Pediatricians play important, ongoing roles in the diagnosis, treatment, and recovery of children with PANDAS and PANS. Recognizing the symptoms, knowing how to evaluate the child for possible PANS/PANDAS and implementing treatment are keys to a full recovery.
SIGNS AND SYMPTOMS OF PANS/PANDAS
Consider PANS/PANDAS when you see a patient with a sudden and dramatic onset of unwanted thoughts, fears, rituals, obsessive compulsive disorder, and an overall abrupt decline in mental health. Strep or another infection may be triggering the neurobehavioral changes and distress.
Children with PANS/PANDAS have an abrupt and dramatic onset of OCD or Restrictive Eating Disorder plus additional symptoms from at least 2 of the following categories:
- Anxiety and/or separation anxiety
- Emotional lability and/or depression
- Irritability, aggression, and/or severe oppositional behaviors
- Behavioral regression
- Deterioration in school performance
- Sensory or motor abnormalities (including tics)
- Somatic signs and symptoms, including sleep disturbances or urinary frequency
PANDAS/PANS may be considered a form of Basal Ganglia Autoimmune Encephalitis. Click here to compare the difference between PANS/PANDAS and traditional childhood OCD.
WHAT IS PANS/PANDAS?
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a clinically defined disorder characterized by the sudden onset of obsessive-compulsive symptoms (OCD) or eating restrictions, concomitant with acute behavioral deterioration in at least two comorbid symptoms from defined categories. While the criteria for diagnosing PANS do not specify a trigger, the syndrome is thought to be an immune reaction to one of a number of physiological stressors including Group A Streptococcal infection, Mycoplasma pneumonia infection, influenza, upper respiratory infections, sinusitis, and psychosocial stresses. PANS has no age limitation.
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) is a subset of PANS. PANDAS has five distinct criteria for diagnosis, including abrupt OCD or dramatic, disabling tics; a relapsing-remitting, episodic symptom course; young age at onset (average of 6–7 years); presence of neurologic abnormalities; and temporal association between symptom onset and Group A strep infection. The 5 criteria usually are accompanied by similar comorbid symptoms as found in PANS.
WHAT ARE THE BEST RESOURCES TO HELP ME WITH MY PATIENT?
The flowcharts for diagnosing and treating PANS and PANDAS walk you through evaluating patients for possible PANS/PANDAS then guides you through treatment considerations based on symptom severity.
PANS Research Consortium Consensus Statement and Treatment Recommendations
“In cohorts of well-characterized PANS patients, evidence of postinfectious autoimmunity and/or neuroinflammation is found in more than 80% of cases (Swedo, et al.).” The JCAP papers include details on PANS/PANDAS treatment options including antibiotics to remove the source of inflammation (strep or other infection), anti-inflammatories, IVIG, behavioral therapies, and more.
Seeing Your First Child with PANDAS/PANS
“Seeing Your First Child with PANDAS/PANS”, by Margo Thienemann, MD, co-director of Stanford’s Immune Behavioral Health Clinic and the PPN Diagnostics and Therapeutics Committee, provides an overview and current theories, PANDAS/PANS symptoms and diagnostic criteria, workup recommendations, and expectations.
Pediatricians can diagnose PANS/PANDAS and implement the majority of treatments. There are a limited number of multidisciplinary care clinics available for more complex cases. Please note some clinics have strict criteria for seeing new patients due to high demand.