Ella Walter
PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are severe forms of obsessive-compulsive disorder (OCD) that appear abruptly in young children, accompanied by other confusing and distressing symptoms. PANDAS is a subgroup of PANS. While PANS does not specify the type of infection that triggers the symptoms, PANDAS is specifically used when the triggering infection is strep. Children with PANS may have had the flu, chickenpox, or Lyme disease, but the cause is unclear. PANS and PANDAS can be treated with medicines and therapy. While it is distressing for parents to witness their children suffering from PANS or PANDAS, studies suggest that about 95% of children will outgrow these disorders by adolescence or young adulthood when their immune systems fully mature.
| Characteristics | Values |
|---|---|
| PANS and PANDAS | Pediatric Acute-onset Neuropsychiatric Syndrome and Pediatric Autoimmune Neuropsychiatric Disorders associated with Streptococcal Infections, respectively |
| Cause | A strep infection, or other infections like the flu, chickenpox, or Lyme disease |
| Symptoms | OCD, anxiety, anger, irritability, rage, screaming, violent behaviour, contamination fears, worry for self or others, hoarding, inability to make decisions, number and colour obsessions, symmetry urges, motor tics, depression, suicidal thoughts, deterioration in school performance, motor or sensory abnormalities, sleep disturbances, bedwetting, changes in urinary frequency or intensity |
| Diagnosis | Doctors will ask questions about symptoms, perform an exam, and test for infections |
| Treatment | Antibiotics, tonsillectomy, intravenous immunoglobulin (IVIG), non-steroidal anti-inflammatory drugs (NSAIDs), omega 3 fish oil supplements, cognitive behavioural therapy, exposure and response prevention therapy, anti-depressants, selective serotonin reuptake inhibitors (SSRIs), herbal antibiotics, anti-inflammatories |
| Prognosis | Some studies suggest that about 95% of children will outgrow PANS or PANDAS by adolescence or young adulthood. There is also some evidence that puberty may help reduce symptoms, but this is not yet proven. |
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What You'll Learn
PANS and PANDAS are treatable with medication and therapy
PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are severe forms of obsessive-compulsive disorder (OCD) that can cause intense symptoms of anxiety and depression in children. While PANS is a more general term that does not specify the type of infection triggering the symptoms, PANDAS specifically refers to cases triggered by a streptococcal infection.
These conditions can be treated with a combination of medication and therapy. Antibiotics are the primary treatment, especially in cases of strep infection. Many children respond within the first week of antibiotic treatment, and if the symptoms disappear, it is recommended to finish the course and then practice "watchful waiting". However, some children do not respond to antibiotics alone and may experience relapses triggered by subsequent infections. In such cases, doctors may target what are called the "three S's": symptoms, source, and system.
Treatment for the symptoms may include cognitive behavioural therapy (CBT) and anti-depressant or anti-obsessional medication, such as selective serotonin reuptake inhibitors (SSRIs). CBT for OCD involves exposure and response prevention, which helps to reduce ritual behaviours associated with OCD. Therapy can also address other behavioural and mood symptoms, such as habit reversal therapy for tics.
While there is some evidence that symptoms of PANDAS and PANS may reduce with puberty, it is not proven. Therefore, early diagnosis and treatment are critical to managing these conditions effectively. Additionally, as PANDAS is triggered by a strep infection, preventing subsequent strep infections can help minimise the likelihood of worsening existing symptoms or developing PANDAS/PANS if the child did not previously have it.
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Antibiotics are the primary treatment
PANS stands for "pediatric acute-onset neuropsychiatric syndrome," and PANDAS is a type of PANS that is thought to be related to a strep infection. PANDAS is short for "pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections." Children with PANS/PANDAS may exhibit sudden anger, irritability, episodes of extreme rage, screaming, violent behavior, and obsessive-compulsive symptoms.
In addition to antibiotics, tonsillectomy has been studied as a treatment for PANS and PANDAS. While some patients experienced complete symptom relief after the procedure, the study was not controlled, and experts consider the evidence too incomplete to determine its effectiveness. Intravenous immunoglobulin (IVIG) is another treatment option for children who do not respond to other treatments. However, it is costly and typically not covered by insurance. Non-steroidal anti-inflammatory drugs (NSAIDs) and supplements, such as Omega 3 fish oil, may also be recommended to reduce inflammation.
While PANS and PANDAS can be distressing for both children and parents, it is important to remember that symptoms do eventually subside for most patients. Studies suggest that about 95% of children will outgrow PANS or PANDAS by adolescence or young adulthood when their immune systems fully mature. In the meantime, cognitive behavioral therapy (CBT) can help children manage the mental and emotional difficulties associated with these conditions. Therapy can include exposure and response prevention to reduce ritual behaviors and address other behavior and mood symptoms.
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Tonsillectomy is a controversial treatment option
PANS and PANDAS are acute-onset OCD conditions in children. Children with these conditions may exhibit sudden anger, irritability, episodes of extreme rage, screaming or violent behaviour. They may also show signs of new and intense fears or concerns about things being even, clean, dirty, or a certain way. These fears and concerns can be so strong that the child is hard to comfort.
