Understanding PANS/PANDAS: The Link between Infection and Sudden OCD or Tics in Kids
by Dr. Emily Lesnak
What is PANS/PANDAS?
PANS (pediatric acute-onset neuropsychiatric syndrome) is an abrupt onset of obsessive compulsive symptoms (OCD) or restrictive eating behavior in the pediatric population. PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) is a subset of PANS with a similar symptom picture to PANS and typically triggered by Group A strep infection (GAS). Since PANS and PANDAS are very similar in their symptoms and treatment they will be referred to interchangeably throughout this blog post.
What are common symptoms?
PANS symptoms include sudden onset of obsessive compulsive symptoms (like compulsive hand washing, repeatedly closing doors or turning off lights, etc…) or restrictive eating behavior. Other symptoms that can be associated with PANS/PANDAS include:
Anxiety
motor abnormalities like tics or writing problems
increased sensitivity to lights, noise, sounds
Sleep disturbances
Changes in behavior - increased aggression or irritability, self harm, etc…
Developmental regression, memory changes
Why does this happen?
The immune system typically does a good job at not attacking itself, but in some people this protective measure can be overridden by particular organisms. The leading theory is that PANS/PANDAS is autoimmune encephalopathy, which is when the immune system confuses brain tissue for an offending organism (or in the case of PANDAS, Group A strep organism) and starts to attack that brain tissue leading to symptoms explained above.
How is PANS/PANDAS diagnosed?
There is no definitive test to diagnose PANS/PANDAS, so diagnosis is made on a clinical basis. It is important to rule out other causes that might have similar symptoms, so generally blood work is done and referrals to a neurologist or cardiologist are considered. Testing for GAS is important since that is a common trigger for PANDAS.
The following criteria need to be met in order to diagnose PANS:
Abrupt onset of symptoms
At least 2 additional neuropsychiatric symptoms: anxiety, depression, decline in cognition, motor or sensory abnormalities, sleep disturbance or abnormal urination pattern, developmental regression, decline in school performance, irritability or aggression
Symptoms are not better explained by an alternative diagnosis
The following criteria need to be met in order to diagnose PANDAS:
Presence of OCD or tics
Symptoms start between age 3 and puberty
Acute onset and symptoms that come and go
Association with GAS infection
Association with neurological abnormalities
Oftentimes blood work will be recommended to check for GAS antibodies to look at past infection if there is no active infection. Blood work can also be helpful to rule out other disorders or to test for other associated conditions or nutrient deficiencies that could benefit from supplementation to help treat.
How do you treat PANS/PANDAS?
There are three main goals when treating PANS/PANDAS:
Treat the infection and acute inflammation
Treat the symptoms
Prevention, immune support, treat autoimmune disease
It is most important to treat the acute infection so as to stop triggering the autoimmune response. Since GAS is the most common infection when we are talking about PANS/PANDAS, it will be often recommended to treat with oral antibiotics or topical antibiotics if there is a GAS skin infection. Sometimes herbal antimicrobials will be considered if antibiotic treatment is not working.
Anti-inflammatories can be helpful to treat the acute inflammation, this could look like using something like ibuprofen or supplemental antiinflammatories. For people who are really affected by the inflammation, medications like oral steroids or IV therapy is needed.
Treating the other associated neurological symptoms can be done in many ways, like using prescription mood medications or supplemental therapies including herbal medicine, magnesium, certain B vitamins, omega 3 fats, and many other supplemental therapies that can be tailored to the patient.
Basic lifestyle factors, like getting enough sleep, eating a diet high in antioxidants, regular movement, and keeping stress to a minimum are pillars in prevention and treating the autoimmune reaction. Supporting a good intestinal probiotics and treating any related digestive issues are important when we are thinking for treating autoimmune disease and prevention of PANS/PANDAS.
The treatment of PANS/PANDAS is very individualized depending on someone’s symptom picture, medical history, and lab results. There are many options for treatment that can be helpful to treat symptoms and help with prevention.
Have additional questions or concerns about this? Schedule a visit with one of our team members here.
See you in clinic,
Dr. Lesnak
References:
https://www.pandasppn.org/what-are-pans-pandas/
Gagliano A, Carta A, Tanca MG, Sotgiu S. Pediatric Acute-Onset Neuropsychiatric Syndrome: Current Perspectives. Neuropsychiatr Dis Treat. 2023 May 24;19:1221-1250. doi: 10.2147/NDT.S362202. PMID: 37251418; PMCID: PMC10225150.
Leonardi L, Perna C, Bernabei I, Fiore M, Ma M, Frankovich J, Tarani L, Spalice A. Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS): Immunological Features Underpinning Controversial Entities. Children (Basel). 2024 Aug 27;11(9):1043. doi: 10.3390/children11091043. PMID: 39334578; PMCID: PMC11430956.