Ella Walter
PANS, or Pediatric Acute-onset Neuropsychiatric Syndrome, is a clinically defined disorder characterized by the sudden onset of obsessive-compulsive symptoms (OCD) or eating restrictions, along with acute behavioural deterioration in at least two designated domains. PANS has no age limitation, but symptoms typically begin during the grade-school years. Patients can also have their initial symptom onset during adolescence. PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, is a subset of PANS and is linked to a strep bacterial infection. PANDAS symptoms have been reported to vary widely from child to child and can involve a combination of psychological and neurological conditions. The symptoms are thought to start suddenly and occur in episodes. While PANS/PANDAS is typically associated with children, this article will explore the onset of symptoms in adults.
| Characteristics | Values |
|---|---|
| Full Form | PANS (“Pediatric Acute-onset Neuropsychiatric Syndrome”) |
| PANS Onset | Dramatic and abrupt, sometimes overnight |
| Age Group | PANS has no age limitation but symptoms typically begin during the grade-school years. PANDAS requires symptom onset prior to puberty. |
| Symptoms | OCD, eating restrictions, anxiety, sensory amplification or motor abnormalities, behavioral regression, deterioration in school performance, mood disorder, urinary symptoms and/or sleep disturbances |
| Cause | PANS is caused by many different disease mechanisms and etiologies. PANDAS is caused by a streptococcal infection. |
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What You'll Learn
PANS is rare in adults
PANS, or "Pediatric Acute-onset Neuropsychiatric Syndrome", is a clinically defined disorder characterized by the sudden onset of obsessive-compulsive symptoms (OCD) or eating restrictions, along with acute behavioural deterioration in at least two designated domains. It is believed to be triggered by one or more pathogens, including infectious agents such as influenza, varicella, and mycoplasma pneumoniae. Lyme disease has also been proposed as a potential trigger. PANS is typically associated with children, and while it can be diagnosed in adults, it is considered rare in this age group.
PANDAS, or "Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections", is a subtype of PANS that is specifically linked to a strep bacterial infection. It is characterised by abrupt OCD or dramatic, disabling tics, and an episodic symptom course. PANDAS is also considered rare in adults, with most cases occurring in children between the ages of 3 and 12.
The symptoms of PANS and PANDAS can vary in severity and onset but typically present suddenly and intensely. They can include anxiety, sensory amplification or motor abnormalities, behavioural regression, deterioration in school performance, mood disorders, urinary symptoms, sleep disturbances, tics, and unusual movements. These symptoms can be managed and treated through various approaches, including antibiotics, cognitive behavioural therapy, and habit reversal training. However, there is currently no definitive cure for PANS or PANDAS.
While PANS and PANDAS primarily affect children, it is important to recognise that adults can also be diagnosed with these disorders, albeit rarely. The onset of symptoms in adults may vary, and further research is needed to fully understand the progression and impact of these disorders in the adult population.
Additionally, it is worth noting that PANS and PANDAS can have long-term effects if left untreated. In some cases, these disorders may impact an individual's quality of life into adulthood, affecting their physical and mental opportunities for success. Therefore, early diagnosis and treatment are crucial to reducing the duration and intensity of symptoms and preventing potential permanent psychological and neurological issues.
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PANS symptoms in adults
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a clinically defined disorder characterised by the sudden onset of obsessive-compulsive symptoms (OCD) or eating restrictions, concomitant with acute behavioural deterioration in at least two designated domains. Comorbid symptoms may include anxiety, sensory amplification or motor abnormalities, behavioural regression, deterioration in school performance, mood disorder, urinary symptoms, and/or sleep disturbances. PANS is believed to be triggered by one or more pathogens, including influenza, varicella, and mycoplasma pneumoniae. Lyme disease has also been proposed as a trigger.
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) is a subset of PANS and is linked to a strep bacterial infection. PANDAS is characterised by the abrupt onset of OCD or disabling tics, a relapsing-remitting episodic symptom course, and a young age of onset. While PANDAS and PANS are more prevalent in children, adults can be diagnosed with either condition. However, it is believed that PANDAS symptoms disappear in adulthood, and it is not thought that a person would present with PANDAS symptoms later in life.
While the focus of research has been on children with PANS, the link between the immune system and neuropsychiatric symptoms can be seen in patients of many ages. Some teenagers and adults have symptoms and medical histories consistent with PANS. There are also multiple case reports of teenagers and adults with symptoms and lab results that support a PANDAS diagnosis. However, it is important to note that the majority of children with PANS and PANDAS are misdiagnosed and treated with a combination of SSRI medications and talk therapy, which do not address the biological causes of these conditions.
The symptoms of PANS and PANDAS can cause serious debilitation and extreme neurological changes, including seizures and/or problems with balance, speech, or vision. Psychiatric symptoms can also occur and can include aggression, inappropriate or compulsive behaviours, or fear. In some cases, PANS and PANDAS can lead to permanent psychological and neurological issues if left untreated. Therefore, it is important to seek proper diagnosis and treatment for these conditions to manage symptoms and promote healing on a biological level.
