Understanding Pans Disease: An Emerging Health Concern

PANS (Paediatric Acute-onset Neuropsychiatric Syndrome) is a clinical diagnosis given to children who exhibit a dramatic and abrupt onset of neuropsychiatric symptoms, including obsessions, compulsions, or food restriction. It is characterised by the sudden development of obsessive-compulsive disorder (OCD) or severely restrictive eating habits, accompanied by at least two additional neuropsychiatric symptoms. These symptoms can include anxiety, mood swings, irritability, sleep disturbances, and urinary issues. PANS is often triggered by infections, metabolic disturbances, or inflammatory reactions, but the exact cause is unknown in most cases. PANS is a general term that does not specify the type of infection triggering the symptoms, and the behaviour changes can reach full intensity within 24 to 48 hours.

PANS and PANDAS are conditions that affect the brain

PANS (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 patients may also experience comorbid symptoms such as anxiety, sensory amplification, motor abnormalities, behavioural regression, deterioration in school performance, mood disorders, urinary symptoms, and/or sleep disturbances. PANS is typically triggered by infections, metabolic disturbances, or other inflammatory reactions, though the cause is unknown in most cases.

PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) is a subset of PANS. PANDAS patients experience similar symptoms to PANS patients, but their onset is linked specifically to a streptococcal infection. PANDAS was first reported in 1998 and has distinct diagnostic criteria, including abrupt OCD or dramatic, disabling tics; a relapsing-remitting, episodic symptom course; young age at onset (6-7 years on average); presence of neurologic abnormalities; and a temporal association between symptom onset and Group A strep infection.

Both PANS and PANDAS are episodic disorders, with symptoms disappearing for extended periods and then reappearing, stimulated by later exposure to strep or other bacteria or viruses. Symptoms may become increasingly severe with multiple recurrences.

PANS and PANDAS are neuropsychiatric conditions, meaning they present both neurological and psychiatric symptoms. They are often grouped together due to their shared symptoms, and both conditions can begin quite suddenly, with symptoms coming and going over time.

PANS and PANDAS affect the brain, causing a variety of symptoms ranging from mental health issues to changes in behaviour and difficulties with movement. People with PANS or PANDAS may experience anxiety, emotional lability, irritability, aggression, behavioural regression, sudden deterioration in school performance, motor or sensory abnormalities, insomnia, enuresis, and urinary frequency. In some cases, hallucinations and/or psychosis may also be present.

PANS is a clinically defined disorder characterised by the sudden onset of OCD symptoms or eating restrictions

PANS, or Pediatric Acute-onset Neuropsychiatric Syndrome, is a clinically defined disorder characterised by the abrupt onset of obsessive-compulsive disorder (OCD) symptoms or severely restricted food intake. The onset of symptoms is usually sudden and dramatic, sometimes occurring overnight, and reaching full-scale intensity within 24 to 48 hours.

PANS is a neuropsychiatric condition triggered by a misdirected immune response to a variety of infections, metabolic disturbances, or other inflammatory reactions. The exact cause of PANS is unknown in most cases, but it is believed to be triggered by pathogens, with cases linked to infections such as Lyme disease, the flu, mononucleosis, and mycoplasma.

The diagnosis of PANS requires the presence of one major symptom, either OCD or restricted food intake, along with at least two additional neuropsychiatric symptoms. These accompanying symptoms can include anxiety, mood swings, irritability, sleep disturbances, urinary issues, sensory abnormalities, and deterioration in school performance.

PANS is often accompanied by severe behavioural changes, with children exhibiting emotional lability, depression, irritability, aggression, and oppositional behaviours. They may also experience regression, acting much younger than their age, using baby talk, or exhibiting clingy behaviour.

PANS is a clinically diagnosed condition, and there is no specific test to prove or disprove its presence. The diagnosis is based on the observation of specific signs and symptoms by medical professionals, along with a review of the patient's medical history, current symptoms, and a physical examination.

PANDAS is a subset of PANS and is caused by streptococcal infections

PANDAS (Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections) is a subset of PANS (Paediatric Acute-onset Neuropsychiatric Syndrome). PANDAS is caused by streptococcal infections, specifically Group A streptococcal (GAS) infections. Streptococcal bacteria are ancient bacteria that can "hide" in the body and evade detection by mimicking human cells. This can lead to the body's immune system attacking its own cells, causing inflammation and neurological dysfunction. PANDAS is characterised by the sudden onset of severe OCD symptoms, tics, and other behavioural changes in children. These symptoms can be so extreme that parents may describe their child as having changed overnight.

