Cody Casey
PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, is a rare autoimmune condition that occurs following a Group A Streptococcus (strep) infection. PANS, or Pediatric Acute-Onset Neuropsychiatric Syndrome, is a similar condition that is not associated with strep infections. Both conditions cause a sudden onset of severe OCD symptoms and other behavioural changes in children. While fever is a common symptom of strep infections, many children with PANDAS do not present with classic strep signs, and may or may not experience fever.
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What You'll Learn
- PANDAS is caused by a streptococcal infection, typically strep throat or scarlet fever
- PANS is caused by other infections, such as Lyme disease or influenza
- PANDAS and PANS are not contagious
- Symptoms of PANDAS and PANS include OCD, tics, anxiety, and aggression
- Treatment options include antibiotics, IVIG, plasmapheresis, and cognitive behavioural therapy
PANDAS is caused by a streptococcal infection, typically strep throat or scarlet fever
PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, is caused by a streptococcal infection, typically strep throat or scarlet fever. It is characterised by the abrupt onset or worsening of obsessive-compulsive disorder (OCD), tics, or both, following a strep infection. The symptoms of PANDAS are usually dramatic and sudden, and can include motor or vocal tics, obsessions, compulsions, mood swings, irritability, anxiety, and separation anxiety.
Strep infections, including strep throat and scarlet fever, are caused by Group A Streptococcus bacteria, which are very ancient organisms that can survive in the human body by hiding from the immune system. They do this by putting molecules on their cell walls so that they appear similar to molecules found in the heart, joints, skin, and brain tissues. PANDAS is thought to occur when the body's immune system produces antibodies to fight the strep bacteria, but these antibodies also mistakenly attack healthy cells in other tissues because of the molecular mimicry exhibited by the bacteria.
The diagnosis of PANDAS is typically made based on clinical features and a careful medical history, as there are no specific laboratory or neurological tests available. Treatment for PANDAS involves addressing both the physical and psychiatric symptoms. Antibiotics are used to treat active strep infections, while cognitive behavioural therapy (CBT) can help children manage the mental and emotional difficulties associated with PANDAS.
While PANDAS is typically associated with strep throat and scarlet fever, it is important to note that strep infections can also affect other areas of the body, such as the sinuses, anus, vagina, or urethral opening of the penis. These infections may be more difficult to detect and can trigger PANDAS symptoms, requiring thorough evaluation and treatment.
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PANS is caused by other infections, such as Lyme disease or influenza
PANS, or Pediatric Acute-onset Neuropsychiatric Syndrome, is often associated with infections other than Group A Streptococcus (strep). In fact, PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) is considered a subset of PANS.
PANS can be caused by other infections, such as Lyme disease or influenza. Other infections that can cause PANS include chickenpox and mycoplasma. Lyme disease, caused by the Borrelia burgdorferi bacterium, and influenza (flu) can trigger PANS and lead to severe OCD symptoms and other sudden changes in a child's behaviour. These behavioural changes can be extreme, with parents reporting that their child seemed to "'change overnight".
The symptoms of PANS caused by Lyme disease or influenza are similar to those of PANDAS. These include the sudden onset of obsessive-compulsive disorder (OCD), tics, anxiety, personality changes, sensory sensitivities, restrictive eating habits, irritability, aggressive behaviour, extreme moodiness, deterioration of motor skills, visual or auditory hallucinations, sensitivity to light, sound and touch, sleep disturbances, and fatigue.
The diagnosis of PANS, like PANDAS, is clinical, and there are no specific laboratory tests to confirm it. Doctors will evaluate the patient's symptoms, medical history, and rule out other neurological or medical disorders. The treatment for PANS caused by Lyme disease or influenza is similar to that of PANDAS and includes medicines to treat the infection, antibiotics, and cognitive behavioural therapy (CBT) to manage mental and emotional difficulties.
It is important to note that PANS and PANDAS are rare and lesser-known disorders, and they often go misdiagnosed or undetected. However, early identification and treatment can lead to a full recovery.
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PANDAS and PANS are not contagious
PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) and PANS (Paediatric Acute-onset Neuropsychiatric Syndrome) are not contagious. They are autoimmune conditions that occur after an infection, most commonly a streptococcal (strep) infection.
PANDAS is a type of PANS that specifically requires the presence of a strep infection. In PANDAS, the strep bacteria hide from the immune system by mimicking molecules found in the child's heart, joints, skin, and brain. This results in the immune system attacking the mimicked molecules in the child's own tissues, leading to brain inflammation and autoimmune processes that affect the central nervous system. The symptoms of PANDAS include obsessive-compulsive disorder (OCD), tic disorder, anxiety, irritability, moodiness, deterioration of motor skills, visual or auditory hallucinations, sensitivity to light, sound, and touch, sleep disturbances, and fatigue.
PANS, on the other hand, can be triggered by various infectious agents, including influenza, varicella, mycoplasma pneumonia, and Lyme disease. The symptoms of PANS are similar to those of PANDAS, including OCD, tics, anxiety, irritability, aggressive behaviour, moodiness, deterioration of motor skills, hallucinations, sensory sensitivities, and sleep disturbances.
Both PANDAS and PANS can be treated with medicines and therapy. While there is currently no cure for these conditions, treatments such as IVIG, plasmapheresis, and antibiotics can help minimise the severity of symptoms. Neuropsychiatric treatment and holistic approaches, such as functional medicine, dietary measures, and homeopathy, are also recommended.
