Ella Walter
PANS, or Pediatric Acute-onset Neuropsychiatric Syndrome, is a severe form of obsessive-compulsive disorder (OCD) that appears suddenly in young children, accompanied by other confusing and distressing symptoms. PANS is a clinical diagnosis based on signs, symptoms, medical history, and laboratory findings that cannot be explained by other neurological or medical disorders. To diagnose PANS, clinicians must rule out other potential disorders, including the toxic effects of drugs or medications, and perform a comprehensive evaluation. The diagnosis should be considered when OCD symptoms, eating restrictions, or tics develop suddenly, accompanied by other behavioural and emotional changes.
| Characteristics | Values |
|---|---|
| Diagnosis | PANS is a clinical diagnosis based on signs, symptoms, medical history, and laboratory findings. |
| Onset | Abrupt, acute, and dramatic onset of OCD or severely restricted food intake. |
| Additional Symptoms | At least 2 of the following: anxiety, emotional lability, depression, irritability, aggression, behavioural regression, deterioration in school performance, motor or sensory abnormalities, somatic symptoms, sleep disturbances, enuresis, or urinary frequency. |
| Exclusion Criteria | Symptoms must not be better explained by a known neurological or medical disorder, such as Sydenham chorea, systemic lupus erythematosus, or Tourette disorder, or toxic effects of drugs or medications. |
| Age | PANS has no age limitation, but symptoms typically begin during grade school or adolescence. |
| Infections | PANS can be triggered by various infections, including streptococcal infections, but it is not limited to strep. |
| Laboratory Tests | Autoimmune Brain Panel, blood tests for strep, and other immunological research. |
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What You'll Learn
Abrupt onset of OCD or restricted eating
PANS, or Pediatric Acute-onset Neuropsychiatric Syndrome, is characterised by an abrupt, acute, and dramatic onset of obsessive-compulsive disorder (OCD) or severely restricted food intake. This is accompanied by additional neuropsychiatric symptoms such as anxiety, emotional lability, depression, irritability, aggression, behavioural regression, and sleep disturbances.
The onset of OCD or restricted eating in PANS is described as abrupt and dramatic, with full-blown symptoms appearing virtually overnight. This is accompanied by other neurological symptoms, such as restricted eating, anger, and depression. The symptoms of PANS can be so severe that they interfere with a child's ability to function, and they may require hospitalization.
The abrupt onset of OCD or restricted eating in PANS can be very distressing for both the child and their parents. Children with PANS may experience a compulsive need to perform certain rituals, such as carrying a plastic bucket due to a fear of vomiting. They may also refuse to eat for several days, display fears of contaminants, or develop separation anxiety. These symptoms can be debilitating and baffling, and they often occur alongside other neurological issues.
The diagnosis of PANS requires ruling out other potential disorders and conducting a comprehensive evaluation. Clinicians must consider the patient's medical history and perform a thorough physical and neurological examination. There is no single definitive test for PANS, and the diagnosis is based on clinical presentation, including the abrupt onset of OCD or restricted eating.
It is important to note that not all children with PANS will present with the same symptoms, and the diagnostic criteria are designed to guide clinical diagnosis. Treatment for PANS may include antidepressants and antipsychotics, but these medications should be started at lower doses due to potential side effects.
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Presence of additional neuropsychiatric symptoms
PANS, or Pediatric Acute-onset Neuropsychiatric Syndrome, is a clinical diagnosis based on a collection of signs, symptoms, medical history, and laboratory findings that cannot be explained by any other neurological or medical disorders. The diagnosis of PANS should be considered when symptoms of OCD, eating restrictions, or tics start suddenly and are accompanied by other emotional and behavioural changes, frequent urination, motor abnormalities, and/or handwriting changes.
To be diagnosed with PANS, a patient must meet the following criteria:
The patient must present with a concurrent onset of additional neuropsychiatric symptoms, with similarly severe and acute onset, from at least two of the following seven categories:
- Anxiety: PANS patients may experience intense anxiety, including panic attacks and separation anxiety.
- Emotional lability: Emotional lability refers to rapid and unpredictable mood swings. Children with PANS can experience severe depression, even with suicidal ideation.
- Irritability, aggression, and/or severely oppositional behaviours: These behaviours can manifest as tantrums and hyperactivity.
- Behavioural (developmental) regression: Children with PANS may act much younger than their age, such as reverting to baby talk or exhibiting new phobias.
- Sudden deterioration in school performance: This includes a loss of academic ability and handwriting skills.
- Motor or sensory abnormalities: These can include involuntary, purposeless movements called tics.
- Somatic signs and symptoms: Somatic symptoms include sleep disturbances, enuresis (bedwetting), or urinary frequency.
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No better explanation from neurological or medical disorders
PANS (pediatric acute-onset neuropsychiatric syndrome) is a clinical diagnosis that requires ruling out other neurological or medical disorders. The criteria for diagnosing PANS include an abrupt, acute, and dramatic onset of obsessive-compulsive disorder (OCD) or severely restricted food intake. This is accompanied by additional neuropsychiatric symptoms, including anxiety, emotional lability, depression, irritability, aggression, behavioural regression, and somatic symptoms such as sleep disturbances and urinary issues.
To diagnose PANS, clinicians must conduct a comprehensive evaluation to rule out other potential disorders, including the toxic effects of drugs or medications. A complete medical history, along with a thorough physical and neurological examination, is recommended. PANS has no age limitation, but symptoms typically appear during grade school or adolescence.
