What Causes PANS/PANDAS and Why Are Cases Increasing?

There’s a mysterious neuroinflammatory disorder on the rise in children, which is catching many parents —and even doctors — off guard.

Imagine your child who’s hitting all of his milestones and flourishing in his own independence, suddenly becoming so defiant and aggressive that he’s kicked out of his pre-K class.

Or an outgoing middle-schooler previously excelling in extracurriculars and all her academics, who overnight can barely get out of bed, complete her schoolwork and develops severe anxiety around her peers.

For many parents and their children, these heart-wrenching situations have become real. More doctors are beginning to realize the effects of a neuroinflammatory immune disorder known as PANS or PANDAS. In this article, you’ll learn what triggers PANS and/or PANDAS, why we’re seeing an increase in children, and what you can do to minimize your child’s risk to this life-altering condition.

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What Is the Difference Between PANS and PANDAS?

PANS and PANDAS are both conditions in which the immune system becomes dysregulated in response to an infectious agent.

PANS is an acronym for Pediatric Acute-onset Neuropsychiatric Syndrome, and it’s an umbrella classification for a syndrome that can be caused by almost any infection, including:

  • Lyme disease
  • The flu
  • Chickenpox
  • Epstein Barr (Mono)
  • Upper respiratory infections
  • Pneumonia
  • Strep

PANDAS is a subset of PANS and is the diagnosis given when the triggering infection is known to have been caused by streptococcal bacteria specifically (1). PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections.

This is the same streptococcal bacteria associated with strep throat, and can also be the cause of skin infections as well, which can also trigger PANDAS.

If your child has had an infection within the past year, and you notice any of the symptoms below, contact CentreSpringMD Integrative Pediatrics today for questions about possible PANS treatment.

What Causes PANS/PANDAS?

An infection is the primary triggering event for PANS/PANDAS, and while the type of infection may differ, the chain of events is similar.

Streptococcal bacteria are very ancient bacteria that have evolved to evade detection in the body for as long as possible. So regardless of whether or not your child is given a course of antibiotics initially, these bacteria can “hide” in the body using a process called molecular mimicry. 

Strep cells camouflage themselves by placing molecules on their surface that looks almost identical to your child’s own tissues, thereby delaying detection by the immune system and allowing them to replicate unchecked.

Eventually, your child’s immune system detects the invading cells and mounts an appropriate response. But because the bacteria now resemble the body’s own cells, the immune system mistakenly attacks both the pathogen and healthy cells.

Neurologists believe PANS/PANDAS symptoms are caused by the immune system attacking cells in a part of the brain called the basal ganglia, which is responsible for motor skills, learning, and behavior (2).

Symptoms of PANS/PANDAS

The most common hallmark of PANS and PANDAS is the sudden and severe onset of symptoms. Many parents report symptoms appearing “almost overnight” highlighting the alarming speed with which a child shows signs. Symptoms come on suddenly and reach full intensity within 24-48 hours of appearance.What Causes PANS/PANDAS and Why

Current symptom criteria for PANS diagnosis are:

  • OCD⁠
  • Oppositional Defiance Disorder⁠
  • Anorexia⁠ (refusal of food)
  • Aggression or violent behavior
  • ADHD symptoms⁠
  • Anxiety or depressive symptoms
  • Fear
  • Rapid mood swings
  • Insomnia⁠
  • Behavior regression
  • Loss of previously acquired skills
  • Deterioration in academic performance (ADHD-like symptoms, memory changes)

Many times, somatic symptoms with no clear cause are present, like bed-wetting, increased urinary frequency, and sleep disturbances.

PANS/PANDAS symptoms can appear in a 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 (3).

The PANS Network estimates that PANS/PANDAS affects as many as 1 in 200 children, even though most doctors still believe this condition is rare.

With PANS cases increasing, integrative doctors and pediatricians will be your best resource for answers about this complex condition that requires multiple treatment modalities. 

Schedule your appointment as soon as possible if you suspect PANS/PANDAS symptoms are affecting your child.

Can PANS Be Cured?

