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PANDAS Syndrome

PANDAS Syndrome

What is PANDAS syndrome?

PANDAS syndrome stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.

It is a term used to describe children who either:

  • Rapidly develop obsessive compulsive disorder (OCD) or tic disorders after a specific type of infection, called group A beta-hemolytic streptococcal (GABHS) infections (such as Strep throat or Scarlet fever) or
  • Symptoms of OCD or a tic disorder rapidly worsen following a GABHS infection in children who already have these conditions.

What causes PANDAS syndrome?

Experts aren’t exactly sure what causes PANDAS syndrome, but it appears to be an autoimmune disorder. This means that the immune system starts to attack healthy cells, and in PANDAS Syndrome, this means brain cells.

Experts believe this is because Strep bacteria can mimic healthy cells, which allows them to evade detection for long periods. When the immune system finally recognizes these bacteria as foreign, it reacts to the Strep bacteria by producing antibodies.

Unfortunately, these antibodies attack both Strep bacteria and normal human cells, because they look similar. Some of these antibodies target the brain, causing symptoms such as OCD, tics, and other abnormal behaviors.

What are the symptoms of PANDAS syndrome?

PANDAS syndrome typically first appears in children from aged three to puberty. After the age of 12, reactions to Strep infections are rare, and it is unlikely an adult could develop PANDAS, although this has not been studied.

Symptoms of PANDAS syndrome are usually dramatic and appear to happen overnight and out of the blue. Symptoms may include:

  • Motor or vocal tics
  • Obsessions or compulsions
  • Anxiety including separation anxiety
  • Changes in motor skills, such as handwriting changes
  • Difficulty sleeping
  • Joint pains
  • Mood changes, such as irritability, sadness, or tendency to laugh or cry at inappropriate moments
  • Nighttime bed-wetting, frequent daytime urination, or both
  • Symptoms of attention-deficit/hyperactivity disorder (ADHD), such as hyperactivity, inattention, or fidgeting.

How is PANDAS syndrome diagnosed?

If you suspect your child may have PANDAS syndrome, or if your child has developed unusual behaviors or tics out of the blue, see your doctor. There are no laboratory tests to diagnose PANDAS syndrome, although a throat culture or blood test may be performed to test for a Strep infection. The following are a set of criteria that are used to determine whether your child has the disorder or not:

  • The presence of OCD, a tic disorder, or both
  • Dramatic ups and downs are seen in these conditions, rather than subtle changes. Improvement is slow and worsening of symptoms occurs if the child develops another infection
  • Increased symptoms may last several weeks or months
  • Onset occurred between the ages of three and puberty
  • Associated with group A Beta-hemolytic strep infection (ie, a positive throat culture for strep, history of scarlet fever, or blood test to document preceding strep infection)
  • Associated with neurological abnormalities, such as physical hyperactivity or unusual, jerky movements that are not in the child’s control
  • Abrupt onset or worsening of symptoms.

Sometimes Strep infections can be hidden (called an occult infection) and strep bacteria may be infecting the sinuses, anus, vagina, or urethral opening of the penis. Infections other than the throat should be considered if a throat culture comes back negative for Strep.

How is PANDAS syndrome treated?

Treatment involves treating the Strep infection, if it is still present, with antibiotics.

Care should be taken to ensure the child does not get reinfected with Strep, such as replacing toothbrushes or screening family members for Strep to make sure none are “Strep carriers,” who could serve as a source of the strep bacteria.

PANDAS-related obsessive-compulsive symptoms may be treated with cognitive behavioral therapy (CBT) or medications, such as selective serotonin reuptake inhibitor (SSRIs).

Plasma exchange or immunoglobulin (IVIG) may be considered for children severely affected by PANDAS syndrome.