UNDERSTANDING
PANS/PANDAS
Learn the signs, symptoms,
and next steps of PANS/PANDAS.
PANS/PANDAS Symptoms
PANS
Pediatric Acute-onset Neuropsychiatric Syndrome includes an acute onset of the following symptoms:
- OCD and/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
PANS 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. Learn more about PANS at https://www.pandasppn.org/pans.
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
- Temporal association between symptom onset and Group A strep infection
The 5 criteria usually are accompanied by similar comorbid symptoms as found in PANS. Learn more about PANDAS at https://www.pandasppn.org/pandas.
PANS/PANDAS Fast Facts
Consider PANS/PANDAS when you see a patient with a sudden and dramatic onset of unwanted thoughts, fears, rituals, obsessive compulsive disorder, and/or an overall abrupt decline in mental health.
Strep or other infections, such as Mycoplasma pneumonia, influenza, upper respiratory infections, or sinusitis, may be triggering the neurobehavioral changes and psychological distress.
PANS/PANDAS is treatable. Treatment is a three pronged approach that addresses the source (infections), the immune system dysfunction, and the symptoms.
What should I do if I suspect PANS/PANDAS?
PANS/PANDAS Diagnostic and Treatment Flowcharts
The PANS/PANDAS charts guide you through evaluating and diagnosing your patient and treatment considerations based on the symptom severity for mild, moderate, and severe cases.
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 theories, PANDAS/PANS symptoms and diagnostic criteria, workup recommendations, and expectations.
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.
PANS/PANDAS Practitioner Directory
Pediatricians can diagnose PANS/PANDAS and implement the majority of treatments. The PANDAS Physicians Network Practitioner Directory is made available by the PPN as an informational resource. The directory includes the names of PPN doctor and medical professional members who have given their permission to be identified publicly.