Emilie Meyer
PANS, or Pediatric Acute-onset Neuropsychiatric Syndrome, is a severe form of obsessive-compulsive disorder (OCD) that appears suddenly in young children. It is characterized by intense fears, concerns, and compulsions, as well as other distressing symptoms. Those suffering from PANS experience emotional lability, which can cause rapid shifts in emotions, from despair to euphoria, and can also lead to panic attacks and suicidal thoughts. Treatment options include antibiotics, CBT, SSRIs, IVIG, and plasmapheresis. This paragraph provides an introduction to PANS, its symptoms, and potential treatment methods.
How to stop a PANS flare
| Characteristics | Values |
|---|---|
| Treatment | Antibiotics, CBT, SSRIs, IVIG, plasmapheresis, steroids |
| Symptoms | Emotional lability, behavioural regression, irritability, aggression, deterioration in school performance, motor or sensory abnormalities, somatic symptoms |
| Causes | Infections, immune system response |
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What You'll Learn
Antibiotics, CBT and SSRIs
PANS/PANDAS is an autoimmune response where the immune system attacks the brain, generating neuropsychiatric symptoms. The treatment approach involves addressing symptoms, infections, inflammation, and the immune system. Antibiotics, CBT, and SSRIs are all used in the treatment of PANS/PANDAS, often in conjunction with other therapies.
Antibiotics
Antibiotics are used to treat PANS/PANDAS flares triggered by an infection. GAS and strep throat are the most studied inciting infections, but other infections like upper respiratory tract infections, Mycoplasma pneumoniae, and influenza can also trigger flares. Patients are advised to treat the underlying infection thoroughly, and even without a documented infection, a course of antibiotics is suggested at the time of diagnosis. Prophylactic antibiotics are also recommended for patients with a history of rheumatic fever, Sydenham's chorea, or PANDAS to prevent reinfection and reduce the risk of developing more severe symptoms.
CBT
Cognitive-behavioral therapy (CBT) is a type of behavioral therapy that is used in conjunction with antibiotics and SSRIs to treat PANS/PANDAS. It may not be suitable for patients during the acute stage of illness due to overwhelming symptoms, but caregivers can be instructed on behavioral interventions to manage symptoms at home. CBT is particularly effective in controlling symptoms when combined with other treatments, and in preventing relapses.
SSRIs
SSRIs, or selective serotonin reuptake inhibitors, are a type of psychiatric medication used to treat PANS/PANDAS. These medications are typically started at a low dose and gradually increased over time. Patients with mild to moderate symptoms may not require SSRIs, while those with more severe symptoms may benefit from their use in conjunction with behavioral therapy and other pharmacological treatments. SSRIs can cause increased anxiety, especially at the beginning of treatment, but this side effect often improves as the body adjusts to the medication. Dietary changes, such as reducing high-fat, high-sugar, and high-caffeine foods, as well as regular physical activity, can help mitigate anxiety caused by SSRIs.
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Plasmapheresis
PANS (Paediatric Autoimmune Neuropsychiatric Syndrome) and PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are forms of severe, acute-onset OCD (Obsessive-Compulsive Disorder) in children. PANS/PANDAS can cause a range of behavioural and emotional symptoms, including severe depression, irritability, aggression, deterioration in school performance, and somatic symptoms such as sleep disturbances.
However, it is important to note that plasmapheresis is an invasive procedure with potential risks, including mild adverse events such as vasovagal episodes related to needle insertion and cutaneous paresthesias related to citrate-induced hypocalcemia. In rare cases, machine malfunction can result in blood loss, leading to anaemia or temporary neutropenia. Plasmapheresis is typically administered in a hospital setting, and patients may require multiple treatments over several weeks to achieve the desired outcome.
To optimise the success of plasmapheresis and minimise symptoms and risks, patients are advised to take several steps before the procedure. These include consuming a nutritious meal, getting a good night's sleep, staying hydrated, and avoiding smoking and tobacco use. Additionally, patients should consult with their doctor to determine if any vaccinations are needed and make necessary adjustments to their medication regimen.
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Prednisone
PANS (Paediatric Autoimmune Neuropsychiatric Syndrome) is a severe form of obsessive-compulsive disorder (OCD) that appears suddenly in young children, accompanied by other confusing and distressing symptoms. It can cause behavioural regression, emotional lability, irritability, aggression, deterioration in school performance, motor or sensory abnormalities, and somatic symptoms.
To be diagnosed with PANS, a patient must exhibit two or more of the following symptoms:
- Behavioural regression: Children may act much younger than their age, such as reverting to baby talk.
- Emotional lability: Children may experience severe mood swings, depression, or suicidal thoughts.
- Irritability, aggression, and/or severely oppositional behaviours.
