Ella Walter
PANS and PANDAS are severe forms of obsessive-compulsive disorder (OCD) that appear suddenly in young children, accompanied by other confusing and distressing symptoms. PANDAS is a subgroup of PANS and is caused by a streptococcal infection. PANS is caused by other infections such as Lyme disease, mononucleosis, mycoplasma, and the flu. If you think your child may have PANDAS or PANS, contact your child's doctor right away. Your doctor can help you find a mental health therapist or you can visit the International OCD Foundation website to find an expert trained to provide cognitive behavioural therapy for OCD in children.
| Characteristics | Values |
|---|---|
| PANS Definition | Pediatric Acute-onset Neuropsychiatric Syndrome |
| PANDAS Definition | Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections |
| PANS Symptoms | Acute-onset OCD, anorexia, separation anxiety, panic attacks, depression, suicidality, regression, tics, rage, eating restriction, deterioration in school performance, memory impairment |
| PANDAS Symptoms | Acute-onset OCD, tics, anorexia, separation anxiety, panic attacks, depression, suicidality, regression, rage, eating restriction, deterioration in school performance, memory impairment |
| PANS Causes | Lyme disease, mononucleosis, mycoplasma (walking pneumonia), the flu (H1N1), Epstein Barr virus, Borrelia burgdorferi |
| PANDAS Causes | Streptococcus (Strep) infection |
| Treatment | Exposure therapy, antidepressant medication, antibiotics, cognitive behavioral therapy, surgical treatment |
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What You'll Learn
Recognising PANS and PANDAS
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 suddenly in young children, accompanied by other confusing and distressing symptoms. PANDAS is a sub-group of PANS.
PANS and PANDAS are episodic disorders. Symptoms may disappear for extended periods and then reappear, stimulated by exposure to strep or some other bacteria or virus. Symptoms may get increasingly severe with multiple recurrences.
PANS and PANDAS occur after an infection, most commonly a strep infection. Brain inflammation occurs when the body’s immune system mistakenly attacks healthy brain cells, leading to autoimmune processes that affect central nervous system function. An affected child generally has a sudden, dramatic change in personality, displayed as OCD, anxiety, tics or other abnormal movements, personality changes, decline in math and handwriting abilities, sensory sensitivities, restrictive eating, irritability or aggressive behaviour, extreme moodiness or depression, deterioration of motor skills, visual or auditory hallucinations, sleep disturbance or fatigue, and more.
PANDAS is specifically linked to streptococcus ("strep") infections, whereas PANS is associated with other infections, including the flu, chickenpox, mycoplasma, and Lyme disease.
PANS and PANDAS are rare and lesser-known disorders, and doctors often mistake them for other conditions. If you think your child may have PANS or PANDAS, contact your child's doctor right away. It's best to start therapy as soon as possible.
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How PANS and PANDAS are diagnosed
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Acute-onset Neuropsychiatric Disorders Associated with Streptococcus) are rare disorders that are often mistaken for other conditions. PANDAS is a subcategory of PANS and is caused by a streptococcal infection. PANS can be caused by other infections, including the flu, chickenpox, mycoplasma, and Lyme disease.
PANS and PANDAS are severe forms of obsessive-compulsive disorder (OCD) that appear suddenly in young children, accompanied by other confusing and distressing symptoms. PANDAS is specifically linked to streptococcal infections, with symptoms including tics and obsessive-compulsive behaviour. PANS criteria include the sudden onset of OCD or severely restricted food intake, along with two of the following seven criteria: emotional lability (mood swings), irritability, aggression, oppositional behaviour, behavioural regression, sudden deterioration in school performance, or anxiety and depression.
If you suspect your child may have PANS or PANDAS, it is important to contact your doctor right away and provide a thorough medical history and description of symptoms to aid in the diagnosis. Meeting with a specialist is the best way to get a diagnosis, as they will evaluate signs, symptoms, medical history, and laboratory findings to rule out other neurological or medical disorders.
There is broad acceptance that PANDAS is an immune response to the strep bacteria, which mimics human heart or brain tissue. This misdirected immune response can also cause rheumatic fever, where the immune system attacks the heart instead of the brain. Treatment for PANDAS includes antibiotics for active strep infections, cognitive behavioural therapy, and habit reversal training for tics. PANS and PANDAS can be treated with medicines and therapy, and doctors can provide guidance and support to families.
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Treatment options for PANS and PANDAS
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Acute-onset Neuropsychiatric Disorders Associated with Streptococcus) are severe forms of OCD that appear suddenly in young children. PANDAS is a more specific term used when the triggering infection is strep, and it is a subgroup of PANS.
There are several treatment options for PANS and PANDAS:
- Antibiotics: Antibiotics can help control or reduce symptoms of PANDAS and PANS, including OCD, anxiety, depression, and tics. Beta-lactams are the most effective antibiotics for Group A Streptococcal (GAS) infections and include penicillin, amoxicillin, and cephalosporins. The response to antibiotics is typically seen within a week or two of therapy, but some children experience improvement within 24-48 hours.
