THE BASICS OF
DID YOU KNOW?
Infections can trigger a misdirected immune response causing inflammation in the brain. Psychiatric and neurologic symptoms can manifest due to the inflammation. This is called PANS/PANDAS.
How do I recognize PANS/PANDAS?
The acute and dramatic onset of mood and behavioral changes are red flags of possible PANDAS/PANS. The symptoms of PANDAS and PANS include:
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
Is PANDAS/PANS the same as childhood OCD? Why does the diagnosis matter?
PANDAS/PANS may be considered a form of Basal Ganglia Autoimmune Encephalitis. The presentation of PANDAS/PANS varies from traditional childhood OCD, and it has different treatment options. View the comparison chart to learn how PANDAS/PANS differs from traditional childhood OCD.
What is PANS/PANDAS?
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a clinically defined disorder. Patients experience a sudden onset of obsessive-compulsive symptoms (OCD) and/or eating restrictions, along with acute deterioration in at least two of the symptom categories listed above. The syndrome is thought to be an immune reaction to a number of physiological stressors including Group A Streptococcal infection, Mycoplasma pneumonia infection, influenza, upper respiratory infections, sinusitis, Lyme, 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.
I suspect PANS/PANDAS.
What are the next steps?
Familiarize yourself with the PANS/PANDAS flowcharts.
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.
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.