About PANDAS Syndrome

Overview

Pediatric Autoimmmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS) syndrome is a condition that affects the brain and can happen suddenly after a strep infection, such as strep throat. It is believed to be an autoimmune disorder, meaning the body’s immune system attacks its own healthy cells by mistake. In PANDAS, this can affect an area of the brain called the basal ganglia, which helps control movement and learning. Symptoms may include sudden movements or “tics”, changes in speech, obsessive thoughts, repetitive behaviors, and other unexpected actions. PANDAS is often misdiagnosed initially as attention deficit hyperactivity disorder (ADHD), autism, or unrelated obsessive compulsive disorder (OCD). It is important for parents or caregivers to provide doctors with a complete medical history and inform them if a child's symptoms change after an infection. Another related condition called Sydenham chorea can occur after untreated strep infections and causes uncontrolled movements and mental health symptoms.

Causes and Risk Factors

The root causes of PANDAS syndrome are still being researched. One theory suggests that it may be caused by a faulty an immune response to a strep infection. Strep bacteria can “disguise” themselves by copying normal molecules in the body, confusing the immune system. As a result, the immune system makes antibodies that mistakenly attack the body's own tissues, including the basal ganglia in the brain. This can lead to behavior and movement symptoms of PANDAS.

Risk factors:

• Exposure to strep infections: Taking steps to prevent and promptly treat strep infections may help reduce the risk of developing PANDAS syndrome.
• Environmental stress: Managing and reducing environmental stressors may potentially lower the risk of triggering PANDAS symptoms.

It's important to note that these risk factors are based on general principles and not specific recommendations for PANDAS syndrome. It's always best to consult with a healthcare professional for personalized advice.

Symptoms

The most common early symptoms of PANDAS syndrome include:

• Sudden onset of obsessive-compulsive behaviors (OCD) or restricted food intake
• Sudden movements or sounds that happen without control
• Separation anxiety
• Mood changes, such as irritability or depression
• Trouble sleeping
• Joint pain

As PANDAS syndrome progresses or reaches higher severity, other common symptoms that may occur include:

• Difficulty concentrating
• A drop in school performance
• Changes in handwriting or other fine motor skills
• Going back to younger behaviors, like having temper tantrums or talking like a baby
• Symptoms of attention-deficit/hyperactivity disorder (ADHD), such as hyperactivity, inattention, or fidgeting
• Urinary problems, such as frequent urination or bedwetting

It's important to note that not all children with PANDAS will experience all of these symptoms. Each child may have a unique combination of physical and psychiatric symptoms. If you suspect your child may have PANDAS syndrome, it's important to consult with a healthcare professional for an accurate diagnosis and appropriate management.

Diagnosis

To diagnose PANDAS syndrome, the following examinations, tests, and procedures are commonly performed:

• Physical exam: A healthcare provider will look for sudden changes in behavior or movement, such as new tics, compulsive actions, or emotional outbursts. They may also ask about any recent strep infections, as this can be related to the start of PANDAS symptoms.
• Lab tests: Blood tests may be done to help rule out other conditions that could be causing symptoms similar to PANDAS. These tests can include liver and kidney function tests, complete blood cell count (CBC) with manual differential, inflammatory markers like erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), metabolic panel, and urinalysis.
• Streptococcal infection confirmation: A positive throat swab and higher levels of antistreptolysin-O (ASO) or anti-DNase B antibodies in the blood can confirm recent or current streptococcal infection.
• ASO and anti-DNase B levels: These blood tests measure specific antibody levels to help distinguish between someone who simply carries the strep bacteria and someone who has an active strep infection.
• Other infectious triggers: If PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is suspected, a healthcare provider will look for any infection that might be causing symptoms. Unlike PANDAS, which happens after a strep infection, PANS can develop after any type of infection.
• Imaging studies: Doctors may recommend imaging studies like magnetic resonance imaging (MRIs) to check for neurological changes that could help confirm a PANDAS diagnosis or rule out other conditions.

It's important to consult with a healthcare provider about which specific examinations, tests, and procedures are appropriate for your individual situation.

Treatment Options

The goals of treatment for PANDAS syndrome are to reduce symptoms and improve the overall well-being of the child. Here are the different types of treatments and how they work to achieve these goals:

• Medication:
  • Antibiotics: Some experts suggest trying antibiotics for PANDAS to help kill the streptococcus bacteria causing the symptoms.
  • Selective serotonin reuptake inhibitors (SSRI): Medications that can help ease tics and obsessive-compulsive disorder (OCD) symptoms. Doctors prescribe a low dosage initially and gradually increase it while monitoring symptoms.
  • Glucocorticoids help reduce symptoms during flare-ups.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) may be helpful in reducing symptoms during flare-ups.
• Therapies:
  • Cognitive behavioral therapy (CBT): Helps children manage obsessive or anxious thoughts and develop better coping strategies.
  • Eye Movement Desensitization and Reprocessing (EMDR) therapy: Focuses on the present and helps people work through troubling thoughts and memories.
  • Family therapy: Prepares family members to support and speak up for the child.
• Therapeutic procedures: It is important to note that neither of these treatments has been proven to have clear benefits.
  • Plasma exchange: Removes faulty antibodies from the blood, which may be helpful in severe cases.
  • Intravenous immunoglobulin (IVIG) therapy: Boosts the child's immune system using healthy donor blood plasma products.
• Self-care and health behavior changes:
  • Disability accommodations at school: Children with PANDAS may need accommodations to support their learning.
  • Family support: Providing a supportive environment for the child.
• Other treatments:
  • Complementary and alternative medicine (CAM): Natural treatments like dietary supplements and homeopathy may be used alongside medical treatments, although research is limited.

Remember, treatment decisions should be made on a case-by-case basis in consultation with a healthcare professional.

Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Side effects can occur. Check with your health care professional or read the information provided with your medication for side effect information.