Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, PANS, Pediatric Acute-Onset Neuropsychiatric Syndrome, Childhood Acute Neuropsychiatric Symptoms
Signs and Symptoms of PANDAS
According to the NIMH, PANDAS can be diagnosed in pre-pubertal children (between the ages of 3 and 12, generally) if the following symptom criteria are met:
Whether or not a child has been exposed to strep bacteria can be determined via lab testing. However, the presence of strep is not enough to warrant a PANDAS diagnosis, and there is no definitive test to determine whether or not a child has PANDAS. If a child displays sudden, dramatic symptoms of OCD or tics, in addition to a positive strep test, a doctor may make a PANDAS diagnosis; they may, however, withhold a diagnosis as they search for other potential causes of the symptoms.
OCD symptoms and tics are the most prominent symptoms of PANDAS. However, many children with the syndrome also develop intense anxiety—sometimes reaching the point of panic attacks—or dramatic mood swings; tantrums or meltdowns are sometimes reported in PANDAS patients. Children may also demonstrate changes in fine motor skills (struggling with handwriting, for instance), as well as sleep problems; some children, even older ones, may start to wet the bed or begin to urinate more frequently during the day. Some children—mostly girls, according to some small studies—may also start restricting food or show other symptoms of anorexia.
PANDAS is marked by its extremely sudden onset—some parents report that their child seemingly became a totally different person overnight. To differentiate between PANDAS and OCD or tic disorders, then, doctors typically examine the trajectory of the symptoms. If they appear suddenly, rather than developing over time, coincide with the presence of strep bacteria, and improve slowly as the infection clears, the doctor may determine that they are indicative of PANDAS.
How Is PANDAS Treated?
To treat PANDAS, the NIMH emphasizes, the underlying strep infection must be treated. In many cases, this can be accomplished with a single course of antibiotics. More serious strep infections may require a longer course of treatment or multiple courses of antibiotics. Once the strep has been treated, PANDAS symptoms will typically start to fade, the NIMH reports, though they may take a few months to disappear altogether.
To prevent strep reinfection, parents should discard toothbrushes and sterilize other objects that go into a child’s mouth. Testing siblings for strep may also be a good idea, even if they’re not showing symptoms; they may be carrying the bacteria and could potentially reinfect the affected child.
Though the symptoms of PANDAS should subside once the infection has been treated, progress may be slow, and a short course of therapy can help a child manage the conditions in the meantime. Cognitive-behavioral therapy (CBT) or exposure and response prevention therapy (ERP) can help a child take control of obsessions or compulsions or learn coping skills to handle strong emotions while the treatment takes its course.
Some children with PANDAS may respond positively to SSRIs . However, the NIMH cautions that children with PANDAS may be more likely than other children to experience significant side effects from these drugs, so it’s best to start with a low dose and stop use (under a doctor’s supervision) if symptoms start to worsen or side effects become unmanageable.
Explore More About PANDAS
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