What are PANS and PANDAS?
It’s important to understand that PANS and PANDAS are medical conditions brought on by post-infectious autoimmune encephalitis. This condition occurs when the body’s immune system mistakenly attacks healthy brain cells, leading to inflammation of the brain. In essence, it’s a misdirected immune response.
Although the physiological mechanisms are the same, PANS and PANDAS are defined by different triggers.
Below is an overview of each illness.
Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)
PANS is typically characterized by an acute onset of obsessive-compulsive disorder (OCD), tics, and/or restricted food intake, along with at least two out of seven of the following neuropsychiatric symptoms:
Anxiety
Depression
Emotional lability (rapid or dramatic changes in mood)
Irritability
Aggression, and/or severe oppositional behaviors
Behavioral (developmental) regression
Sudden deterioration in school performance (often a decline in math and handwriting abilities)
Motor or sensory abnormalities
Sleep disturbances
Enuresis, or urinary frequency
PANS is a clinical diagnosis based on a child’s medical history and physical examination. Upon a complete evaluation, the symptoms cannot be better explained by another diagnosis. PANS can be triggered by infections, metabolic disturbances, and other inflammatory reactions. Infectious triggers include upper respiratory infections, influenza, sinus infections, mycoplasma pneumonia, and Lyme disease, among others. PANS is an umbrella term for many triggers that create inflammation in the brain, leading a child to exhibit behavioral, cognitive, and/or emotional changes.
Pediatric Autoimmune Neuropsychiatric Syndrome Associated with Streptococcus (PANDAS)
PANDAS is a subset of PANS. It is triggered by group A Strep (GAS) infections, which can occur in many parts of the body (e.g., sinuses and anus)—not just the throat. The onset of PANDAS symptoms can occur within days or months of contracting strep.
Like PANS, PANDAS is a clinical diagnosis defined by the following criteria:
Presence of significant obsessions, compulsions, and/or tics
Abrupt onset of symptoms or a relapsing-remitting course of symptom severity
Pre-pubertal onset
Association with streptococcal infection
Association with other neuropsychiatric symptoms, including:
Anxiety
Restricted food intake
Emotional lability (rapid or dramatic changes in mood)
Urinary frequency
Sleep disturbances
PANS/PANDAS symptoms can range from mild to severe. In mild cases, a child might function well enough to continue to attend school. Moderate symptoms might cause a child to miss significant days of school or even become homebound. In severe cases, PANS/PANDAS symptoms can become life-threatening.
After the initial onset and treatment, PANS/PANDAS patients can experience a frustrating relapse of symptoms. Initial triggers may differ from secondary triggers. During each recurrence, symptoms can worsen, and new ones may manifest.
Treatment for PANS/PANDAS
Treatment for PANS/PANDAS usually involves addressing the underlying infection through antibiotics & antivirals. Other treatments for PANS/PANDAS include nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and immune modulating therapies such as intravenous immunoglobulin therapy (IVIg), Rituximab, and plasmapheresis.
Unfortunately, many children and young adults with PANS/PANDAS are misdiagnosed with a psychiatric illness and prescribed psychotropic medications, rather than being evaluated and treated for the root infection. By bringing more education and awareness to communities about PANS/PANDAS, The JBC Foundation aims to erase misconceptions about the illnesses and promote appropriate diagnosis and treatment for more children.
