Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, PANS, Pediatric Acute-Onset Neuropsychiatric Syndrome, Childhood Acute Neuropsychiatric Symptoms
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections—PANDAS for short—is a childhood syndrome thought to be triggered by strep throat and related infections from strep bacteria. Children with PANDAS syndrome will typically develop tics—uncontrolled movements or sounds—and/or symptoms of obsessive-compulsive disorder, seemingly overnight. Other symptoms may arise as well; children diagnosed with PANDAS can display dramatic mood swings or experience sudden bouts of anxiety , and some evidence suggests that a small number may display signs of anorexia.
Though undoubtedly alarming to many parents—especially due to their rapid onset—these symptoms are thought to be the result of an immune reaction and usually improve once the infection has been treated.
PANDAS is a complex—and to many, controversial—syndrome. First recognized by neuropsychiatrist Susan Swedo in a 1998 paper, PANDAS is thought to be related to Sydenham's chorea, or "St. Vitus' dance," an autoimmune disorder triggered by streptococcus bacteria that results in rapid, jerking movements in affected children. While studying Sydenham's, Swedo identified a group of children who appeared to develop other more complex symptoms, like those of OCD, after contracting strep. After examining and treating many of the children by targeting their strep infections, Swedo theorized that PANDAS may be the cause.
Key Takeaways
- PANDAS affects mental, emotional, and physical wellbeing
- Understanding pandas is the first step toward managing it
- Evidence-based approaches can significantly improve outcomes
- Building daily habits is more effective than one-time interventions
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.
Not necessarily. Children with OCD and tic disorders can and do get strep throat—in most cases, the conditions are entirely unrelated. If the child only developed OCD symptoms or tics very suddenly after contracting strep throat—or if the symptoms went away once the strep was treated—it’s possible that they were due to PANDAS.
Tic disorders usually onset in early childhood, so a child developing a tic is not in itself a sign of PANDAS. Tics wax and wane—and can be suppressed with effort—meaning that in some cases, a tic may seem to “suddenly” appear. In rare cases, tic disorders may be the result of a strep infection. However, Susan Swedo, the researcher who is credited with discovering PANDAS, cautions that a PANDAS diagnosis should only be granted when all other possible explanations for tics (and other PANDAS symptoms) have been ruled out.
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.
PANDAS symptoms usually fade once the underlying infection is treated. Untreated, PANDAS may continue to worsen and could turn into a chronic condition. But because untreated strep throat can cause complications above and beyond PANDAS, a course of antibiotics is usually recommended, regardless of psychiatric symptoms. PANDAS symptoms may return if a child gets strep throat again, in which case antibiotic treatment may need to be restarted.
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Frequently Asked Questions
What exactly is pandas?
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, PANS, Pediatric Acute-Onset Neuropsychiatric Syndrome, Childhood Acute Neuropsychiatric Symptoms
What are the signs 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 PA
How can pandas be 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
Is pandas a serious condition?
PANDAS exists on a spectrum. While mild forms are a normal part of life, persistent or severe pandas can significantly impact daily functioning and quality of life. It's important to seek professional support if pandas is interfering with work, relationships, or wellbeing.
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