Signs and symptoms are usually sudden and severe
Pediatric autoimmune neuropsychiatric disorders affect movement, motor control, emotions, and behavior. This abnormal immune response often presents with a range of symptoms that come on suddenly and reach full intensity within 24-48 hours of appearance.
Children with PANDAS may experience dramatic onset of symptoms such as emotional outbursts, social withdrawal, and sleep disturbances. PANDAS can also lead to problems with cognitive function, such as learning difficulties, memory loss, and trouble with speech or language. Symptom severity varies from child to child.
Some common symptoms include:
- Sudden onset obsessive compulsive symptoms (OCD)
- Oppositional Defiance Disorder (ODD)
- Tics or sudden movements
- Anxiety and/or separation anxiety
- Rapid, exaggerated changes in mood
- Decline in school performance
- Sensory abnormalities (to foods, light, overstimulation, etc.)
- Insomnia and frequent awakenings
- Aggression or violent behavior
- ADHD symptoms
- Loss of previously acquired skills
- Deterioration in academic performance (ADHD-like symptoms, memory changes)
PANS/PANDAS symptoms can appear in as little as a few days after the initial infection, or as long as 4 to 6 months if antibiotics didn’t fully eradicate the bacteria (2).
What triggers PANS/PANDAS?
It’s believed that these conditions are triggered by an abnormal immune response to an infection. In the case of PANDAS, strep bacteria trigger an autoimmune response that results in the immune system attacking the basal ganglia in the brain.
In the case of PANS, a variety of infections including strep, Lyme disease, and mycoplasma pneumonia can trigger the same abnormal immune response leading to similar symptoms. Other illnesses that may trigger PANS include:
- Lyme disease
- The flu
- Chicken pox
- Epstein Barr (Mono)
- Upper respiratory infections
Autoimmune response to strep infection
The autoimmune response by the body to an infection is believed to be a result of molecular mimicry. Molecular mimicry is a phenomenon where the body’s immune system mistakes the proteins on the surface of the invading pathogen—in the case of PANDAS, group A streptococcus—for those of the host, the child (3).
Then, the immune system starts attacking not just the pathogen but also the body’s own healthy tissues. In the case of PANS and PANDAS, the immune system is believed to mistakenly attack the basal ganglia, leading to the onset of neuropsychiatric symptoms (4).
The inflammation caused by the immune response also interferes with neuronal signaling, affecting the circuitry in the brain.
Learn more: The Hidden Triggers of Autoimmune Disease
Children are most susceptible to developing PANS & PANDAS
Children the ages of 3 and 14 are most susceptible to developing PANS after a streptococcal infection, and the condition affects more boys than girls. It’s believed that some children may be more genetically predisposed to developing these conditions, while others may have a weakened immune system that struggles to fight off infections.
Environmental factors may play a role in triggering the immune response that leads to PANS/PANDAS. It’s important to note that while many children may get strep infections, not all of them will develop PANDAS. The condition is believed to occur in about 1 in 200 children who have a strep infection, and symptoms usually occur within 4-6 months after the initial infection (2).
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Early diagnosis and treatment is crucial to prevent the long-term neurological effects of these conditions. Functional medicine doctors take a holistic approach to diagnosing PANS/PANDAS, considering the child’s symptoms, medical history, and environmental factors.
Official diagnostic criteria for PANS/PANDAS
According to the PANDAS Physician Network, to diagnose PANDAS, the patient must fulfill the following criteria:
- Presence of OCD and/or tics, particularly multiple, complex or unusual tics
- Age Requirement (Symptoms of the disorder first become evident between 3 years of age and puberty)
- Acute onset and episodic (relapsing-remitting) course
- Association with Group A Streptococcal (GAS) infection
- Association with Neurological Abnormalities
There are three severity levels for PANDAS: Mild, Moderate and Severe.
Doctors may perform blood tests to look for signs of inflammation or abnormal immune function. High levels of antistreptolysin-O (ASO) or anti-DNase B antibodies are often found in children with PANDAS (5). Doctors may also perform a brain imaging study, such as an MRI, to look for signs of inflammation or damage to the basal ganglia.
Doctors may also use the Cunningham Panel, which tests for antibodies against specific brain proteins that are elevated in children with PANS/PANDAS (6).
A thorough evaluation of the child’s symptoms and medical history, along with appropriate testing, can help functional medicine doctors diagnose PANS/PANDAS and develop an individualized treatment plan.
What to remember
PANS/PANDAS are debilitating neurological conditions that affect children, often appearing suddenly following an infection, particularly strep. Symptoms can include mood swings, tics, OCD, learning difficulties, and sleep disturbances. The conditions occur as a result of an abnormal immune response to the infection that leads to damage to the basal ganglia in the brain.
Functional medicine doctors take a holistic approach to diagnose and treat PANS/PANDAS, considering the child’s symptoms, medical history, and environmental factors. They may perform blood tests, brain imaging studies, and use the Cunningham Panel to evaluate the child’s condition and develop an individualized treatment plan. Early diagnosis and treatment are crucial to mitigating the long-term effects of these complex pediatric conditions.