PANDAS was first reported in 1998 by a team at the National Institute of Mental Health and has five distinct diagnostic criteria: abrupt "overnight" OCD or dramatic, disabling tics; a relapsing-remitting, episodic symptom course; young age at onset (average of 6-7 years); presence of neurologic abnormalities; and a temporal association between symptom onset and GAS infection. PANDAS is the only subtype of PANS that specifically requires symptoms to be associated with a streptococcal infection.

PANS, on the other hand, is a more general term that does not specify the type of infection thought to trigger the symptoms. PANS is believed to be triggered by one or more pathogens, including infections such as influenza, varicella, mycoplasma pneumoniae, and Lyme disease. PANS is characterised by the sudden onset of OCD symptoms or eating restrictions, along with acute behavioural deterioration in at least two designated domains. PANS symptoms may include anxiety, sensory amplification, motor abnormalities, behavioural regression, deterioration in school performance, mood disorders, urinary symptoms, and sleep disturbances.

Both PANDAS and PANS can be treated with medications and therapy. Treatment for PANDAS typically involves antibiotics to address the underlying infection, anti-inflammatories, and in some cases, treatments to suppress the immune response, such as prednisone. Cognitive behavioural therapy (CBT) is also used to address OCD symptoms and exposure and response prevention therapy to reduce ritual behaviours.

PANS and PANDAS are episodic disorders

PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are episodic disorders. This means that symptoms may disappear for extended periods and then reappear, stimulated by a later exposure to strep or some other bacteria or virus. Symptoms may get increasingly severe with multiple recurrences.

PANS and PANDAS are severe forms of obsessive-compulsive disorder (OCD) that appear suddenly in young children, accompanied by other confusing and distressing symptoms. They are diagnosed if a child has sudden, severe OCD and other disturbing symptoms.

PANS is a more general term that does not specify the type of infection thought to trigger the symptoms. It’s called “acute onset” because the behaviour changes come on suddenly, reaching full-scale intensity within 24 to 48 hours. It’s a syndrome because there are quite a few other symptoms that appear alongside the intense anxiety.

PANDAS is a more specific term used when the triggering infection is strep. PANDAS is a subgroup of PANS. Some 86% of acute onset OCD cases are linked to strep.

PANS cases have also been linked to other infections, including Lyme disease, mononucleosis, mycoplasma (walking pneumonia) and the flu (such as H1N1).

Symptoms of PANS and PANDAS include:

• Severe separation anxiety
• Handwriting suddenly becomes unrecognisable
• Drawings look like scribbles
• Starts wetting the bed
• Can’t manage the math or reading he could do effortlessly the previous week
• Sleep disturbances or fatigue
• Visual or auditory hallucinations
• Sensitivity to light, sound, and touch

PANS and PANDAS are treatable

PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Acute-onset Neuropsychiatric Disorders Associated with Streptococcus/Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections) are treatable conditions. They are characterised by the sudden onset of obsessive-compulsive symptoms (OCD) and other severe behavioural changes in children. While PANDAS is specifically triggered by a streptococcal infection, PANS is associated with a variety of infections, including influenza, varicella, and mycoplasma pneumonia.

The treatment approach for PANS and PANDAS involves three complementary interventions:

• Treating symptoms: Psychiatric medications and therapies are used to provide symptomatic relief. Psychoactive medications include selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines, while therapies such as cognitive behavioural therapy (CBT) and exposure response prevention (ERP) are also employed.
• Removing the inflammatory source: Antimicrobial treatments, such as antibiotics, are used to eliminate the underlying infection causing neuroinflammation.
• Treating immune system dysregulation: Anti-inflammatory and immunomodulating medications are administered to address disturbances in the immune system. This includes treatments like intravenous immunoglobulin (IVIG), plasmapheresis (PEX), and immunomodulatory agents.

It is important to note that early treatment is crucial for PANS and PANDAS. If left untreated, these conditions can cause permanent debilitation or even become encephalitic. With timely and appropriate medical intervention, however, PANS and PANDAS can be effectively managed, and children can return to their normal lives.

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