Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus (PANDAS) is caused by the body’s immune reaction to streptococcal infections, also known as “strep throat.” Many people think strep is the issue, which is not true. If that were the case, many more people would be at risk. PANDAS disease involves the immune system, antibodies, and how it triggers neuropsychiatric symptoms.
Researchers have discovered that the infection causes the reaction, and strep is not always the triggering infection. Lyme, Thyroid, Celiac, and Kawasaki diseases can also be present at the onset. Also, Lupus and Rheumatic Fever.
When strep throat is found to be the absolute trigger for neuropsychiatric symptoms, it is diagnosed as PANDAS. When one of the other infections is the trigger, the diagnosis is PANS or Pediatric Acute Onset Neuropsychiatric Syndrome.
What researchers don’t know for sure yet is how the immune system has such an influence on neuropsychiatric symptoms.
Who Gets PANDAS?
The PANDAS Network reports that one in every 200 children experiences PANDAS. They also note that this is a conservative estimate. In a study of 700 children, the majority of 69% were diagnosed between ages four and nine. Obsessive-compulsive disorder (OCD) and Tourette’s syndrome were the most prevalent neuropsychiatric disorders with either strep throat or another infection, with 49% of patients having both.
In addition, 70% of the patients had both an autoimmune illness and strep throat.
How PANDAS Disease Occurs in Children
Infections are caused by bacteria that get into a child’s body. Some bacteria are excellent at hiding in cell walls once inside the body, making it hard for the immune system to find them. They hide by creating molecules that look exactly like molecules already in a child’s body. They do this on the heart, joints, skin, and brain. Strep bacteria and Lyme bacteria are two examples of bacteria that mimic healthy molecules.
Eventually, the immune system senses a foreign substance exists and is triggered to hunt the bacteria and destroy it. Unfortunately, the immune system cannot distinguish between good and destructive molecules, so it attacks both.
When the immune system attacks molecules in the brain, neuropsychiatric disorders may appear, like OCD and Tourette’s. The reason behind the immune system’s attacks is not fully understood.
Symptoms of Strep Throat
Recognizing and receiving treatment for strep throat early may prevent later symptoms of PANS or PANDAS. Strep throat symptoms include having a sore throat for more than five days, white patches on the tonsils or back of the throat, swollen lymph nodes, pain or difficulty swallowing, and pain in the ears and joints.
The longer an infection goes untreated, the higher the risk of it becoming resistant to antibiotics, making it even more challenging to treat. Untreated strep can lead to PANDAS in some children.
Symptoms of PANDAS
To be diagnosed with PANDAS, specific symptoms must be present since no lab tests are available. Doctors use the following as a guide:
- The patient has not gone through puberty, with most onsets between age 3 and puberty.
- The patient has a positive test for strep throat or another infection, such as Lyme disease.
- The patient shows signs of neurological abnormalities.
- The patient has sudden onset or worsening of symptoms.
- The patient has OCD or tics or both.
Doctors will also look for symptoms such as attention deficit hyperactivity disorder and anxiety-related issues, especially when separating from a parent. Additionally, a child may have sleep disturbances, mood changes, bed wetting, joint pains, or changes in motor skill abilities.
What are the Signs of Pediatric OCD?
Obsessive-compulsive disorder is most often seen in children with PANDAS. A child with OCD has uncontrollable obsessions (thoughts) and compulsions (behaviors). They cannot move on from certain thoughts unless they engage in specific behaviors. OCD is a type of anxiety disorder, and to cope, children often create routines and rituals. When a child has PANDAS, they have a bacterial infection that either triggers OCD or makes OCD symptoms worse, which may include one or many of the following:
- Obsession with dirt and germs
- Counting and thinking about number sequences
- Desire for everything to be in a particular order
- Thoughts that include violence to them and others
- Aggressive urges or impulses
- Excessive attention to detail
The above thoughts are often followed by one or some of the following behaviors:
- Repetitive handwashing
- Checking and rechecking
- Completing tasks in a strict routine
- Hoarding objects
- Counting and recounting
- Cursing or making obscene comments or actions
- Repeating questions, words, sounds, etc.
What Are the Treatments for PANDAS?
The first step in treatment is to find the right doctor. Pediatricians will likely prescribe medicine to treat strep throat, but unfortunately, they do not always eliminate the infection. Ask your child’s pediatrician for a referral to an infectious diseases doctor immediately.
A specialist in the field of PANDAS or PANS will analyze blood work through basic and advanced tests. They will also use viral and bacterial testing methods to learn if strep or other infections are present. For example, specialists will test for Lyme disease, coinfections, Epstein-Barr virus, mycoplasma pneumonia, and more.
Treatments will vary per child but may include:
- Immunotherapy
- Immunoglobulin Therapy
- IV Antibiotics
- Specific treatments for known infections
- Stem cell therapy
- Removing trigger factors
- Neuro-regenerative peptide therapy
- Reduce inflammation
- Plasmapheresis
Because more than half of strep infections are missed in young children, it’s crucial to seek help from a doctor with advanced testing and treatment methods.
Getting the Right Diagnosis
If diagnosing strep was simple, many children would be spared symptoms of PANDAS disease. Unfortunately, the following is true:
- Strep can occur in other parts of the body, not just the throat.
- Strep tests produce 15% to 20% false negatives.
- Family members should also be tested for strep, even if they do not have symptoms, since it is highly contagious.
Contact a specialist in infectious diseases today to get accurate answers regarding strep, PANS, or PANDAS, and available treatments. Learn how they can help your child return to being a happy, healthy child again.
Check This Out!
Check out Dr. Omar Morales’ video about a PANDAS and PANS case study: https://www.youtube.com/watch?v=oNI52TIFEGA
