Tillie Doyle
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) are conditions that cause a sudden onset of severe obsessive-compulsive disorder (OCD) symptoms and other abrupt behavioural changes in children. PANDAS is a subset of PANS and is specifically triggered by a streptococcal (strep) bacterial infection, whereas PANS can be caused by other viral or bacterial infections. The conditions are believed to occur when the immune system mistakenly attacks healthy brain cells, leading to inflammation and autoimmune processes that affect central nervous system function.
| Characteristics | Values |
|---|---|
| Full form | PANDAS: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections |
| PANS: Pediatric Acute-Onset Neuropsychiatric Syndrome | |
| Diagnosis | PANDAS: Abrupt onset of OCD, or dramatic, disabling tics; an episodic symptom course, or relapsing-remitting course of severity; pre-pubertal onset; presence of neurologic and neuropsychiatric abnormalities; occurrence of a strep infection before symptom onset |
| PANS: Sudden onset of OCD or severely restricted food intake; sudden onset of at least two other neuropsychiatric symptoms; history of a strep or other infection within 3 months of symptom onset; physical hyperactivity or unusual, jerky movements outside the child's control | |
| Cause | PANDAS: An abnormal immune response to a strep infection, where the immune system mistakenly attacks healthy brain cells, leading to inflammation |
| PANS: An abnormal immune response to an infection (not always strep), where the immune system mistakenly attacks healthy brain cells, leading to inflammation | |
| Treatment | Medicines, therapy, and cognitive behavioural therapy for OCD |
| Age of onset | PANDAS: 6-7 years |
| PANS: 3 years to puberty | |
| Prevalence | Affects as many as 1 in 200 children |
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What You'll Learn
- PANDAS and PANS cause a sudden onset of severe OCD symptoms
- PANDAS is a subset of PANS
- PANDAS and PANS are believed to be caused by an abnormal immune response to common infections
- PANDAS and PANS can be treated with medicines and therapy
- PANDAS and PANS are incredibly tough conditions to live with for all concerned
PANDAS and PANS cause a sudden onset of severe OCD symptoms
PANDAS and PANS are two names for a mental health condition known as acute-onset OCD (obsessive-compulsive disorder). Typically, children with OCD develop the disorder gradually. However, in cases of acute-onset OCD, symptoms appear suddenly and dramatically. Parents of children with acute-onset OCD often describe their child as having changed “overnight” or “out of the blue”.
The onset of OCD symptoms in PANDAS and PANS is linked to an infection. PANDAS is specifically associated with a streptococcal infection, commonly known as strep throat. PANS, on the other hand, is linked to other infections such as influenza, varicella, mycoplasma, and Lyme disease.
The underlying mechanism of PANDAS and PANS involves a faulty immune response. Instead of attacking the infection, the body's immune system mistakenly targets the basal ganglia, a part of the brain that affects thoughts, feelings, movement, and behaviours. This results in brain inflammation and autoimmune processes that affect the central nervous system.
The symptoms of PANDAS and PANS can be severe and include obsessions, compulsions, or both. Children may develop new and intense fears or concerns about things being even, clean, or dirty. These thoughts and concerns can be overwhelming and difficult to manage. Compulsions or rituals may also develop, such as repeatedly washing or touching things, or performing specific actions in a certain way.
It is important to seek medical help if you suspect your child may have PANDAS or PANS. Treatment options include medications and therapy, such as cognitive behavioural therapy and exposure and response prevention. Early intervention is crucial to reduce the duration and intensity of symptoms and prevent potential long-term psychological and neurological issues.
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PANDAS is a subset of PANS
PANDAS and PANS are both disorders that cause a sudden onset of severe OCD symptoms and other sudden behavioural changes in children. PANS, or Pediatric Acute-onset Neuropsychiatric Syndrome, is a clinically defined disorder characterised by the sudden onset of obsessive-compulsive symptoms (OCD) or eating restrictions, along with acute behavioural deterioration in at least two designated domains. PANS does not require a known trigger, although it is believed to be triggered by one or more pathogens.
PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, is a subset of PANS. PANDAS was first reported by a team at the National Institute of Mental Health in 1998. It has five distinct criteria for diagnosis: abrupt onset of OCD or dramatic, disabling tics; an episodic symptom course, or relapsing-remitting course of severity; pre-pubertal onset; the presence of neurologic and neuropsychiatric abnormalities; and the occurrence of a strep infection before symptom onset. PANDAS is the only subtype of PANS that requires that symptoms be associated with a strep infection.
PANDAS and PANS are increasingly recognised as forms of autoimmune encephalitis (AE), specifically post-infectious basal ganglia encephalitis (BGE). The basal ganglia is a part of the brain that affects thoughts, feelings, movement, and other behaviours. Experts believe that irritation in this part of the brain leads to the symptoms of PANDAS and PANS.
Both PANDAS and PANS can be treated with medicines and therapy. Doctors and mental health experts can also give families guidance and support to help them through challenging times.
