What is PANDAS?
PANDAS stands for pediatric autoimmune neuropsychiatric disorders associated with streptococcus. The syndrome involves sudden and often major changes in personality, behavior, and movement in children following an infection involving Streptococcus pyogenes (streptococcal-Ainfection).
Strep infections can be mild, causing nothing more than a minor skin infection or sore throat. On the other hand, they can cause severe strep throat, scarlet fever, and other illnesses. Strep is found inside the throat and on the surface of the skin. You contract it when an infected person coughs or sneezes and you breathe in the droplets or touch contaminated surfaces, and then touch your face.
Most people with a strep infection make a full recovery. However, some children develop sudden physical and psychiatric symptoms a few weeks after infection. Once they start, these symptoms tend to rapidly get worse.
Continue reading to learn more about the symptoms of PANDAS, how it’s treated, and where you can turn for help.
The symptoms of PANDAS start suddenly, about four to six weeks after a strep infection. They include behaviors similar to obsessive-compulsive disorder (OCD) and Tourette syndrome. These symptoms can interfere with schooling and quickly become debilitating. Symptoms worsen and reach their peak usually within two to three days, unlike other childhood psychiatric illnesses that develop more gradually.
Psychological symptoms may include:
- obsessive, compulsive, and repetitive behaviors
- separation anxiety, fear, and panic attacks
- incessant screaming, irritability, and frequent mood changes
- emotional and developmental regression
- visual or auditory hallucinations
- depression and suicidal thoughts
Physical symptoms may include:
- tics and unusual movements
- sensitivities to light, sound, and touch
- deterioration of small motor skills or poor handwriting
- hyperactivity or an inability to focus
- memory problems
- trouble sleeping
- refusing to eat, which can lead to weight loss
- joint pain
- frequent urination and bedwetting
- near catatonic state
Children with PANDAS don’t always have all of these symptoms, but they generally have a mix of several physical and psychiatric symptoms.
The exact cause of PANDAS is the subject of ongoing research.
One theory proposes that it may be due to a faulty immune response to strep infection. Strep bacteria are particularly good at hiding from the immune system. They mask themselves with molecules that look similar to normal molecules found in the body.
The immune system eventually catches on to the strep bacteria and begins producing antibodies. However, the disguise continues to confuse the antibodies. As a result, the antibodies attack the body’s own tissues. Antibodies targeting a particular area of the brain, the basal ganglia, may cause the neuropsychiatric symptoms of PANDAS.
The same set of symptoms can be brought on by infections that don’t involve strep bacteria. When that’s the case, it’s called pediatric acute-onset neuropsychiatric syndrome (PANS).
(Video) Understanding Pediatric Acute-onset Neuropsychiatric Syndrome
Some other possible risk factors include a genetic predisposition and recurrent infections.
Your child is more likely to get a strep infection in late fall and early spring, especially when they’re in close quarters with large groups of people. To help prevent strep infection, teach your child not to share eating utensils or drinking glasses, and to wash their hands often. They should also avoid touching their eyes and face whenever possible.
If your child is showing unusual symptoms after an infection of any kind, make an appointment with your pediatrician right away. It might be helpful to keep a journal detailing these symptoms, including when they started and how they’re affecting your child’s life. Bring this information, along with a list of any prescription or over-the-counter medications your child takes or has recently taken, when you visit the doctor. Be sure to report any infections or illnesses that have been going around at school or home.
To diagnose a strep infection, your pediatrician may take a throat culture or run a blood test. However, there are no laboratory or neurological tests to diagnose PANDAS. Instead, your doctor may want to perform a variety of blood and urine tests to rule out some other childhood ailments.
A diagnosis of PANDAS requires a careful medical history and physical examination. The criteria for diagnosis are:
- being between three years old and puberty
- sudden onset or worsening of already existing symptoms, with symptoms becoming more severe for periods of time
- presence of obsessive-compulsive behaviors, tic disorder, or both
- evidence of other neuropsychiatric symptoms, such as hyperactivity, mood changes, developmental regression, or anxiety
- previous or current strep-A infection, confirmed by a throat culture or blood test
(Video) Identifying and Treating PANDAS in Autistic Children
Treating PANDAS involves addressing both the physical and psychiatric symptoms. To start, your pediatrician will focus on making sure the strep infection is completely gone. You’ll also need to work with a licensed mental health professional familiar with OCD and PANDAS.
Treating the strep infection
Strep infections are treated with antibiotics. Most strep infections are successfully treated with a single course of antibiotics. Some of the antibiotics used to treat strep include:
You should also consider having other family members tested for strep because it’s possible to carry the bacteria even though you have no symptoms. To help avoid re-infection, replace your child’s toothbrush right away and again when they finish their full course of antibiotics.
