Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) are related disorders affecting children. Research suggests that the causes may involve genetic, environmental, and immunological factors. Diagnosis of PANS and PANDAS can be challenging, as the symptoms can be similar to other conditions.
According to the PANDAS Network:
- One-quarter of all children will develop PANS and PANDAS in the United States.
- The most common age of onset is 4-9 years (69%)
- 81% report a strep infection, and 11% report other causes, such as Lyme disease, viruses, and mycoplasma pneumonia (walking pneumonia).
What are the Symptoms of PANS and PANDAS?
PANS is characterized by the sudden onset of neuropsychiatric symptoms, such as obsessive-compulsive disorder (OCD), anxiety, and tics. On the other hand, PANDAS refers explicitly to PANS cases triggered by a streptococcal infection, such as strep throat. Both disorders are believed to be caused by an abnormal immune response, where the body’s immune system mistakenly attacks the brain, leading to the onset of symptoms.
Symptoms vary but may include the following:
- Anxiety and Separation Anxiety
- Aggression and Irritability
- Hyperactivity
- Obsessive Compulsive Disorder (OCD)
- Repetitive Tics
- Loss of Control for Emotional Responses
- Depression
- Behavioral Regression
- Sudden Poor School Performance
- Sensory Sensitivity
- Hallucinations
- Dilated Pupils
- Joint Pain
- Unusual Body Movements
Diagnosing PANS and PANDAS
The prognosis can be good if a diagnosis and cause are identified early. Some children quickly return to normal function with treatment, but not all children experience a swift recovery. It is critical to seek a doctor’s help as soon as possible if your child experiences a sudden and dramatic change in behavior. A physician will first examine the child’s behavior and ask about past and recent health history, and order the following tests:
- Comprehensive tests for strep infection: strep culture; if negative peri-anal strep culture; and blood tests for ASO and Anti-DNase B antibody titers;
- Strep throat culture tests for family members to determine if any are strep carriers;
- Viral tests for Lyme disease, Epstein Barr, and Herpes Symplex;
- If the child has uncontrolled coughing, the doctor may test for bacterial walking pneumonia caused by the bacteria mycoplasma;
- Tests to measure organ function, inflammatory markers, autoimmune response, antibodies, and nutrient deficiencies;
- Gut health biomarkers.
Integrative Treatments for PANS and PANDAS
Overall, integrative medical treatment for PANS and PANDAS takes a holistic approach, combining various strategies to address the complex nature of these disorders. Integrative medical approaches address the psychological and neurological aspects of PANS and PANDAS to reduce inflammation and help improve cognitive function and reduce anxiety and other behavioral symptoms.
The primary goal is to address the underlying causes of these disorders, provide symptom relief, reduce brain inflammation, and restore the child’s quality of life. Integrative physicians will also consider the relationship between the gut and brain, immune function, and brain health.
Physicians will establish the best course of treatment using medications and dietary changes to reduce inflammation and improve symptoms and interventions to address inflammation and support immune function. Other integrative therapies may include cognitive-behavioral therapy, acupuncture, functional neurology, and neurofeedback.
When children present sudden symptoms, such as OCD, eating problems, and dramatic changes in behavior and mood, early intervention is essential. A combination of conventional and functional medicine, along with integrative therapies, will provide the best outcomes.
