PANS and PANDAS Syndromes in Children

Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) are conditions that are characterized by a sudden and severe onset of obsessive-compulsive disorder (OCD) or restrictive eating disorder in children before puberty. PANS and PANDAS are also often associated with noticeable changes in mood, behavior, and sensory and motor function in children. PANS may be triggered by various infections, immune system issues, or environmental factors. PANDAS is a subtype of PANS and is specifically associated with an infection from streptococcal (strep) bacteria—such as strep throat or scarlet fever.

Researchers don’t know the exact causes of PANS. One theory is that it is triggered by an immune response that leads to inflammation in the brain. Infections other than strep, immune system disruptions, or environmental factors may cause this reaction. When the immune system mistakenly attacks healthy brain tissue, it can lead to sudden and severe symptoms, such as obsessive-compulsive behaviors, tics, anxiety, and mood changes.

PANDAS is a specific type of PANS that is believed to be caused by a strep infection. When the immune system fights the infection, it may mistakenly attack healthy areas of the body—including the brain—which can lead to the sudden development of OCD, tics, and other symptoms of PANDAS. Researchers are still looking for the specific antibody that may cause PANDAS.

PANS and PANDAS share many of the same symptoms. Children with PANS or PANDAS may experience:

• Sudden and severe onset of OCD or tic disorder
• Changes to eating, such as refusing to eat or showing highly selective eating patterns
• Changes in motor skills, such as changes in handwriting
• Joint pains
• Mood changes, such as irritability, sadness, or a tendency to laugh or cry unexpectedly and inappropriately
• Sudden onset of nighttime bed-wetting, frequent daytime urination, or both
• Sudden onset of separation anxiety
• Hyperactivity, inattention, or fidgeting
• Trouble sleeping

PANS and PANDAS are episodic disorders, meaning that symptoms may disappear for extended periods and then reappear. For example, if a child with PANDAS gets another strep infection, their symptoms may worsen. Symptoms may get increasingly severe with multiple recurrences. Many children with typical OCD or tics develop obsessions and compulsions over time—it may take weeks, months, or even years before OCD-like symptoms become noticeable to others. In contrast, children with PANS or PANDAS have a very sudden onset or worsening of symptoms—with symptoms usually reaching full intensity in a few days after onset— followed by a slow, gradual improvement.

Treatment for PANS or PANDAS focuses on addressing the underlying cause, managing symptoms, and supporting the immune system. Children and their families can work with their health care provider to develop a comprehensive treatment plan. The best treatment for sudden episodes of PANDAS is to treat the strep infection with antibiotics. Health care providers will order a throat culture to see if strep bacteria are present. If the throat culture is positive, antibiotics are usually prescribed to treat the strep infection and reduce PANDAS symptoms.

Children with PANS or PANDAS may benefit from cognitive behavioral therapy, selective serotonin reuptake inhibitor (SSRI) medication, or both to help manage OCD, anxiety, tics, or eating issues. It’s important to work closely with a health care provider to manage PANS or PANDAS. If symptoms worsen, treatment adjustments may be necessary. Children and their families should consult with a health care provider before stopping or changing any medication.

Allison Green
Boston Tutoring Services