Ella Walter
PANS (pediatric acute-onset neuropsychiatric syndrome) and PANDAS (pediatric autoimmune neuropsychiatric disorder associated with streptococcus, or 'strep') are rare neuropsychiatric conditions that affect children and young adolescents. PANS is caused by a bacterial or viral infection that triggers an immune response, and theoretically, any infection can trigger an immune response resulting in PANS. Epstein Barr, the virus that causes mono, is one of the infections thought to be primarily responsible for causing PANS.
| Characteristics | Values |
|---|---|
| Mono as a cause of PANS | Epstein-Barr virus (which causes mono) is one of the primary causes of PANS |
| PANS definition | Pediatric acute-onset neuropsychiatric syndrome |
| PANS cause | A bacterial or viral infection that triggers an immune response |
| PANS symptoms | Obsession, compulsions, tics, anorexia, separation anxiety, panic attacks, depression, suicidality, labile emotions, decline in school performance, personality changes, bedtime fears/rituals, restlessness, restricted food intake |
| PANS diagnosis | No conclusive blood or neurological test; clinical observation by professionals, parents, and educators; ruling out other neurological or medical causes |
| PANS treatment | Antibiotics, intravenous immunoglobulin (IVIG) therapy, plasma exchange, cognitive behavioral therapy (CBT), exposure and response prevention (ERP) |
| PANS prevention | Supporting the immune system, reducing toxins, avoiding inflammatory foods, eating a healthy diet |
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What You'll Learn
Mono is one of many infections that can cause PANS/PANDAS
PANS (pediatric acute-onset neuropsychiatric syndrome) and PANDAS (pediatric autoimmune neuropsychiatric disorder associated with streptococcus, or 'strep') are rare neuropsychiatric conditions that affect children and young adolescents. PANS and PANDAS are triggered primarily by infections like Lyme disease, mono, mycoplasma (walking pneumonia), the flu, and others.
The key to preventing PANS or PANDAS is to support the immune system. Factors such as increased exposure to toxins in the diet and environment, impairments to the body's ability to detox, gut dysbiosis, and leaky gut can all negatively impact immune system health and function. An overactive immune system can cause inflammation, which occurs in the brain and nerve cells in PANS/PANDAS.
The Epstein-Barr virus, which causes "mono" or infectious mononucleosis, is one of several infections that can trigger an immune response resulting in PANS or PANDAS. During a PANS flare-up, the most common symptoms identified include labile emotions, a decline in school performance, personality changes, bedtime fears/rituals, and restlessness.
PANDAS is a subcategory of PANS associated specifically with streptococcal infection. However, it is now recognized that a range of infections, not just strep, can trigger PANDAS symptoms. Antibiotics are often used to treat PANDAS and prevent recurring strep infections, but they may not prevent all later episodes of PANDAS symptoms. This is because the immune system, once primed, continues to react dangerously to other kinds of infections, misidentifying the brain as foreign and generating symptoms.
Effective treatments for OCD, such as cognitive-behavioral therapy (CBT) and exposure and response prevention (ERP), may significantly improve OCD symptoms when administered by a trained therapist.
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PANS/PANDAS are rare neuropsychiatric conditions
PANS (pediatric acute-onset neuropsychiatric syndrome) and PANDAS (pediatric autoimmune neuropsychiatric disorder associated with streptococcus, or 'strep') are rare neuropsychiatric conditions that affect children and young adolescents aged 3 to 14. These conditions are characterised by acute-onset OCD, with children exhibiting compulsive rituals, anorexia, separation anxiety, panic attacks, depression, and even suicidality. PANDAS is a subcategory of PANS specifically associated with streptococcal infection, although other infections such as Lyme disease, mono, mycoplasma, and the flu can also trigger PANDAS symptoms.
The key to preventing PANS or PANDAS lies in supporting the immune system, as these conditions are caused by a misdirected immune response to an infection. In the case of PANS/PANDAS, the immune system attacks healthy brain tissue, causing inflammation in the brain and nerve cells. This results in the onset of various mental health symptoms, including OCD, Tourette's, ADHD, and conduct disorder. While the exact number of children who will develop PANS/PANDAS is unknown, it is estimated that approximately 1 in 200 children may be affected.
Diagnosis of PANS/PANDAS can be challenging due to the lack of conclusive blood or neurological tests. Currently, diagnosis relies primarily on clinical observation by professionals, parents, and educators, as well as laboratory tests that can detect current or past infections. Treatment options include antibiotics to eliminate any underlying infections, as well as exposure therapy and antidepressant medication for symptom management. In some cases, intravenous immunoglobulin (IVIG) therapy or plasma exchange may be considered if symptoms do not improve with antibiotics alone.
To support immune system health and prevent PANS/PANDAS, it is important to maintain a healthy diet, mostly comprising plants, high-quality proteins, and healthy fats. Sugary foods, simple carbohydrates, and artificial sweeteners should be avoided as they contribute to inflammation and gut dysbiosis. Probiotics and fermented foods can also help improve immune function. Additionally, it is crucial to minimise exposure to toxins in the diet and environment, address any impairments to the body's ability to detox, and maintain a healthy balance of microorganisms in the intestines.
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PANS/PANDAS are forms of severe, acute-onset OCD
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Acute-onset Neuropsychiatric Disorder Associated with Streptococcus) are severe forms of Obsessive-Compulsive Disorder (OCD) that appear abruptly in young children, accompanied by other distressing symptoms. PANDAS is a subcategory of PANS associated specifically with streptococcal infection. The PANDAS diagnosis was first followed by PANS when doctors began seeing patients with the same symptoms but with infections other than strep.