Treating psychological symptoms
Psychiatric symptoms may start to improve with antibiotics, but they’ll likely still need to be addressed separately. OCD and other psychiatric symptoms are generally treated with cognitive behavioral therapy.
OCD also usually responds well to selective serotonin reuptake inhibitors, a type of antidepressant. Some common ones include:
These medications will be prescribed in small doses to start. They can be slowly increased if necessary.
Other treatments are controversial and must be decided on a case-by-case basis. Some doctors may prescribe corticosteroids, such as prednisone, to improve symptoms of OCD. However, steroids can make tics even
Some severe cases of PANDAS might not respond to medications and therapy. If this happens, a blood plasma exchange to remove the faulty antibodies from their blood is sometimes recommended. Your pediatrician may also recommend intravenous immunoglobulin therapy. This procedure uses healthy donor blood plasma products to help boost your child’s immune system. While some clinicians report success with these treatments, there are no studies confirming that they work.
Are there any potential complications?(Video) Did your child change after strep? They may have PANDAS.
Are there any potential complications?
Symptoms of PANDAS can leave your child unable to function at school or in social situations. Untreated, symptoms of PANDAS may continue to worsen and can result in permanent cognitive damage. For some children, PANDAS can become a chronic autoimmune condition.
Having a child with PANDAS can be extremely stressful because it tends to come on without warning. Over the course of a few days, you might notice dramatic behavioral changes with no apparent cause. Adding to this challenge is the fact that there is no one test for PANDAS, though diagnostic criteria have been developed. It’s important to make sure these criteria are met before diagnosing PANDAS.
If you feel overwhelmed, consider these resources:
- PANDAS Network offers general information, news about the latest research, and lists of doctors and support groups.
- International OCD Foundation has information about OCD in children as well as a downloadable fact sheet comparing OCD to PANDAS and PANS. This is especially helpful if your pediatrician isn’t very familiar with PANDAS.
- The PANDAS Physicians Network offers PANDAS Practitioner Directory, a searchable database of doctors who are familiar with PANDAS.
Your child may also need extra help at school. Talk to their teacher or school administrators about the diagnosis, what it means, and how you can all work together in the best interests of your child.
(Video) About PANS PANDAS from ASPIRE
PANDAS wasn’t identified until 1998, so there aren’t any long-term studies of children with PANDAS. However, this doesn’t mean your child can’t get better.
Some children improve quickly after starting antibiotics, though symptoms may return if they get a new strep infection. Most recover without significant long-term symptoms. For others, it can become an ongoing problem requiring periodic use of antibiotics to control infections that may cause flare-ups.
What causes Pandas syndrome? ›
PANDAS is short for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. A child may be diagnosed with PANDAS when: Obsessive-compulsive disorder (OCD), tic disorder, or both suddenly appear following a streptococcal (strep) infection, such as strep throat or scarlet fever.What is the diagnosis of pandas syndrome? ›
A clinical diagnosis of PANDAS is defined by the following criteria: Presence of significant obsessions, compulsions or tics. Abrupt onset of symptoms or a relapsing-remitting course of symptom severity. Pre-pubertal onset.What triggers a pans flare? ›
PANS can be triggered by one or more infections, like the flu, Lyme disease, mycoplasma (a type of walking pneumonia), chicken pox, upper respiratory infections, and an unending list of viruses, including COVID-19 and its variants.Can stress trigger PANDAS? ›
PANS can be triggered by viruses, bacteria, mold, allergies, and even emotional trauma and stress! Put simply, PANS is a subtype of pediatric neurological disorders, and PANDAS is a subset of PANS used when strep infection was identified before symptoms began.How do you treat PANDAS naturally? ›
One way that probiotics may be helpful for PANDAS is in preventing digestive problems due to antibiotics, a common treatment for PANDAS. Research has found that probiotics show promise for this purpose. Another way is through the gut-brain axis, or how digestive health and brain health can impact each other.What is the best treatment for PANDAS? ›
The American Society for Apheresis lists plasma exchange as an accepted first-line therapy, either alone or with other treatment for a PANDAS exacerbation.How do you treat pans PANDAS? ›
If symptoms persist, nonsteroidal anti-inflammatory drugs and/or short oral corticosteroid bursts are recommended. For moderate-to-severe PANS, oral or intravenous corticosteroids may be sufficient. However, intravenous immunoglobulin (IVIG) is often the preferred treatment for these patients by most PRC members.How does PANDAS affect the brain? ›
PANDAS/PANS causes inflammation in an area of the brain called the basal ganglia, which helps govern emotions and motor control. When the immune system creates antibodies to the strep infection, these antibodies mistakenly attack tissue in the basal ganglia as well.How long do PANDAS symptoms last? ›
In PANDAS children, a strep infection occurs before or at the time the OCD symptoms ramp up. Assuming the infection is adequately treated, the first symptoms generally improve within 4-6 weeks.Do PANDAS symptoms come and go? ›
In PANDAS, symptoms come on abruptly (flare) and remit. This may come in cycles and include mental health disturbances, physical symptoms and behavioral issues.
