PANDAS/PANS Awareness

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection) and PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) are real conditions, so why are our children not being properly diagnosed?

Many parents come to my office in distress with very serious and real concerns regarding their child’s health, yet the awareness of PANDAS/PANS is not yet prevalent among healthcare practitioners.  This leads to parents not being heard, and children not receiving the correct treatment.

Referencing the Merck Manual, the physician’s bible of medical conditions and their corresponding treatment strategies, PANDAS/PANS is listed forefront under Pediatric OCD:

“Some cases (of pediatric OCD) have been associated with infection. Those associated with group A β-hemolytic streptococci are called PANDAS (pediatric autoimmune neuropsychiatric disorder associated with streptococcus). Those associated with other infections are called PANS (pediatric acute-onset neuropsychiatric syndrome).  Research in this area is ongoing, and if PANDAS or PANS is suspected, consultation with a specialist is strongly recommended.”

PANDAS/PANS is a temporary problem caused by inflammation in the basal ganglia of the brain.  This inflammation is triggered by an infection, such as Group A beta-hemolytic Strep.  The immune system reacts to the Strep infection, and creates antibodies that cross-react with protein components (“antigens”) in the basal ganglia of the brain.  This sudden and acute-onset of brain inflammation causes a distinct subset of symptoms that rapidly afflict the child.

PANDAS/PANS Symptoms

PANDAS and PANS  are conditions that are characterized by sudden and dramatic onset of one or more of the following symptoms:

  • Obsessive Compulsive Disorder (OCD)
  • Anxiety, separation anxiety and irrational fears
  • Tics – motor and/or verbal, choreiform movements of the limbs, “Tourettes”
  • Food restriction or eating disorder
  • Depression, irritability, aggression
  • Intrusive thoughts
  • Behavioural regression or deterioration in performance at school
  • Urinary frequency or bedwetting

PANDAS is a diagnosis that follows immediately or shortly after a Group A beta-hemolytic Streptococcal infection such as Strep throat, although not all children may have a confirmed Strep throat history or a positive Strep test.  PANS is a similar condition, associated with an infectious trigger other than Streptococcus, which may include Mycoplasma or Borrelia (Lyme disease) and Lyme co-infections.

Testing and Treatment for PANDAS and PANS

The following tests may be warranted, depending on the case:

  • Strep throat swab
  • Strep antibody titres: Antistreptolysin-O, Anti-DNase B
  • Testing for other infections such as: Mycoplasma, Lyme disease and co-infections, Herpes Simplex Virues (HSV) I and II, Human Herpes Virus (HSV) 6, Epstein Barr Virus (EBV), Cytomegalovirus (CMV)
  • Food Sensitivity Panel
  • Testing for celiac disease
  • Stool analysis for bacterial and yeast overgrowth, beneficial bacteria levels, and parasitology
  • Organic Acids Testing

Treatment strategies for PANDAS and PANS are unique to the needs of each child.  A general protocol may include:

  • Antibiotic therapy
  • Probiotic bacteria and beneficial yeast
  • Immune support and immune system modulation
  • Natural anti-inflammatories, ibuprofen, or prednisone
  • Gut healing program for digestive tract inflammation, infection, dysbiosis (bacterial imbalance),  leaky gut syndrome
  • Intravenous immunoglobulin (IVIG)
  • Plasmaphoresis