- IVIG Therapy: Intravenous administration of immunoglobulins (IVIG) and similar treatments may improve the symptoms of PANS and PANDAS by addressing the underlying infection and autoimmune reaction. However, these treatments can cause side effects such as nausea, vomiting, headaches, dizziness, and an increased risk of infection. Due to these side effects and risks, IVIG treatment is usually considered only for children with severe cases of PANS or PANDAS.
- Non-invasive options: Over-the-counter anti-inflammatory drugs, such as oral nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, can help control the inflammation caused by the autoimmune response. These medications are particularly useful for exacerbations or "mini-flares" that occur after immunotherapy.
- Plasmapheresis: Plasmapheresis is an invasive procedure that carries risks and should be done in pediatric apheresis centers. It is typically considered for children with severe or life-threatening symptoms.
- Therapy: Therapy for OCD, such as exposure and response prevention, can help reduce ritual behaviors and address other behavior and mood symptoms associated with PANDAS or PANS. Habit reversal therapy can be beneficial for children with tics. Therapists work closely with parents to guide them in managing their child's symptoms and improving their overall well-being.
It is important to work closely with a healthcare provider to manage PANS or PANDAS and make treatment adjustments as needed. Early intervention is crucial, and children can recover fully with prompt and appropriate treatment.
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The difference between PANS and PANDAS
PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections) are both infection-triggered autoimmune disorders that affect the basal ganglia, a region of the brain responsible for motor movements, learning, cognition, and emotion. However, there are some key differences between the two conditions.
PANS can occur at any age, although symptoms often begin during grade school or adolescence. It is a broader syndrome that includes PANDAS, and can be triggered by various infections or inflammatory reactions beyond just strep, such as Lyme disease, influenza, Epstein-Barr virus (EBV), or even non-infectious triggers. PANS symptoms include OCD-like behaviours, tics and/or restrictive eating, and can also manifest as emotional lability, ADHD-like behaviours, anxiety, depression, oppositional behaviours, and sleep disturbances, among others.
PANDAS, on the other hand, has stricter diagnostic criteria and typically appears between the ages of 3 and 12, with an average onset age of 6-7 years. It is specifically associated with streptococcal (strep) infections, such as strep throat, and requires a documented recent strep infection for diagnosis. PANDAS symptoms include abrupt "overnight" OCD or disabling tics, sensory abnormalities, anxiety, mood swings, irritability, sleep disturbances, and behavioural regression. It is important to note that not all children with strep infections will develop PANDAS; only a subset with genetic susceptibility will develop autoimmune brain inflammation.
While PANS and PANDAS share many similar symptoms and respond to similar treatment regimens, they are distinct conditions. PANS is a broader category that encompasses various infectious and non-infectious triggers, while PANDAS is specifically linked to strep infections.
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Signs and symptoms of PANS and PANDAS
PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) is characterised by the sudden onset of OCD symptoms or disordered eating after an infection or other triggers to the immune system. The symptoms of PANS and PANDAS are usually intense, occur quickly and unexpectedly, and may come and go over time. They can include:
- Compulsions (repetitive behaviours a person feels the urge to do)
- Obsessions (uncontrollable and recurring thoughts)
- Emotional lability (mood swings) or depression
- Irritability, aggression, or oppositional behaviour
- Behavioural (developmental) regression
- Sudden deterioration in school performance
- Motor or sensory abnormalities, including tics or involuntary movements
- Sleep disturbances or bedwetting (enuresis)
- Visual or auditory hallucinations
- Sensitivity to light, sound, and touch
- Fatigue
- Anxiety
- Disinterest in food
- Fidgeting and symptoms similar to ADHD
PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) is a subset of PANS. It is believed to be caused by a strep infection. When the immune system fights the infection, it may mistakenly attack healthy areas of the body, including the brain, leading to the sudden development of OCD, tics, and other symptoms. The symptoms of PANDAS have been reported to vary widely from child to child and can involve a combination of psychological and neurological conditions.
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Frequently asked questions
PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome. It is a childhood condition characterized by the sudden onset of obsessive-compulsive disorder (OCD) symptoms and/or eating restrictions following a bacterial or viral infection, including COVID-19.
PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. It is a subgroup of PANS and is specifically used when the triggering infection is strep.
The primary symptom of PANS and PANDAS is acute-onset OCD. Children with PANS and PANDAS also develop other distressing and confusing symptoms, including regression, tics, eating restrictions, rage, depression, and even suicidality.
The treatment for PANS and PANDAS depends on the cause of the disorder. Some doctors recommend antibiotics to get rid of any underlying infection. Other treatments include exposure therapy, antidepressant medication, and cognitive behavioral therapy.
If you think your child may have PANS or PANDAS, contact your child's doctor right away. Your doctor can help you find a mental health therapist or you can visit the International OCD Foundation website to find an expert trained in cognitive behavioral therapy for OCD in children.
