Tiffany Haney
PANS (Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus) and PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are severe forms of obsessive-compulsive disorder (OCD) that appear suddenly in young children, accompanied by other distressing symptoms. While PANDAS is caused by strep, a distinct strain of illness, PANS can be caused by any immune-disrupting illness. Scientists believe that 1 in 200 children suffer from PANS or PANDAS, with an average age of onset between 4 and 10 years. But does it ever go away?
| Characteristics | Values |
|---|---|
| Cause | PANDAS is caused by strep, a distinct strain of illness. PANS can be caused by any immune-disrupting illness. |
| Treatment | Antibiotics, steroids, immune therapies, CBT, anti-inflammatory medication, and dietary changes are all treatments for PANS. |
| Onset | PANS appears suddenly in young children, with an average age of onset between 4 and 10 years. |
| Symptoms | PANS presents as an acute onset of OCD and anxiety, accompanied by other confusing and distressing symptoms. |
| Diagnosis | PANS is diagnosed through throat cultures to look for strep and exams to detect hidden strep infections. |
| Relapse | Symptoms can come back during a flare-up or relapse, usually triggered by exposure to another virus, strep throat, or environmental substances. |
| Severity | Symptoms may increase in severity with each episode, lasting longer and progressively worsening over time. |
| Prognosis | While symptoms can last for months or years, they eventually subside for most patients. |
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What You'll Learn
- PANS is caused by any immune-disrupting illness, whereas PANDAS is caused by strep
- Treatment for PANS and PANDAS differs from OCD treatment
- Symptoms can go away for a while after an infection is treated, but they can come back
- Tonsillectomy is a controversial treatment option for PANS and PANDAS
- PANS and PANDAS are severe forms of OCD that appear suddenly in young children
PANS is caused by any immune-disrupting illness, whereas PANDAS is caused by strep
PANS and PANDAS are severe forms of obsessive-compulsive disorder (OCD) that appear suddenly in young children, accompanied by other confusing and distressing symptoms. PANS stands for "pediatric acute-onset neuropsychiatric syndrome". PANDAS, on the other hand, stands for "pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections".
PANS is caused by any immune-disrupting illness, whereas PANDAS is caused by a strep infection. PANDAS is a subset of PANS and was first reported by a team at the National Institute of Mental Health in 1998. PANDAS has five distinct criteria for diagnosis, including abrupt "overnight" OCD or dramatic, disabling tics; a relapsing-remitting, episodic symptom course; young age at onset (average of 6-7 years); presence of neurologic abnormalities; and temporal association between symptom onset and Group A strep (GAS) infection. The five criteria are usually accompanied by similar comorbid symptoms as found in PANS.
PANDAS is considered a pediatric disorder and typically first appears in childhood from age 3 to puberty. Reactions to strep infections are rare after age 12, but researchers recognize that PANDAS could occur, though rarely, among adolescents. It is possible that adolescents and adults may have immune-mediated OCD, but this is not known. The diagnosis of PANDAS is a clinical diagnosis, and there are no lab tests that can diagnose it.
PANS has been reported to occur in association with a variety of infectious agents, including influenza, varicella, and mycoplasma pneumoniae. Lyme disease is another example of an illness that can trigger PANS.
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Treatment for PANS and PANDAS differs from OCD treatment
PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Acute-Onset Neuropsychiatric Disorders Associated with Streptococcus) are severe forms of obsessive-compulsive disorder (OCD) that appear suddenly in young children. PANDAS is a subgroup of PANS and is specifically used when the triggering infection is strep. PANS cases have also been linked to other infections, including Lyme disease, mononucleosis, mycoplasma, and the flu.
Treatment for PANS and PANDAS differs from traditional OCD treatment. While OCD is often treated with cognitive-behavioral therapy (CBT) and anti-obsessional medication, PANS and PANDAS treatments focus on addressing the underlying infection and immune response. This may include a course of antibiotics to treat the infection and intravenous immunoglobulin (IVIG) to balance the immune system. In some cases, steroids and immune therapies may also be used. Additionally, diet is considered an important part of treatment, as lowering inflammation through dietary changes can help reduce symptoms.
It is important to note that PANS and PANDAS treatments are currently under-researched, and there may be risks associated with certain treatment options. For example, while IVIG has been shown to reduce OCD symptom severity in children with PANDAS, it is often not covered by insurance and can be expensive. Furthermore, as children with PANS and PANDAS may experience extreme behavioral changes, therapy for these conditions also involves providing guidance and support to families to help them through challenging times.
While PANS and PANDAS can cause severe and distressing symptoms, they can be treated, and children can experience improvement. Early diagnosis and treatment are crucial, and parents are advised to seek medical help as soon as they notice any sudden changes in their child's behavior.
