What is PANDAS?
PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection (strep). It is a disorder first recognized in 1998, in which children have a sudden onset of symptoms including OCD and Tourette's-like symptoms, triggered by a strep infection. More recently, cases of sudden onset OCD and tics have been reported as triggered by other infectious diseases, and have being referred to as PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome).
PANDAS is a disorder that typically begins in early childhood (ages 4-10). 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. However, the child may or may not have observable strep symptoms so it is often difficult to tell if you are dealing with PANDAS or not. In fact, many individuals never experience acute strep symptoms, and symptom exacerbations can occur immediately following or several weeks after acute strep symptoms disappear. Symptom exacerbations are often rapid and dramatic, while symptom remissions are often slower.
How is PANDAS different from OCD or Tourette's?
OCD and Tourette's symptoms wax and wane unpredictably with gradual onset, while PANDAS usually has a dramatic, severe, or "out of the blue" onset. Parents of children with PANDAS often report that one day their child was fine, and the next day they woke up to a child exhibiting multiple severe symptoms.
What causes PANDAS?
PANDAS is caused when the bacterial Streptococcal pathogen triggers an acute neuropsychiatric disease. In its most simple terms, when the body detects a bacterial infection, the autoimmune system creates antibodies to fight the infection. In the case of PANDAS, the strep infection causes antibodies to be created, but instead of only attacking the strep, the antibodies also cross the blood-brain barrier and attack the Basal Ganglia. This causes swelling in the caudate, putamen, and globus pallidus parts of the brain and causes the PANDAS symptoms. In PANS, different pathogens can trigger the immune system, which in various ways also activate parts of the brain that cause psychiatric symptoms.
Most children will get strep in their lifetime but will never develop PANDAS. However, some children, due to genetic and environmental factors, will develop PANDAS.
How do you treat PANDAS?
There are two categories of treatment approaches available for PANDAS. The first category focuses on managing the psychiatric symptoms of the disorder. The OCD, tics, and some of the mood and attention symptoms of PANDAs can be targeted with a myriad of cognitive behavioral therapy (CBT) treatments. Exposure and Response Prevention (ERP) is an empirically validated and highly successful treatment for OCD, and Comprehensive Behavioral Intervention for Tics (CBIT) is an empirically validated treatment for tics. Both of these treatments are effective in helping ameliorate the symptoms of PANDAS, although treatment for children with PANDAS can be more challenging due to the sudden onset and nature of the disorder. CBT also helps the family learn to coping skills to help the family of a child with PANDAS deal with the symptoms and future exacerbations.
Psychiatric medications can also be used to address the symptoms of PANDAS. SSRIs, mood stabilizes, and other psychiatric medications have been used with mixed results with PANDAS.
The second category focuses on targeting the infectious disease/ antibody triggers that cause PANDAS. These treatments include antibiotics, IVIG (intravenous immunoglobin), plasmapheresis, steroids, ibuprofen and NSAIDs. These treatments are still being researched and currently the results are mixed with some children experience significant symptom reduction, while others do not. These treatments should be considered carefully under the guidance of an experienced pediatric neurologist or psychiatrist.
National Institute of Mental Health PANDAS site
Articles published about PANDAS