PANS is characterised by a sudden and dramatic onset of OCD symptoms or eating restrictions, accompanied by a baffling set of other neurological symptoms. The diagnosis should be considered when OCD, eating restrictions, or tics develop suddenly alongside emotional and behavioural changes, frequent urination, motor abnormalities, or handwriting changes.
The Autoimmune Brain Panel™ (also known as the Cunningham Panel™) is a laboratory test that can assist clinicians in diagnosing PANS by providing evidence of an underlying autoimmune dysfunction. This test measures antineuronal antibody levels, including dopamine receptors and CaM kinase II, which have been found to be elevated in patients with PANS.
It is important to note that PANS is a diagnosis of exclusion, meaning that other known medical conditions must be ruled out first. The symptoms of PANS can overlap with many other medical conditions, making it a challenging diagnosis. However, the abrupt and dramatic onset of symptoms, along with the presence of additional neuropsychiatric issues, are key factors in distinguishing PANS from other disorders.
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Laboratory findings and medical history
PANS (pediatric acute-onset neuropsychiatric syndrome) is a clinical diagnosis based on the collection of signs, symptoms, medical history, and laboratory findings. There is currently no 100% definitive test for PANS. However, laboratory findings and medical history play a crucial role in ruling out other potential disorders and confirming a PANS diagnosis.
Laboratory findings can provide valuable insights into the underlying causes and mechanisms of PANS. One important laboratory test is the Autoimmune Brain Panel™ (also known as the Cunningham Panel™), which assists clinicians in identifying an underlying autoimmune dysfunction. This panel measures antineuronal antibody levels, including dopamine receptor, lysoganglioside, tubulin, and CaM kinase II receptor-stimulating antibodies. These antibodies have been found to react with human basal ganglia in patients with PANS and related disorders such as Sydenham chorea and Tourette syndrome.
In addition to the Autoimmune Brain Panel™, other laboratory tests can aid in the diagnostic process. Recent immunological research suggests that blood tests for streptococcal infections may be valuable, as PANS is often triggered by infections, including streptococcal infections. Over half of strep infections are missed in young children, and even asymptomatic infections can be immunologically significant. Therefore, a blood test or a 48-hour culture can help identify a possible infectious trigger.
Medical history is also a critical component of diagnosing PANS. A comprehensive medical history, including information on any infections, exposure to illnesses, allergies, and dietary changes, can help clinicians rule out other potential disorders and identify any triggers or contributing factors. Additionally, a detailed medical history can reveal patterns or connections between symptoms, providing valuable insights into the underlying causes of PANS.
Furthermore, the acute and dramatic onset of symptoms in PANS can be a distinguishing feature in the diagnostic process. The sudden onset of obsessive-compulsive disorder (OCD) or severely restricted food intake, accompanied by additional neuropsychiatric symptoms, is a hallmark of PANS. This abrupt change in behaviour can be a critical indicator for clinicians, as it separates PANS from other disorders, such as typical OCD or eating disorders, where symptoms usually develop gradually.
In summary, laboratory findings and medical history are essential tools in the diagnosis of PANS. While there is no single definitive test, the combination of laboratory results, medical history, and clinical presentation allows clinicians to rule out other disorders and confirm a PANS diagnosis. This comprehensive approach ensures that patients receive accurate diagnoses and appropriate treatment plans.
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Treatment and family support
PANS (pediatric acute-onset neuropsychiatric syndrome) and PANDAS (pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections) are severe forms of obsessive-compulsive disorder (OCD) that appear abruptly in young children, accompanied by other distressing symptoms. PANS is a more general term that does not specify the type of infection thought to trigger the symptoms, while PANDAS is a more specific term used when the triggering infection is strep.
PANS/PANDAS are medical conditions that require prompt treatment from healthcare professionals. Antibiotics can dramatically improve many patients' neuropsychiatric symptoms, and other treatments include anti-inflammatory drugs, steroids, psychiatric medications, and psychotherapy.
Primary care providers, including pediatricians, family physicians, and nurse practitioners, can diagnose and treat PANS/PANDAS. However, if you need help finding a clinician familiar with these conditions, you can refer to the PPN Practitioner Directory.
There are also national and regional supportive resources for families, including in-person and online support groups, as well as private Facebook groups. It is important for families to find help and support from professionals, family, and friends, as PANS/PANDAS impact the whole family and can be incredibly tough conditions to live with.
Schools can also be difficult for children with PANS/PANDAS, and there are resources available that provide information on the school's impact and steps that school professionals can take to help.
For children who are diagnosed early and a cause has been identified, the prognosis is usually very good, with some patients quickly returning to normal function. However, for those who don't respond as well to antibiotics, alternate treatments shown to work in related conditions are considered.
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Frequently asked questions
Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is a clinical diagnosis given to children who have a dramatic – sometimes overnight – onset of neuropsychiatric symptoms.
PANS is diagnosed clinically but can be difficult to recognise as symptoms overlap with many other medical conditions. It’s a “diagnosis of exclusion” and requires that other known medical conditions be ruled out. To be diagnosed with PANS, a patient must meet the following criteria: an abrupt, acute, dramatic onset of obsessive-compulsive disorder (OCD) or severely restricted food intake; and concurrent presence of additional neuropsychiatric symptoms with similarly severe and acute onset from at least two of the following categories: anxiety; emotional lability and/or depression; irritability, aggression, and/or severe oppositional behaviours; behavioural (developmental) regression; sudden deterioration in school performance; motor or sensory abnormalities; somatic signs and symptoms, including sleep disturbances, enuresis, or urinary frequency.
If you think your child may have PANS, contact your child's doctor right away. It's best to start therapy as soon as you can. Your doctor can help you find a mental health therapist.