How do doctors test for PANDAS? ›
PANDAS/PANS is a clinical diagnosis based on a collection of signs, symptoms, medical history and laboratory findings that cannot be explained by another medical condition. There is no conclusive blood test for PANDAS/PANS, which can make it challenging to get a diagnosis for your child.What part of the brain does pans affect? ›
Experts believe PANDAS and PANS happen because of a problem with the immune system's response to an infection. Instead of attacking the germs, the immune system targets a part of the brain by mistake. This part of the brain is called the basal ganglia. It affects thoughts, feelings, movement, and other behaviors.Can PANDAS cause permanent damage? ›
If the severe symptoms do not stop and persist over many months, permanent cognitive damage can occur. PANDAS children may have moderate to dramatic improvement with antibiotics within one week of treatment, however, further interventions may be needed.Is PANDAS a neurological disorder? ›
Pediatric autoimmune neuropsychiatric disorders associated with Streptococcus infections (PANDAS) is a neurological and psychiatric condition in which symptoms are brought on or worsened by a Streptococcal (strep) infection. PANDAS is a subtype of pediatric acute-onset neuropsychiatric syndrome (PANS).Is PANDAS related to bipolar? ›
PANS/PANDAS is a condition where the immune system attacks the brain, causing inflammation and myriad symptoms mistaken for psychological conditions such as ADHD, OCD, and Bipolar Disorder. Unless treatment addresses the root cause of the inflammation, it can become a life-long condition.Does PANDAS affect speech? ›
Speech, language and feeding can be impacted due to the antibodies attacking the brain in response to PANDAS/PANS. A child may suddenly begin stuttering or even develop selective mutism. Because of this, children with PANDAS/PANS are at a higher chance of coming across an SLP's caseload.Do PANDAS have mood swings? ›
PANDAS symptoms include tics, obsessions and compulsions, mood swings, temper tantrums, attention difficulties, hyperactivity, impulsivity, and unusual movements called choreiform movements. PANDAS has an episodic course which comes and goes with the strep infection.What kind of doctor treats PANDAS? ›
Doctors who treat PANDAS syndrome come from a variety of backgrounds. Pediatrics, neurology, hematology/oncology, psychology, psychiatry, integrative medicine, immunology and rheumatology are just a few of the specialties of PANDAS doctors.What meds treat PANDAS? ›
SSRIs (Selective Serotonin Reuptake Inhibitors): are the first-line medication treatments for symptoms of OCD and anxiety. However, most doctors who recognize PANS & PANDAS prescribe SSRIs only if medical treatments are not sufficient, as SSRIs do not treat underlying infections or issues.Can you heal from PANDAS? ›
Although it may take time, most children who have PANDAS recover completely with treatment. Symptoms tend to slowly get better over several months once the strep infection clears, but there may be ups and downs.
Does Benadryl help PANDAS? ›
Antihistamines (H1 and H2 Blockers)
In addition to their immunologic properties, the H1 blockers (such as diphenhydramine or Benadryl) are “soporific” drugs which produce sleepiness; this side effect can be useful for PANDAS children with initial insomnia.
To diagnose a strep infection, your pediatrician may take a throat culture or run a blood test. However, there are no laboratory or neurological tests to diagnose PANDAS.Does ibuprofen help PANDAS? ›
Oral nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may be beneficial for PANS/PANDAS patients. The medications appear to be particularly useful for exacerbations (or “mini-flares”) which occur in the weeks following immunotherapy.What is the biggest threat for survival of PANDAS? ›
Infrastructure development (such as dams, roads, and railways) is increasingly fragmenting and isolating panda populations, preventing pandas from finding new bamboo forests and potential mates. Forest loss also reduces pandas' access to the bamboo they need to survive.What dangers do PANDAS face? ›
Giant pandas face a number of threats, including from poaching and habitat destruction for farming and tourism. They are currently considered “vulnerable” to extinction by the International Union for the Conservation of Nature's Red List.What do PANDAS do to humans? ›
While pandas are regarded as cuddly, quiet animals, they certainly have a dangerous side when they feel threatened. They're solitary creatures and like to avoid confrontation, the World Wildlife Fund reports, but have sharp claws and teeth and may attack to protect themselves or their cubs if provoked.Do kids outgrow PANDAS? ›
Does PANDAS disease go away? Sometimes, a child can “outgrow” PANDAS if the strep infection is treated, but not always. If the child gets another strep infection, the PANDAS will almost certainly come back if it wasn't treated the first time.Can a child have mild PANDAS? ›
PANS PANDAS: MILD CASE
Children with mild symptoms have obvious impairments as a result of their PANS/PANDAS symptomatology, but these are limited to certain situations or settings.