It is important to note that PANDAS and PANS are rare and lesser-known disorders, and doctors often mistake them for other conditions. Therefore, meeting with a specialist is crucial for obtaining an accurate diagnosis and receiving appropriate treatment.
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Symptoms of PANDAS and PANS include OCD, tics, anxiety, and aggression
PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) and PANS (Paediatric Acute-onset Neuropsychiatric Syndrome) are severe forms of obsessive-compulsive disorder (OCD) that appear suddenly in young children, accompanied by other confusing and distressing symptoms. PANDAS is a type of PANS. In other words, PANDAS without a strep infection is PANS.
The symptoms of PANDAS and PANS include OCD, tics, anxiety, and aggression. The onset of symptoms is usually sudden and intense, and they can get better and then worse again, presenting in an episodic manner. The symptoms of OCD or tic disorders can suddenly become worse following a strep infection, and the symptoms are usually dramatic, happening "overnight and out of the blue". Children with PANDAS may also experience anxiety attacks, or show concerns about separating from parents or loved ones.
In addition to the above symptoms, children with PANDAS or PANS may also experience the following:
- Restrictive eating habits
- Extreme moodiness or depression
- Deterioration of motor skills
- Unusual movements
- Visual or auditory hallucinations
- Sensitivity to light, sound, and touch
- Sleep disturbances or fatigue
- Separation anxiety
- Panic attacks
- Behavioral regression
- Emotional lability
PANDAS and PANS are rare and lesser-known disorders, and doctors often mistake them for other conditions. Many children with PANDAS don't present with classic strep signs such as a sore throat, fever, headache, and stomach ache. If children aren't swabbed thoroughly or in the right places, an infection might be missed.
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Treatment options include antibiotics, IVIG, plasmapheresis, and cognitive behavioural therapy
PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) is a rare and lesser-known disorder that typically first appears in childhood from age 3 to puberty. It is characterised by a sudden onset or worsening of symptoms, followed by a slow, gradual improvement. The symptoms of PANDAS can vary from patient to patient but usually present suddenly and dramatically. They can include:
- Obsessive-compulsive disorder (OCD)
- Tics
- Anxiety
- Irritability
- Mood swings
- Decline in math and handwriting abilities
- Sensory sensitivities
- Restrictive eating
- Visual or auditory hallucinations
- Sleep disturbances
- Fatigue
PANDAS is caused by an autoimmune response to a streptococcal infection, such as strep throat or scarlet fever. The body's immune system mistakenly attacks healthy brain cells, leading to inflammation and autoimmune processes that affect central nervous system function. While there is currently no cure for PANDAS, there are several treatment options available to minimise the severity of symptoms:
Antibiotics
Antibiotics can be used to control or reduce the symptoms of PANDAS, such as OCD, anxiety, depression and tics. In some cases, antibiotics may need to be taken for a minimum of 6 weeks to see a large reduction in symptoms. Prophylactic antibiotics may also be used to prevent future infection-triggered symptom exacerbations.
IVIG
IVIG (intravenous immunoglobulin) therapy addresses the underlying infection and autoimmune reaction that causes PANDAS. It involves the use of an immunoglobulin solution to treat immune deficiencies, encephalitis and other medical conditions. IVIG has been shown to be effective in reducing inflammation caused by autoimmune illnesses and has been endorsed for treating PANDAS by a consortium of physicians and researchers. However, it is important to note that IVIG does not correct the underlying deficiency in antibody production but rather replaces the missing immunoglobulin in a person's bloodstream, so multiple rounds of therapy may be necessary.
Plasmapheresis
Plasmapheresis, also known as plasma exchange (PEX) or therapeutic plasma exchange, is an invasive procedure that removes harmful auto-antibodies from the bloodstream. It is typically performed in a hospital setting and is considered a first-line therapy for PANDAS. Plasmapheresis has been shown to significantly improve symptoms, with some children experiencing near-complete symptom resolution within one to two weeks of treatment. However, due to the risks associated with the procedure, it is recommended that plasmapheresis be performed in specialised paediatric apheresis centres.
Cognitive Behavioural Therapy (CBT)
CBT and/or ERP (Exposure and Response Prevention) may be beneficial for children recovering from PANDAS. It is typically used in conjunction with medical interventions, such as antibiotics and IVIG, to lay the foundation for therapy. CBT can help address the psychiatric symptoms of PANDAS, such as anxiety, obsessive-compulsive behaviours, and fear.
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Frequently asked questions
The symptoms of PANS/PANDAS include:
- Abrupt onset of OCD
- Restrictive eating habits
- Irritability or aggressive behaviour
- Extreme moodiness or depression
- Deterioration of motor skills
- Tics and unusual movements
- Visual or auditory hallucinations
- Sensitivity to light, sound, and touch
- Sleep disturbances or fatigue
- Anxiety or depression
- Bedwetting
- Changes in mood or personality
- Disinterest in food
- Fidgeting and symptoms similar to ADHD
- Cognitive difficulties
- Insomnia
- Anxiety
- Aggression
PANS/PANDAS is caused by a problem with the immune system's response to an infection. The immune system targets the basal ganglia part of the brain by mistake, leading to inflammation. This affects thoughts, feelings, movement, and other behaviours.
Treatment for PANS/PANDAS includes medicines and therapy. Antibiotics are used to treat the infection, and cognitive behavioural therapy (CBT) is used to help children manage mental and emotional difficulties.
Fever is a symptom of a strep infection, which is a common cause of PANDAS. However, many children with PANDAS do not present with classic strep signs, including fever.