Currently, there is no definitive cure for PANS, but if treatment successfully resolves any underlying infection, and reduces inflammation, children can experience dramatic symptom improvement.

Each child’s case of PANS/PANDAS is unique and complex, and it’s important to have an integrative medicine team you trust to handle the root causes of this complicated condition.

Successful treatment of PANS and PANDAS requires an integrative medicine approach addressing diet, gut health, latent infections, toxic load, and more.

How Does An Integrative Doctor Provide Treatment for PANS and PANDAS

Treatment for PANS/PANDAS generally involves a combination of antibiotics to treat the underlying infection (if present after testing for antibodies), anti-inflammatories, and in some cases, treatments to quiet the immune response, like prednisone.

Treatment may resolve PANS/PANDAS symptoms, but in many cases, children may experience ongoing neuropsychiatric issues, for which therapies like CBT/OT/PT/Speech provide help for these lingering symptoms.

This is why an integrative approach to PANS is imperative to restoring your child’s health and wellbeing. Treatment for PANS must be comprehensive and address multiple body systems–not merely symptom management. 

If you or a loved one are struggling to navigate confusing symptoms that appeared suddenly, forward this article, or join the CentreSpringMD PANS and PANDAS Support Group.

What Happens If PANDAS Goes Untreated

It’s crucial to seek an integrative doctor if your child is experiencing PANS symptoms. 

If PANS/PANDAS is left untreated, this type of inflammatory and neurological dysfunction can severely affect your child’s quality of life into adulthood and significantly impact his or her opportunities for success, both physically and mentally.

Frequently, a PANS diagnosis is a diagnosis of exclusion–meaning it’s only made after everything else is ruled out. That equals a lot of trial and error for parents who have had their child’s life turned upside-down.

Because PANS/PANDAS usually presents with neurologic issues, most cases are misdiagnosed, and kids are prescribed psychiatric medications in hopes of managing symptoms. 

This is problematic because many doctors assume there is not an underlying cause of these neuropsychiatric issues.

Without a doubt, the thought of your child dealing with this life-altering condition is enough to put worry into anyone’s heart, but even more, concerning is that cases of PANS and PANDAS are increasing.

Why Are PANS Cases Increasing?

Children being exposed to germs and contracting illnesses or infections is inevitable. It’s part of interacting with the environment and building adaptive immune function into adulthood. But PANS can ensue when certain factors provoke immune dysfunction and neuroinflammation. 

What causes this immune dysfunction?

Universally, modern life is problematic for immune function. There are certain lifestyle, diet, and exposure patterns that can cause the immune system to misfire and trigger autoimmunity, including:

  • Toxin exposure
  • Poor gut health
  • Stress
  • Not enough sleep

Toxin exposure is something our bodies are built to manage through detoxification pathways, but when these pathways are overwhelmed, or not functioning properly due to genetic (MTHFR mutations) or lifestyle factors, it can result in trouble for the immune system. 

Toxin buildup can lead to chronic inflammation, which can increase the likelihood of immune dysregulation.

Because about 80% of the immune system resides in the gut, our digestive system and immune function are inextricably linked–dysfunction in one affects the other. 

A healthy microbiome (intestinal bacteria) communicates with the immune system and keeps unwanted pathogens and microbes in check while protecting the lining of the gut.

High stress and poor sleep also severely suppress immune function and can lead to dysregulation if not addressed. 

Kids can experience significant imbalance in this area when academics, social time, and screen time interfere with rest, sleep, and restorative mechanisms that repair immune function.

Preventing PANS/PANDAS

Doctors and researchers are still trying to determine why some children experience PANS after some infections, and why others do not. Likely, the root cause lies in autoimmunity, inflammation, and immune response.  

While there’s no absolute guarantee when it comes to health, the two best things you can do are:

  1. Get swift intervention from an integrative medicine team if you suspect PANS/PANDAS
  2. Take care to prioritize immune function in both children and adults.

Click here for 10 things you can start right now to improve overall health and immune function


  1. https://rarediseases.info.nih.gov/diseases/13087/pediatric-acute-onset-neuropsychiatric-syndrome
  2. https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00564/full
  3. http://pandasnetwork.org/



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