PANDAS may be quite rare. But some evidence suggests it could account for as many as 1 in 10 new cases of OCD in children each year. We simply don't know for certain, as the majority of cases may go undiagnosed. Typically, children affected by PANDAS have a dramatic – even overnight – onset of symptoms.How do you treat inflammation in PANDAS brain? ›
In cases where PANDAS is caught early, antibiotics may be the only treatment needed. In other cases, the use of an immunomodulatory therapy (such as steroids or non-steroidal anti-inflammatory medications like ibuprofen or naproxen) will reduce brain inflammation and restore the child to full health.
Can stress trigger pans? ›
Infections, metabolic disturbances, other inflammatory reactions and stress can trigger PANS.Can you recover from pans? ›
What is the prognosis? Many children who get treated for PANDAS/PANS make a complete recovery. However, some children with more persistent symptoms may have a “flare up” again with new future infections.Can PANDAS cause psychosis? ›
Conclusions: Severe psychotic symptoms may be considered one among the other neuropsychiatric clinical manifestations presenting in individuals with PANDAS/PANS syndromes.Can PANDAS be misdiagnosed? ›
PANS and PANDAS can be misdiagnosed as psychiatric illness
Patients with PANS and PANDAS may be misdiagnosed with a psychiatric illness or behavioral disorder, when the symptoms may be the result of a treatable autoimmune dysfunction.
PANDAS is short for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.Does PANDAS ever go away? ›
According to current research, PANDAS is a pediatric disease caused by a strep infection, which is common in young children and demonstrated in these prevalence rates. PANDAS/PANS symptoms seem to flare and remit throughout childhood and disappear in adulthood with proper treatment and symptom maintenance.Is Panda Syndrome permanent? ›
Although it may take time, most children who have PANDAS recover completely with treatment. Symptoms tend to slowly get better over several months once the strep infection clears, but there may be ups and downs. PANDAS is likely to come back if your child gets strep again.Does PANDAS cause brain damage? ›
If the severe symptoms do not stop and persist over many months, permanent cognitive damage can occur. PANDAS children may have moderate to dramatic improvement with antibiotics within one week of treatment, however, further interventions may be needed.Can you prevent PANDAS? ›
Treating a strep infection early with antibiotics can reduce the risk of PANDAS. The longer an infection lasts, the higher the likelihood of bacteria becoming resistant to antibiotics. This in turn may increase the chance that more intensive PANDAS treatments like IVIG and plasmapheresis will be required in the future.What type of doctor treats PANDAS? ›
Doctors who treat PANDAS syndrome come from a variety of backgrounds. Pediatrics, neurology, hematology/oncology, psychology, psychiatry, integrative medicine, immunology and rheumatology are just a few of the specialties of PANDAS doctors.
What happens if PANDAS is not treated? ›
Untreated PANDAS/PANS can cause permanent debilitation, and in some cases, can become encephalitic. Repeat strep infections can cause serious problems, so it is vital to eradicate strep. Subsequent episodes can be caused by environmental and infectious triggers different from the original infection.What is the best antibiotic to treat PANDAS? ›
Azithromycin and penicillin have been utilized in the treatment of PANDAS with observations of improvement in neuropsychiatric symptoms.Is there a blood test for PANDAS? ›
Currently, there is no single blood test that detects PANDAS or PANS. However, lab tests can guide healthcare professionals in the right direction for diagnosing and treating your child's condition.What are the long term consequences of PANDAS? ›
Are there any potential complications? Symptoms of PANDAS can leave your child unable to function at school or in social situations. Untreated, symptoms of PANDAS may continue to worsen and can result in permanent cognitive damage. For some children, PANDAS can become a chronic autoimmune condition.What does PANDAS do to your body? ›
PANDAS and PANS cause a sudden onset of severe OCD symptoms. They also cause other sudden changes in a child's behavior. These can be so extreme that a parent may say their child seemed to "change overnight." PANS and PANDAS can be treated with medicines and therapy.How can I help my child with PANDAS? ›
- Treat the original infection with antibiotics.
- Modulate and modify your child's immune system.
- Psychological therapy and counseling to aid OCD and other symptoms.
Risk factors for developing PANDAS include recurrent group A beta-hemolytic streptococcal (GABHS) bacterium infections, a family history of rheumatic fever, the mother's history of having an autoimmune disease, and being male (boys are three times more likely than girls to develop PANDAS).How common is PANDAS disorder? ›
By Swedo's estimate, the condition affects up to 1 in 200 children, but many experts contest that figure — and even the condition's very existence. Pediatric neurologists point out that Tourette syndrome and OCD are highly heritable; if strep plays a role in these conditions at all, it is extraordinarily rare.