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PANDAS and PANS are believed to be caused by an abnormal immune response to common infections
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) and PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) are believed to be caused by an abnormal immune response to common infections. PANDAS is a subcategory of PANS. PANDAS and PANS are characterised by a sudden onset of severe OCD symptoms and other sudden behavioural changes in children. These symptoms can be so extreme that parents may say their child seemed to "change overnight".
PANDAS is believed to be caused by a strep infection. When the immune system fights the infection, it may mistakenly attack healthy areas of the brain, leading to the sudden development of OCD, tics, and other symptoms. The most common cause of a severe onset of OCD and tics is a group A streptococcus ("strep") infection. When it's clear that a child's symptoms are linked to a strep infection (like strep throat), it's called PANDAS.
PANS does not require a known trigger, although it is believed to be triggered by one or more pathogens. PANS has been reported to occur in association with a variety of infectious agents, including influenza, varicella, and mycoplasma pneumoniae. Lyme disease has also been proposed as a trigger for PANS.
In both cases, the abnormal immune response leads to inflammation in the brain, specifically the basal ganglia. This affects thoughts, feelings, movement, and other behaviours. Researchers believe irritation in this part of the brain leads to the symptoms of PANDAS and PANS.
PANDAS and PANS are treated with medicines and therapy. Antibiotics are usually prescribed to treat the strep infection and reduce PANDAS symptoms. Cognitive behavioural therapy, selective serotonin reuptake inhibitor (SSRI) medication, or both may be used to help manage OCD, anxiety, tics, or eating issues.
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PANDAS and PANS can be treated with medicines and therapy
PANDAS and PANS can be treated with a combination of medicine and therapy. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) are caused by an infection, most commonly a strep infection. The body's immune system mistakenly attacks healthy brain cells, leading to autoimmune processes that affect central nervous system function.
Treatment for PANDAS and PANS includes medication to treat the infection, such as antibiotics, and therapy to address the OCD symptoms. Cognitive behavioural therapy (CBT) is often used, which includes exposure and response prevention (ERP) to reduce ritual behaviours. ERP therapy can also address other behaviour and mood symptoms that may be part of PANDAS or PANS.
Medications such as penicillin, azithromycin, intravenous immunoglobulin (IVIG), plasma exchange (PEX), and corticosteroids have been used to treat PANDAS and PANS. IVIG is endorsed for treating PANDAS by a consortium of physicians and researchers, as it is an autoimmune irregularity that causes inflammation. Tonsillectomy may also be considered as a treatment option.
It is important to treat PANDAS and PANS early and in a timely fashion to prevent permanent psychological and neurological issues. Repeat strep infections can cause serious problems, so it is vital to eradicate strep.
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PANDAS and PANS are incredibly tough conditions to live with for all concerned
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) and PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) are rare disorders that can be tough to live with for both the affected individual and their loved ones. These conditions are characterised by a sudden and severe onset of obsessive-compulsive disorder (OCD) symptoms, along with other abrupt behavioural changes. The symptoms of PANDAS and PANS can be so extreme that a child may seem to have changed "overnight". This can be incredibly distressing for parents and caregivers, who may struggle to understand and cope with their child's sudden transformation.
PANDAS is a subtype of PANS and is specifically associated with an infection from streptococcal (strep) bacteria, such as strep throat or scarlet fever. PANS, on the other hand, may be triggered by various infections, including the flu, chickenpox, mycoplasma, and Lyme disease, or other factors such as immune system issues or environmental factors. While PANDAS and PANS typically first appear in childhood, from age 3 to puberty, it is possible, though rare, for an adult to develop these conditions.
The symptoms of PANDAS and PANS can cause significant disruptions to a person's life. In addition to severe OCD symptoms, individuals may experience anxiety, tics or other abnormal movements, personality changes, a decline in math and handwriting abilities, sensory sensitivities, restrictive eating, and more. The severity and duration of symptoms can vary, with some individuals experiencing episodic symptom courses or relapsing-remitting courses of severity. If left untreated, PANDAS and PANS can cause permanent psychological and neurological issues.
While there is currently no cure for PANDAS or PANS, early treatment is crucial to reducing the duration and intensity of symptoms. Treatment options include medications such as antibiotics and IVIG, plasmapheresis, and cognitive behavioural therapy. Additionally, doctors and mental health experts can provide guidance and support to help families navigate the challenges of living with these conditions.
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Frequently asked questions
PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, and PANS stands for Pediatric Acute-Onset Neuropsychiatric Syndrome. Both conditions cause a sudden onset of severe OCD symptoms and other sudden changes in a child's behaviour.
The main symptoms are new obsessive-compulsive behaviours, tics and/or eating restrictions. Other secondary symptoms include anxiety, changes in mood, difficulties with toileting and sleep, sensory sensitivities and behavioural regression.
The exact causes of PANS are unclear, but it is believed to be triggered by one or more pathogens. PANDAS is a subset of PANS and is specifically associated with a strep infection.
