SIGNS AND SYMPTOMS OF PANS/PANDAS
Consider PANDAS and PANS 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 behavioral changes and psychological distress.
People 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 vs Traditional OCD
PANDAS/PANS may be considered a form of Basal Ganglia Autoimmune Encephalitis. View the comparison chart to learn how PANDAS/PANS varies from 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.
PANDAS IS A SUBSET OF PANS:
I SUSPECT MY PATIENT MAY HAVE PANS/PANDAS.
WHAT ARE THE NEXT STEPS?
Review Seeing Your First Child with PANDAS/PANS.
“Seeing Your First Child with PANDAS/PANS” is a medical guide consisting of: overview and current theories, PANDAS/PANS symptoms and diagnostic criteria, workup recommendations, and expectations.
Read the 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 (streptococcus or another infection), anti-inflammatories, IVIG, behavioral therapies, and more.
Access the PPN Practitioner Directory.
Primary care providers, including pediatricians, family physicians, and nurse practitioners, can diagnose PANS/PANDAS and implement the majority of treatments. However, if you need help finding a doctor or medical professional familiar with PANS/PANDAS, visit the PPN Practitioner Directory. Practitioners can request to be listed in the directory by becoming a member of the PPN.