illnesses or behavioural disorders. However, they are clinical diagnoses based on a patient's symptoms, family history, and laboratory results. In both conditions, autoantibodies target healthy proteins or receptors in the brain, principally in the basal ganglia, a region of the brain responsible for motor movements, learning, cognition, and emotion. This results in brain inflammation (encephalitis) and disruption of normal neuronal functioning, leading to psychiatric and neurological symptoms. These symptoms can include obsessive-compulsive behaviours, tics, restrictive eating, emotional lability, aggression, anxiety, depression, and sleep disturbances.
While PANS and PANDAS are more prevalent in children, they can also affect teenagers and adults. There are multiple case reports of teenagers and adults with symptoms and lab results that support a PANDAS diagnosis. The severity of symptoms and the onset of PANS/PANDAS can vary from patient to patient, but the symptoms usually present suddenly and intensely.
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The conditions can be misdiagnosed as psychiatric illnesses
PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are conditions that can cause a variety of psychiatric symptoms. These symptoms can include obsessive-compulsive disorder (OCD), anxiety, tics, aggression, compulsive behaviours, fear, mood changes, and sensory issues. Due to the nature of these symptoms, PANS and PANDAS can sometimes be misdiagnosed as psychiatric illnesses.
PANS and PANDAS are often associated with infections, particularly strep infections such as strep throat or scarlet fever. In some cases, the body's immune response to these infections can lead to brain inflammation and autoimmune processes that affect the central nervous system. This can result in the onset of psychiatric symptoms. However, because these symptoms can be similar to those of psychiatric disorders, PANS and PANDAS may be misdiagnosed as conditions such as bipolar disorder, dissociative identity disorder, or schizophrenia.
The majority of cases of PANS and PANDAS occur in children, and the conditions are typically first observed between the ages of 3 and puberty. However, it is possible for adolescents and adults to develop PANS or PANDAS, or a similar immune-related form of OCD. In adults, the symptoms of PANS and PANDAS can include OCD, tics, depression, hallucinations, seizures, anger, insomnia, and anorexia, among others. These symptoms may be misattributed to psychiatric illnesses, particularly when the patient is an adult, as PANS and PANDAS are more commonly associated with children.
Additionally, PANS and PANDAS can be challenging to diagnose due to the lack of a gold-standard test. Diagnosis is typically made by a doctor based on testing for active infections, evaluating symptoms, medical history, and laboratory findings that rule out other neurological or medical disorders. The variability of symptoms and the potential for symptoms to come and go can also make diagnosis difficult. As a result, many patients may see multiple doctors before receiving a correct diagnosis.
The misdiagnosis of PANS and PANDAS as psychiatric illnesses can have significant implications for patient care. While treatments such as SSRI medications and talk therapy can help manage psychiatric symptoms, they do not address the underlying biological causes of PANS and PANDAS. Therefore, it is important for healthcare providers to consider the possibility of PANS and PANDAS when evaluating patients with psychiatric symptoms, particularly when standard treatments are not effective.
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Symptoms include OCD, tics, eating disorders, rage, hallucinations, and seizures
PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections) are whole-body conditions that can cause a range of symptoms, including OCD, tics, eating disorders, rage, hallucinations, and seizures. While PANS and PANDAS are more prevalent in children, they can also affect teenagers and adults.
OCD (obsessive-compulsive disorder) is a common symptom of PANS and PANDAS, with sudden and severe obsessions, compulsions, or both. This may manifest as intense fears or concerns, repetitive behaviours, or rituals such as walking in and out of a doorway repeatedly. The onset of OCD symptoms in PANS is often linked to an infection, such as the flu, chickenpox, mycoplasma, or Lyme disease.
Tics and abnormal movements are also frequently associated with PANS and PANDAS. These can include motor or muscle movement issues, such as problems with handwriting, reduced coordination, or other unusual movements. Tics can be addressed through therapy, such as habit reversal training, which can help decrease their frequency and provide individuals with coping mechanisms.
Eating disorders or restrictive eating habits are another symptom of PANS and PANDAS. This may present as a sudden decline in food intake or anorexia. Additionally, individuals with PANS or PANDAS may experience rage or irritability, with sudden and dramatic changes in personality.