One study reported that after tonsillectomy, PANDAS patients had their tonsils analysed, and the children were subsequently tracked for over six months. The tonsils of these patients were found to have many pathogens, most prominently staphylococcus (staph). This suggests that removing the tonsils may reduce the risk of infection and recurrence of PANS/PANDAS symptoms.
However, it is important to note that tonsillectomy has a history of controversy. In the 1940s and 1950s, there was a speculated link between tonsillectomy and bulbar poliomyelitis, a variant that affects the brainstem. This controversy, along with the development of new antibiotics that reduced the seriousness of tonsillitis, contributed to a decline in the popularity of tonsillectomy.
While tonsillectomy may be considered for PANS/PANDAS patients with damaged or cryptic tonsils, it is not recommended as a first-line treatment. Other treatments for PANS and PANDAS include antibiotics, cognitive behavioural therapy, and oral non-steroidal anti-inflammatory drugs (NSAIDs).
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Puberty may help reduce PANDAS symptoms
PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, is a recently identified disease that affects children between the ages of 3 and puberty. It is characterised by a range of psychological and neurological symptoms, including tics, obsessive-compulsive behaviour, and mood disturbances. While PANDAS is typically associated with strep infections, it can also be triggered by other infections such as sinus infections or strep bacteria infecting the anus, vagina, or urethral opening of the penis. These infections can be more challenging to eradicate and may require a longer course of antibiotic treatment.
PANDAS symptoms can vary widely from child to child and can include:
- Emotional lability, leading to uncontrollable laughing or crying
- Extreme rage and violent behaviour
- Sensory sensitivities, hallucinations, or negative reactions to loud noises and light
- Difficulty sleeping or oversleeping, and excessive fatigue
- Bedwetting or night terrors
- Selective eating or refusal to eat
- Reduced coordination and balance issues
- Cognitive difficulties, such as brain fog and a decline in math skills
PANDAS is typically treated with antibiotics to address the underlying infection. Cognitive behavioural therapy and habit reversal training are also used to manage behavioural problems and tics. While there is limited long-term data on the progression of PANDAS, some evidence suggests that puberty may help reduce symptoms. However, this is not yet proven, and researchers are still studying the potential long-term effects of the disease.
In the absence of conclusive data, prevention is critical for children with PANDAS. This includes protecting them from contracting strep infections and seeking prompt treatment if they do become infected. Additionally, parents can work with mental health professionals to manage their child's symptoms through therapy and coping strategies. While PANDAS symptoms can be distressing for both children and parents, it's important to remember that flare-ups do not last forever, and most patients will eventually experience a reduction in symptoms.
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PANDAS symptoms may not disappear when the strep infection goes away
PANDAS, or paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, is a relatively new disease that can be difficult to diagnose. The symptoms of PANDAS typically start suddenly, about four to six weeks after a strep infection. They include behaviours similar to obsessive-compulsive disorder (OCD) and Tourette syndrome. These symptoms can interfere with schooling and quickly become debilitating.
While the strep infection can be treated with antibiotics, PANDAS symptoms may not disappear immediately. Psychiatric symptoms may start to improve with antibiotics, but they will likely still need to be addressed separately. This is because PANDAS is thought to be caused by antibodies that attack the body's own tissues, including areas of the brain, leading to neuropsychiatric symptoms. These symptoms can be severe and long-lasting, and they may worsen with each episode.
Treatment for PANDAS involves addressing both the physical and psychiatric symptoms. In addition to antibiotics for the strep infection, treatment may include cognitive behavioural therapy for OCD and other psychiatric symptoms. Habit reversal training can be effective for tics, and non-steroidal anti-inflammatory drugs (NSAIDs) can help to calm the immune system.
While most children who receive treatment for PANDAS recover completely, it may take several months for symptoms to improve, and there may be ups and downs. PANDAS is likely to return if the child gets strep again, so it is important to prevent reinfection by practising good hygiene and staying away from sick people. Some parents and doctors have also turned to tonsillectomies as a treatment option, though more research is needed to determine its effectiveness.
There is some evidence that puberty may help reduce PANDAS symptoms, though this has not been proven. Studies suggest that about 95% of children will outgrow PANDAS by adolescence or young adulthood when their immune systems fully mature. However, untreated PANDAS can have long-term effects on brain development, so early treatment is critical to prevent possible complications.
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Frequently asked questions
PANS stands for Pediatric Acute-Onset Neuropsychiatric Syndrome, and PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. PANS is a more general term, while PANDAS is a specific type of PANS where the triggering infection is strep. Both PANS and PANDAS are acute-onset OCD in children, with PANDAS being the more severe form.
PANS and PANDAS are relatively new diseases, and researchers are still studying whether children can outgrow them. Some studies suggest that about 95% of children will outgrow PANS or PANDAS by adolescence or young adulthood when their immune systems fully mature. Additionally, there is some evidence that puberty may help reduce symptoms of PANDAS, but this is not yet proven.
Treatment options for PANS and PANDAS include antibiotics, cognitive behavioral therapy (CBT), selective serotonin reuptake inhibitors (SSRIs), tonsillectomy, intravenous immunoglobulin (IVIG), and non-steroidal anti-inflammatory drugs (NSAIDs). While some patients respond quickly to treatment and return to normal function, others may experience relapses or have persistent symptoms.