PANS and PANDAS are caused by a bacterial or viral infection that triggers an immune response. The immune system should respond to the virus or bacteria, but brain and nerve cells suffer collateral damage. Any infection can trigger an immune response resulting in PANS, but the following infections are thought to be primarily responsible: Borrelia Burgdorferi (a tick-borne bacteria that causes Lyme disease), Epstein Barr (the virus that causes "mono"), Herpes simplex (the virus that causes herpes), Influenza (any virus that causes the flu), Mycoplasma pneumonia ("walking pneumonia"), Streptococcus (the bacteria that causes "strep"), and Varicella (the virus that causes chickenpox and shingles).
The symptoms of PANS and PANDAS include dramatic behavioural changes, such as a child suddenly asking for constant reassurance, engaging in endless handwashing, or severely restricting their food intake due to acute fears of contamination, choking, or vomiting. Other symptoms include attention-deficit, fidgeting, restlessness, poor concentration, and hyperactivity. The abrupt, dramatic onset of OCD is the first diagnostic criterion for PANS, followed by the concurrent acute onset of additional symptoms from at least two of seven categories, including anxiety, particularly acute separation anxiety and irrational fears.
The key to preventing PANS or PANDAS is to support the immune system by reducing exposure to toxins, ensuring the body's ability to detox, maintaining a healthy balance of microorganisms in the intestines, and avoiding foods that trigger an immune response. Treatment for PANS and PANDAS includes medicines and therapy, such as cognitive behavioural therapy (CBT) and exposure and response prevention (ERP).
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PANDAS is a subcategory of PANS associated with streptococcal infection
PANS, or Pediatric Acute-onset Neuropsychiatric Syndrome, is caused by a bacterial or viral infection that triggers an immune response. Theoretically, any infection can trigger an immune response resulting in PANS, but certain infections are thought to be primarily responsible, including Epstein-Barr virus, which causes "mono". PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, is a subcategory of PANS specifically associated with streptococcal infection.
PANDAS is an autoimmune condition that occurs following infection with Group A Streptococcus (strep). The immune system attacks the brain, causing mental health symptoms such as OCD, tics, anxiety, and mood changes. PANDAS is often diagnosed in children who experience a sudden, dramatic change in personality and the onset of OCD or tic symptoms following a strep infection. Symptoms typically develop overnight or within a few days and can last 4-6 weeks with treatment, but they can reemerge if the child is reinfected.
While PANDAS is specifically associated with streptococcal infection, PANS can be caused by other infections, including Borrelia burgdorferi (Lyme disease), influenza (flu), and Epstein-Barr virus (mono). The symptoms of PANS and PANDAS are similar and include sudden onset of OCD or severely restricted food intake, emotional lability or mood swings, irritability, aggression, behavioural regression, sudden deterioration in school performance, and motor or sensory abnormalities.
The key to preventing PANS or PANDAS is to support the immune system through a healthy diet, avoiding toxins, and maintaining gut health. Treatment for PANS and PANDAS focuses on restoring immune system health and reducing inflammation, as well as addressing specific symptoms with therapies such as cognitive behavioural therapy (CBT) and exposure and response prevention (ERP). Antibiotics may be used for prevention or prophylaxis for children with recurring strep infections, but they cannot prevent all later episodes of PANDAS symptoms.
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There is no conclusive test for PANS/PANDAS
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) are conditions in which the immune system becomes dysregulated in response to an infectious agent. PANDAS is a subset of PANS and is diagnosed when the infection is known to be caused by streptococcal bacteria. PANS, on the other hand, can be caused by a wide range of infections, including Epstein-Barr, the virus that causes mononucleosis.
Theoretically, any infection can trigger an immune response resulting in PANS or PANDAS. However, certain infections are thought to be primarily responsible, including Epstein-Barr (mono), Borrelia Burgdorferi (Lyme disease), Streptococcus (strep), and Influenza (flu), among others. The key to preventing PANS or PANDAS is to support and strengthen the immune system through a healthy diet, avoiding toxins, and maintaining gut health.
While there are no conclusive or single blood tests to detect PANS or PANDAS, laboratory tests and blood markers can aid healthcare professionals in diagnosing and treating these conditions. The Cunningham Panel, for example, is a series of complex blood tests that help diagnose infection-triggered autoimmune neuropsychiatric syndromes. Basic blood work, viral/bacterial testing, and antibody assessments are also used to guide diagnosis and treatment. Diagnosing PANS and PANDAS relies heavily on symptom presentation, which typically includes a dramatic and sudden change in health or behaviour, such as the sudden onset of OCD-like symptoms, eating disorders, anxiety, and compulsive rituals.
Treatment for PANS and PANDAS typically involves a combination of antibiotics to address the underlying infection, anti-inflammatory medications, and, in some cases, immunosuppressants to calm the immune response. An integrative medicine approach is imperative to effectively manage and resolve symptoms, focusing on diet, gut health, latent infections, and reducing toxic load.
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Frequently asked questions
PANS, or Pediatric Acute-onset Neuropsychiatric Syndrome, is a rare neuropsychiatric condition that affects children and young adolescents. It is caused by a bacterial or viral infection that triggers an immune response.
Theoretically, any infection can trigger an immune response resulting in PANS, but the following infections are thought to be primarily responsible: Borrelia Burgdorferi (a tick-borne bacteria that causes Lyme disease), Epstein Barr (the virus that causes “mono”), Herpes simplex (the virus that causes herpes), Influenza (any virus that causes the flu), Mycoplasma pneumonia (“walking pneumonia”), Streptococcus (the bacteria that causes “strep”), and Varicella (the virus that causes chickenpox and shingles).
Treatment for PANS depends on what the doctor believes caused the disorder. Some doctors think it is best to treat PANS with antibiotics. When symptoms are not due to an infection, doctors recommend the same treatments used for regular OCD, including exposure therapy and antidepressant medication.
