About pandas (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)
What is pandas (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)?
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) facts
- PANDAS is an acronym for "pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections."
- It is a fairly recently described disorder (1990s).
- An autoimmune response to a streptococcal infection causes PANDAS.
- It is diagnosed if there is a history of abruptly developing a number of neuropsychiatric symptoms associated with a strep infection.
- Medication and cognitive behavioral therapy are the primary treatments for PANDAS.
What is PANDAS?
PANDAS is an acronym which refers to "pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections." It is diagnosed clinically after a patient develops a number of behavioral and physical symptoms following a strep throat infection.
Is PANDAS common?
PANDAS is a rare condition. It is believed that approximately one in 2,000 children are affected, though the diagnosis may be overlooked due to some of the common symptoms associated with the disease. In fact, there are some researchers who recommend including PANDAS in a category of other disorders which include similar neuropsychiatric symptoms called CANS (childhood acute neuropsychiatric symptoms) or PANS (pediatric acute-onset neuropsychiatric syndrome).
What is the history of PANDAS?
PANDAS was described in the late 1990s after investigators identified a subgroup of children who developed a sudden onset of obsessive-compulsive disorder (OCD) symptoms, vocal and motor tics, and other behavioral changes. They identified that there was a common association in these children, and that was identified as a recent or active infection with a beta-hemolytic Streptococcus, the bacteria that causes strep throat. Researchers also identified a number of other infectious agents, known to cause significant auto-inflammatory reactions associated with neuropsychiatric symptoms, including influenza, varicella, and even Borrelia burgdorferi (Lyme disease), but the diagnosis of PANDAS is limited to streptococcal infections.
What are the symptoms for pandas (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)?
The symptoms of PANDAS start suddenly, about four to six weeks after a strep infection. They include behaviors similar to obsessive-compulsive disorder (OCD) and Tourette syndrome. These symptoms can interfere with schooling and quickly become debilitating. Symptoms worsen and reach their peak usually within two to three days, unlike other childhood psychiatric illnesses that develop more gradually.
Psychological symptoms may include:
- obsessive, compulsive, and repetitive behaviors
- separation anxiety, fear, and panic attacks
- incessant screaming, irritability, and frequent mood changes
- emotional and developmental regression
- visual or auditory hallucinations
- Depression and suicidal thoughts
Physical symptoms may include:
- tics and unusual movements
- sensitivities to light, sound, and touch
- deterioration of small motor skills or poor handwriting
- hyperactivity or an inability to focus
- memory problems
- trouble sleeping
- refusing to eat, which can lead to weight loss
- joint pain
- frequent urination and bedwetting
- near catatonic state
Children with PANDAS don’t always have all of these symptoms, but they generally have a mix of several physical and psychiatric symptoms.
What are the causes for pandas (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)?
The exact cause of PANDAS is the subject of ongoing research.
One theory proposes that it may be due to a faulty immune response to strep infection. Strep bacteria are particularly good at hiding from the immune system. They mask themselves with molecules that look similar to normal molecules found in the body.
The immune system eventually catches on to the strep bacteria and begins producing antibodies. However, the disguise continues to confuse the antibodies. As a result, the antibodies attack the body’s own tissues. Antibodies targeting a particular area of the brain, the basal ganglia, may cause the neuropsychiatric symptoms of PANDAS.
The same set of symptoms can be brought on by infections that don’t involve strep bacteria. When that’s the case, it’s called pediatric acute-onset neuropsychiatric syndrome (PANS).
What are the treatments for pandas (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)?
PANDAS is treated primarily with cognitive behavioral therapy and medication, depending on the breadth and severity of symptoms. Currently, the primary medical therapy is focused on controlling the OCD symptoms, and therefore selective serotonin reuptake inhibitor (SSRI) medications are frequently used (fluoxetine [Prozac] and others). The other more acute measure in treating PANDAS is treating the strep infection associated with the symptoms. Antibiotics are the treatment of choice to eradicate an active strep throat infection. Your doctor may prescribe penicillin, amoxicillin (Amoxil), azithromycin (Zithromax), or another antibiotic. For severe and refractory symptoms, the use of other treatments aimed at controlling the immune response have been studied and found to be effective. These include the use of intravenous immunoglobulin, steroids, and plasmapheresis (plasma exchange therapy in which blood is withdrawn from an individual and the liquid portion is removed and replaced and the blood is transfused back into the individual). For both treatments, the "offending" antibodies are removed. Steroids are less effective, because, although symptoms decrease during the treatment, they return soon after stopping. More studies are needed to be able to recommend immune-modulating therapies without hesitation.
What are the risk factors for pandas (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)?
PANDAS is most likely to develop in children between 3 and 12 years old who’ve had a strep infection within the last four to six weeks.
Some other possible risk factors include a genetic predisposition and recurrent infections.
Your child is more likely to get a strep infection in late fall and early spring, especially when they’re in close quarters with large groups of people. To help prevent strep infection, teach your child not to share eating utensils or drinking glasses, and to wash their hands often. They should also avoid touching their eyes and face whenever possible.
Is there a cure/medications for pandas (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)?
PANDAS wasn’t identified until 1998, so there aren’t any long-term studies of children with PANDAS. However, this doesn’t mean your child can’t get better.
Some children improve quickly after starting antibiotics, though symptoms may return if they get a new strep infection. Most recover without significant long-term symptoms. For others, it can become an ongoing problem requiring periodic use of antibiotics to control infections that may cause flare-ups.