- Deterioration in school performance: A sudden decline in math and reading skills, memory, and concentration, along with increased hyperactivity.
- Motor or sensory abnormalities: Handwriting and drawing skills may deteriorate, and patients may become distressed by noise or light.
- Somatic symptoms: Sleep disturbances, bedwetting, and changes in urinary frequency or intensity.
PANS flares can be treated with antibiotics, CBT, SSRIs, IVIG, and plasmapheresis (the removal, filtering, and return of blood plasma). In less severe cases, over-the-counter painkillers and time may be sufficient to manage symptoms.
When taking prednisone, it is important to be aware of potential side effects, especially with long-term use or high doses. Common side effects include an increased risk of infection, weight gain, fluid retention, high blood pressure, mood changes, and behavioural changes. More serious side effects may include an increased risk of adrenal gland problems, liver damage, and birth defects. It is crucial to consult a doctor before starting or stopping prednisone and to have regular check-ins to monitor the medication's effectiveness and potential side effects.
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Cognitive behavioural therapy
PANS and PANDAS are severe forms of obsessive-compulsive disorder (OCD) that appear suddenly in young children, accompanied by other confusing and distressing symptoms. While the conditions are related, PANDAS is diagnosed when symptoms have a documented association with group A Streptococcus infections, whereas PANS is a broader diagnostic category used when a bacterial infection other than strep is creating an autoimmune response.
CBT for PANS and PANDAS specifically takes the form of Exposure and Response Prevention (ERP), which has been shown to help children with anxiety and OCD. ERP works by gradually exposing the patient to the fears that trigger their OCD while they learn to resist the urge to complete the compulsive rituals. This starts with a situation that only causes mild anxiety, and the patient gradually moves on to situations that cause more anxiety.
Therapy can also address other behaviour and mood symptoms that may be part of PANS or PANDAS. For example, a therapy called habit reversal can help if a child has tics. Therapists work closely with parents to coach them in ways to help their child's symptoms improve. Therapists also guide parents on how to manage a child's stressful symptoms until they can resolve.
In addition to CBT, other treatments for PANS and PANDAS include antibiotics, steroids, and anti-inflammatory drugs.
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Exposure and response prevention
PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) and PANS (Paediatric Acute-Onset Neuropsychiatric Syndrome) are rare neuropsychiatric conditions that affect children and young adolescents. They are characterised by acute-onset OCD, anxiety, tics, and other abnormal movements, as well as personality changes, decline in math and handwriting abilities, sensory sensitivities, and restrictive eating. The symptoms of PANDAS and PANS can last 4-6 weeks but can re-emerge if the child is reinfected.
PANDAS is caused by an autoimmune response to a strep infection, specifically group A Streptococcus. PANS is a broader diagnostic category used when a bacterial infection other than strep creates a similar autoimmune response, including Lyme disease, mononucleosis, H1N1, and mycoplasma. In both conditions, inflammation caused by the immune response leads to sudden and drastic behavioural and mood changes.
To treat PANDAS and PANS, it is crucial to eliminate the underlying infection, typically with antibiotics. Cognitive behavioural therapy (CBT) and exposure and response prevention (ERP) are also used to manage the psychological impacts of the disorders. ERP is a form of psychotherapy that helps patients manage obsessions and compulsions, as well as emotional reactions such as anxiety, depression, and anger. It also provides guidance to parents and educators on how to best support the patient at home and school.
While there is currently no cure for PANDAS or PANS, treatments such as CBT, ERP, and medications have been shown to effectively reduce symptoms.
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Frequently asked questions
PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome. It is a severe form of Obsessive-Compulsive Disorder (OCD) that appears suddenly in young children.
Children with PANS will experience sudden and severe obsessions, compulsions, or both. They may develop new and intense fears or concerns about things being even, clean, or dirty. These fears and concerns can be so strong that the child may be difficult to comfort.
Treatment for PANS typically involves a combination of medication and therapy. Antibiotics are used to treat the underlying infection, while cognitive behavioral therapy (CBT) is employed to address the OCD symptoms. In severe cases, additional treatments such as IVIG or plasmapheresis may be recommended if initial treatments are unsuccessful.
PANS can cause emotional lability, which means that individuals may experience rapid and unpredictable shifts in emotions. They can feel complete despair one moment and then be high on life the next. Emotional lability can also lead to panic attacks and suicidal thoughts.
Physical symptoms of PANS can include motor or sensory abnormalities, such as dramatic changes in handwriting and drawing abilities. Individuals may also experience sleep disturbances, bedwetting, and changes in urinary frequency or intensity. In some cases, PANS can cause an individual's legs to suddenly give out, resulting in a loss of balance.