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Symptoms can go away for a while after an infection is treated, but they can come back
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus) are severe forms of obsessive-compulsive disorder (OCD) that appear suddenly in young children, accompanied by other confusing and distressing symptoms. The average age of onset is between 4 and 10 years, with symptoms including abrupt behavioural changes, fever, anxiety, and tics. PANDAS is caused by a distinct strain of illness, Streptococcus, whereas PANS can be caused by any immune-disrupting illness.
While symptoms of PANS can improve or even disappear after treatment, they may return in what is known as a flare-up or relapse of the disorder. These relapses are often triggered by exposure to another virus, a new case of strep throat, or environmental factors such as mould or allergens. The severity of symptoms may increase with each episode and can last longer each time. For some children, symptoms can persist for months or even years and progressively worsen. However, it's important to note that a flare-up does not last forever, and symptoms do eventually subside for most patients.
Treatment for PANS and PANDAS aims to address the underlying infections and reduce inflammation. This may include antibiotics, steroids, immune therapies, and anti-inflammatory medications. Dietary interventions, such as gluten-free diets and omega-3 fish oil supplements, can also help manage symptoms by reducing inflammation and supporting the immune system.
In addition to medical treatments, parents play a crucial role in managing their child's PANS or PANDAS. It is recommended that parents partner with medical professionals in figuring out the best course of treatment. Parents should also be mindful of their own mental health and well-being, as caring for a child with PANS/PANDAS can be extremely demanding and lead to high levels of anxiety and caregiver burnout.
While the symptoms of PANS can go away for a while after treatment, relapses are possible, and ongoing management may be necessary. Early recognition, proper diagnosis, and a combination of medical treatments and lifestyle interventions can help improve symptoms and overall quality of life for children and their families.
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Tonsillectomy is a controversial treatment option for PANS and PANDAS
PANS (Paediatric Autoimmune Neuropsychiatric Disorder) and PANDAS (Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections) are severe forms of obsessive-compulsive disorder (OCD) that appear suddenly in young children, accompanied by other confusing and distressing symptoms. PANDAS is caused by a distinct strain of illness, strep, while PANS can be caused by any immune-disrupting illness.
However, establishing the diagnosis of PANDAS is complicated due to underlying comorbidities in neurology-psychiatry and the lack of reliable biomarkers. The positive outcome after tonsillectomy reported in case studies may be influenced by postoperative medication and is not supported by large-scale studies. Due to the considerable post-tonsillectomy morbidity, it is recommended that tonsillectomy for PANDAS be indicated only in supervised clinical studies.
Other treatment options for PANS and PANDAS include vitamin D3 supplementation, oral nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, and probiotics to treat yeast infections.
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PANS and PANDAS are severe forms of OCD that appear suddenly in young children
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Acute-onset Neuropsychiatric Disorders Associated with Streptococcus) are severe forms of OCD that appear abruptly in young children. They are often accompanied by other confusing and distressing symptoms.
PANS and PANDAS are believed to be caused by an abnormal immune response to an infection. In the case of PANDAS, the infection is specifically a group A streptococcus ("strep") infection. PANS can be caused by other infections, such as the flu, chickenpox, mycoplasma, and Lyme disease. The abrupt onset of OCD symptoms is the first diagnostic criterion for PANS. The mean age of OCD in children is between 9 and 10 years, but PANS and PANDAS can appear as early as 3 to 7 years of age.
The treatment for PANS and PANDAS differs significantly from traditional OCD treatment. While OCD treatment typically involves therapy and medication, PANS and PANDAS treatment may include antibiotics, steroids, immune therapies, and dietary changes to reduce inflammation. IVIG (intravenous immunoglobin) has been studied as a possible treatment, showing a reduction in OCD symptom severity for 82% of children suspected of having PANDAS.
Parents of children with PANS or PANDAS often report dramatic behavioral changes. Children who were previously happy, social, and athletic may become inconsolable, exhibiting compulsive behaviours such as walking in circles for hours or washing their hands until they bleed. These behavioural changes can be very distressing for both the child and the parents.
While PANS and PANDAS can have a severe impact on a child's life, there is hope for improvement and recovery. Early diagnosis and treatment are crucial, and with the appropriate medical care and support, children can learn to manage their symptoms and lead happy and healthy lives.
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Frequently asked questions
PANS (and PANDAS) are severe forms of obsessive-compulsive disorder (OCD) that appear suddenly in young children, accompanied by other confusing and distressing symptoms.
PANS is caused by any immune-disrupting illness. PANDAS, a subset of PANS, is caused by strep, a distinct strain of illness.
The average age of onset for PANS is between 4 and 10 years, with symptoms including the sudden development of intense OCD and anxiety.
PANS is an "episodic illness", meaning symptoms can go away after an infection is treated but can come back in what is called a flare-up or relapse of the disorder. However, symptoms do eventually subside for most patients. Treatment options include CBT, diet, treating infections, tonsillectomy, intravenous immunoglobulin (IVIG), and non-steroidal anti-inflammatory drugs (NSAIDs).
