PANS & PANDAS
Understanding PANS and PANDAS:
Pediatric Autoimmune Neuropsychiatric Disorders
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are two conditions that involve sudden and severe neuropsychiatric symptoms in children. These syndromes are thought to be triggered by an abnormal immune response, where the body mistakenly attacks the brain, particularly after an infection. While PANS is broader and can be triggered by various infections or environmental factors, PANDAS is specifically linked to streptococcal infections.
What is PANS?
PANS refer to a collection of symptoms that arise abruptly in children, adolescents,(and sometimes adults) following an infection or environmental trigger that causes an immune response where antibodies mistakenly attack brain cells, particularly in areas of the brain that influence mood, behavior, and motor skills.
Infectious and environmental offenders known to trigger PANS are viruses, bacterial infections (like tick-borne illness), mycoplasma pneumoniae, and mold.
Symptoms of PANS & PANDAS
Both PANS and PANDAS share a hallmark feature: the sudden onset of neuropsychiatric symptoms. A child who was previously healthy and developmentally on track can exhibit alarming behavioral changes seemingly overnight. Some common symptoms include:
SEVER ANXIETY
Intense fears, separation anxiety, or general anxiety that disrupts daily activities.TICS
Involuntary motor or vocal tics, such as blinking, facial grimacing, throat clearing or vocal outbursts.MOOD SWINGS
Sudden irritability, emotional lability, or aggression that is disproportionate to the situation.DECLINE IN SCHOOL PERFORMANCE
Cognitive issues like difficulties with attention, memory, or handwriting. We often see a decline in the subject of math.
What is PANDAS?
PANDAS is a subset of PANS, specifically associated with a recent streptococcal infection.
SLEEP DISTURBANCES
Difficulty falling or staying asleep, or new onset of nightmares.URINARY ISSUES
New-onset bedwetting or frequent urination.SENSORY SENSITIVITIES
Heightened sensitivity to sound, light, textures, or other sensory input.EATING RESTRICTIONS
Fear of eating, choking, certain textures and tastes or swallowing that cause the child to limit the foods they will eat to only 5 select foods. This may lead to significant weight loss.
Diagnostic Criteria for PANS
To diagnose PANS, clinicians use a set of criteria that focuses on the sudden onset of symptoms. The official diagnostic criteria for PANS include:
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The child develops new, intense obsessive-compulsive behaviors or an acute eating disorder
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In addition to OCD or restrictive eating, the child experiences at least two of the following symptoms:
Anxiety (including separation anxiety)
Emotional instability or depression
Irritability, aggression, or severe oppositional behaviors
Behavioral or developmental regression
Sudden decline in academic performance, particularly in math and handwriting
Sensory or motor abnormalities (e.g., tics or handwriting changes)
Somatic symptoms such as sleep disturbances or bedwetting
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This ensures that other potential causes, such as trauma or pre-existing psychiatric conditions, are ruled out.
The Importance of Early Diagnosis and Treatment
PANS and PANDAS can be life-altering for both the child and their family. Early diagnosis is key to managing these disorders and improving outcomes. Treatment typically involves a multi-faceted approach, including:
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Comprehensive lab work is ordered to discover what infections are active. Treatment for the infections is employed with antibiotics, herbal antimicrobials, or both.
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NSAIDs, natural anti-inflammatories, and in severe cases, steroids are initiated to reduce brain inflammation.
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Natural immunomodulators, Helminth therapy, or intravenous immunoglobulin (IVIG) for severe cases.
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CBT can be used to help manage OCD and anxiety.
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Address any eating restrictions, nutritional deficiencies, or weight loss.
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Address OCD, anxiety, depression, and tics.
If left untreated, symptoms can worsen or lead to more persistent neuropsychiatric disorders, so early intervention is critical.