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PANS diagnosis in adults
PANS, or "Pediatric Acute-onset Neuropsychiatric Syndrome", is a clinically defined disorder characterized by the sudden onset of obsessive-compulsive symptoms (OCD) or eating restrictions, along with acute behavioral deterioration in at least two designated domains. It is believed to be triggered by one or more pathogens, but the cause is unknown in most cases. PANS has been associated with various infectious agents, including influenza, varicella, mycoplasma pneumoniae, and Lyme disease.
PANDAS, or "Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections", is a subset of PANS. It is characterized by abrupt "overnight" OCD or dramatic, disabling tics, a relapsing-remitting episodic symptom course, a young age of onset (average of 6-7 years), neurologic abnormalities, and a temporal association with Group A strep (GAS) infection. While PANDAS is linked to a strep bacterial infection, PANS is believed to result from other infections.
The symptoms of PANS and PANDAS typically occur in children between the ages of 3 and 12, with a possible higher prevalence in boys. It is considered rare for teenagers or adults to exhibit mental or neurological symptoms from strep infections. However, some studies suggest that about 95% of children will outgrow PANS or PANDAS by adolescence or young adulthood when their immune systems fully mature.
There is no specific test to diagnose PANS or PANDAS. Healthcare providers perform a physical examination and evaluate the patient's symptoms, including their medical history and exposure to known infections. The PANDAS Physicians Network (PPN) provides flowcharts to help clinicians determine the appropriate diagnosis and treatment protocols for mild, moderate, and severe/extreme cases of PANS and PANDAS.
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PANS treatment in adults
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a clinically defined disorder characterized by the sudden onset of obsessive-compulsive symptoms (OCD) or eating restrictions, along with acute behavioral deterioration in at least two designated domains. While PANS primarily affects children, with an onset between the ages of three and twelve, it is not limited to a specific age range. Some patients continue to experience symptoms into adulthood.
PANS is often misdiagnosed as a psychiatric disorder, and patients may be admitted to psychiatric wards and receive improper care. This is due in part to the fact that there is no test to diagnose PANS; it is a clinical diagnosis. However, laboratory tests can help differentiate between PANS and PANDAS, a subtype of PANS associated with a strep infection.
Treatment for PANS is based on severity and includes antibiotics for active infections, cognitive behavioral therapy for behavioral and psychiatric disorders, and habit reversal training for tics. Intravenous immunoglobulin (IVIG) has also been used to treat PANS.
While there is currently no cure for PANS, management strategies can help patients cope with the condition. These include talking to friends, co-workers, or loved ones to manage stress and anxiety. For children, parents can help by talking through their fears and making a plan to deal with them.
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PANS research in adults
PANS, or "Pediatric Acute-onset Neuropsychiatric Syndrome", is a clinically defined disorder characterized by the sudden onset of obsessive-compulsive symptoms (OCD) or eating restrictions, along with acute behavioural deterioration in at least two designated domains. While PANS is typically associated with children, some adults do suffer from the disorder.
PANS is believed to be triggered by one or more pathogens, and it has been reported to occur in association with various infectious agents, including influenza, varicella, and mycoplasma pneumoniae. Lyme disease has also been proposed as a trigger for neuropsychiatric symptoms. PANDAS, or "Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections", is a subset of PANS that is specifically linked to a strep bacterial infection.
The symptoms of PANS typically appear suddenly and can include OCD, severe eating restrictions, anxiety, sensory amplification or motor abnormalities, behavioural regression, deterioration in school performance, mood disorders, urinary symptoms, and sleep disturbances. While PANS and PANDAS are often associated with children, some adults can also develop these disorders, and there is ongoing research to better understand and support adult patients.
The diagnosis and treatment of PANS and PANDAS in adults can be challenging. Many adults with PANS or PANDAS report struggling to receive a correct diagnosis, as symptoms may overlap with neurodivergent traits or other psychological disorders. Additionally, there is a lack of specialised care and support for adults with these disorders, as most resources and treatments are geared towards paediatric patients.
Some organisations, such as PANS PANDAS UK, are actively working to improve the diagnosis, treatment, and support offered to people with PANS and PANDAS, including adults. They are collaborating with the NHS to ensure better recognition and management of these disorders across the country. While there is currently no cure for PANS or PANDAS, treatments such as cognitive behavioural therapy and habit reversal training can help manage the symptoms and provide patients with coping strategies.
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Frequently asked questions
PANS stands for "Pediatric Acute-onset Neuropsychiatric Syndrome". It is characterised by the sudden onset of obsessive-compulsive symptoms (OCD) or eating restrictions, along with acute behavioural deterioration in at least two designated domains.
PANDAS stands for "Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections". It is a subset of PANS and is linked to a strep bacterial infection.
Symptoms of PANS and PANDAS include:
- OCD
- Tics
- Anxiety
- Depression
- Irritability
- Aggression
- Sleep disturbances
- Urinary symptoms
- Eating restrictions