Hallucinations and seizures are also possible symptoms of PANS and PANDAS. Hallucinations can be visual or auditory, while seizures may occur alongside other neurological changes, such as problems with balance, speech, or vision.
While there is currently no cure for PANS or PANDAS, treatments such as IVIG, plasmapheresis, antibiotics, and cognitive behavioural therapy can help minimise the severity of symptoms and provide support for those affected.
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Treatments include IVIG, steroids, antibiotics, and plasmapheresis
While there is currently no cure for PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) or PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections), treatments such as IVIG, steroids, antibiotics, and plasmapheresis can help to minimize the severity of symptoms.
IVIG Treatment
IVIG (intravenous immunoglobulin) therapy is one of the most effective treatments for PANS/PANDAS, with some patients experiencing significant improvement or even complete remission of symptoms after a single dose. IVIG is made from pooled human donor blood products, and it carries a risk of severe allergic reactions, which is why diphenhydramine, an antihistamine, and steroids are administered beforehand. It is important to note that IVIG is also one of the most expensive treatment options.
Steroids
Intravenous steroids are used to reduce inflammation in the brain and have been shown to reduce the severity of symptoms in patients with Sydenham's chorea. However, some children with PANS/PANDAS may experience a worsening of tics or aggression with steroid use, so it is important to discuss the pros and cons with a medical professional.
Antibiotics
Long-term prophylactic antibiotic use for PANDAS has been shown to play a role in managing the disorder and reducing neuropsychiatric symptom exacerbations. Antibiotics are also used alongside plasmapheresis to treat PANS/PANDAS.
Plasmapheresis
Plasmapheresis, or therapeutic plasma exchange, is not widely offered as a treatment for PANS/PANDAS, but it has been shown to improve symptoms, even during the procedure. It is considered a preferred method of treatment for severe, life-threatening symptoms due to its quick response rate.
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PANS/PANDAS can affect neurodivergent individuals
PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections) are neuroimmune conditions that can lead to abrupt changes in thinking and behaviour. While PANS and PANDAS are more prevalent in children, they can also affect adults.
PANS and PANDAS are encephalopathies, which are diseases that affect the functioning of the brain. They are marked by the abrupt onset of OCD or anorexia, with at least two concurrent symptoms out of a list of seven, including tics, anxiety, personality changes, and decline in math and handwriting abilities. The symptoms can vary in severity and can get better and worse in an episodic manner.
PANS and PANDAS can be challenging to diagnose, especially in adults, as many doctors are not trained to recognize these conditions. The symptoms can also overlap with other neurodivergent conditions such as OCD, Tourette's syndrome, autism, and anxiety, which can lead to misdiagnosis or diagnostic overshadowing, where new symptoms are attributed to an existing condition. In some cases, individuals with PANS or PANDAS may be incorrectly perceived as having a mental illness, as their symptoms may be interpreted as psychological rather than biological in origin.
There is currently no cure for PANS or PANDAS, but treatments such as IVIG, plasmapheresis, and antibiotics can help minimize the severity of symptoms. It is important for neurodivergent individuals to receive a medical evaluation if PANS or PANDAS is suspected, especially if there is an acute, marked, or distressing change in their behaviour or mental health. While the focus of research has been on children with PANS and PANDAS, it is recognized that these conditions can affect teenagers and adults as well.
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Frequently asked questions
Yes, PANS and PANDAS can affect adults. While the conditions are more prevalent in children, there are reports of teenagers and adults with symptoms and lab results that support a PANS or PANDAS diagnosis.
The symptoms of PANS or PANDAS in adults can include OCD, tics, eating disorders, anxiety, depression, hallucinations, seizures, and rage.
PANS or PANDAS can be treated in adults using IVIG, steroids, antibiotics, plasmapheresis, and immunomodulation.
PANS and PANDAS are often overlooked and undiagnosed in adults because they are not commonly looked for in adult patients. Additionally, some symptoms of PANS and PANDAS may overlap with neurodivergent traits, making these conditions harder to identify.
PANS is the general term for acute neuropsychiatric disorders, while PANDAS specifically refers to disorders triggered by Group A strep infections.
