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:

  1. One-quarter of all children will develop PANS and PANDAS in the United States.
  2. The most common age of onset is 4-9 years (69%)
  3. 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

pans/pandasThe 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:

  1. Comprehensive tests for strep infection: strep culture; if negative peri-anal strep culture; and blood tests for ASO and Anti-DNase B antibody titers;
  2. Strep throat culture tests for family members to determine if any are strep carriers;
  3. Viral tests for Lyme disease, Epstein Barr, and Herpes Symplex;
  4. If the child has uncontrolled coughing, the doctor may test for bacterial walking pneumonia caused by the bacteria mycoplasma;
  5. Tests to measure organ function, inflammatory markers, autoimmune response, antibodies, and nutrient deficiencies;
  6. Gut health biomarkers.

Integrative Treatments for PANS and PANDAS

pans/pandasOverall, 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.


By submitting this form, you are consenting to receive marketing emails from: Functional Medicine Doctor Irvine. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email. Emails are serviced by Constant Contact


What Causes PANS and PANDAS?

PANS and PANDAS are childhood conditions caused by factors that overstimulate the immune system, such as strep infection, flu, pneumonia, or even the common cold. The immune system over-reacts, causing an autoimmune response that leads to inflammation in the part of the brain responsible for motor control, executive functions, behaviors, and emotions. The neurological inflammatory reaction can cause sudden neurological, psychological, and cognitive symptoms.

Are PANS and PANDAS Easy to Diagnose?

The research is limited surrounding PANS and PANDAS, according to the PANDAS Network. As such, the condition is frequently misdiagnosed. Experts sometimes see PANS and PANDAS in combination with other autoimmune disorders, immune deficiencies, and other neurological or psychiatric disorders. This can complicate a diagnosis and make treatment more difficult because physicians may assume psychiatric conditions cause the symptoms. If your child expresses similar symptoms, they must undergo a comprehensive medical exam to diagnose or rule out PANS and PANDAS.

Where Can I Get More Information on PANS and PANDAS?

  1. The PANDAS Network is dedicated to improving diagnosing and treating children with PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) and PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome).
  2. For physicians, get more information at the PANDAS Physicians Network.
  3. The Child Mind Institute provides a comprehensive guide to both PANS and PANDAS.

It is important to note that not all cases of strep throat lead to PANS or PANDAS, but the presence of strep infection can trigger these conditions in susceptible individuals. Early recognition and appropriate treatment of strep throat are crucial to prevent the development of PANS or PANDAS in exposed children.

Even if PANS or PANDAS isn’t what is going on with your child, these symptoms are almost always the result of autoimmunity and its ugly twin, inflammation — each capable of impacting the central nervous system. Treatments are available to restore immune system health and function and reduce the inflammation. The sooner you act, the sooner your child will experience relief, and the better the outcome. Left untreated, these conditions can cause long-term health and developmental problems.

If you live in Los Angeles or the Orange County area and believe your child has PANS or PANDAS, don’t hesitate to contact our clinic immediately to discuss medical necessity and insurance plans. We cannot accept all patients who inquire, so please call to discuss this with our staff.

Hear About a New Level of Care and Compassion from Arabella

After being passed around from doctor-to-doctor and multiple emergency room visits, no one knew what was causing Arabella’s nerve, joint and muscle pain, extreme fatigue and inability to walk. Was it multiple sclerosis? Was it Lyme Disease? What it something else? A friend’s recommendation led her to Restoration Healthcare, who confirmed it was Lyme Disease.

She describes the experience as being engaging with high standards of care from people who actually care about their patients. The clinic explored every aspect of Arabella’s health including nutritional status, hormone balance, immunity and even the emotional toll she and her family experienced prior to coming to Restoration Healthcare. “It’s a different level of compassion,” she says.

Related Posts