What is PANS/PANDAS?
What is PANS/ PANDAS?
PANS: Pediatric Acute-onset Neuropsychiatric Syndrome
PANDAS: Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections
Both PANS and PANDAS are types of autoimmune disorders that result in basal ganglia encephalitis and are believed to be triggered primarily by infections. These disorders are characterized by the sudden onset of neurologic and psychiatric symptoms preceded by an infection(s) (Brown et al., 2017; Chang et al., 2015; Gamucci et al., 2019).
Symptoms of PANS/PANDAS
PANS and PANDAS symptoms can vary in severity from person to person(Frankovich et al., 2015). Common symptoms of PANS/PANDAS my include obsessive-compulsive or repetitive type behaviors (Hesselmark & Bejerot, 2019), motor/vocal tics (Pranzatelli et al., 2017), restrictive eating(Aman et al., 2022), emotional lability, ADHD-like behaviors (i.e., irritability, impulsivity)(Alexander et al., 2011), aggression, bursts of rage, anxiety(Bernstein et al., 2010), depression, oppositional behaviors, behavioral regression, motor and sensory abnormalities, sleep disturbances, school refusal, decline in school performance, enuresis or increase in urinary frequency(What Is PANS?, 2023).
Infections Associated with PANS/PANDAS?
Infections that have been reported in patients with PANS include: influenza, Epstein Barr virus (EBV), mycoplasma pneumonia, herpes simplex virus (HSV), varicella, upper respiratory infections (including rhinosinusitis, pharyngitis, or bronchitis), and Borrelia burgdorferi (Lyme disease). Other infections that have been identified in patients with PANS include: babesia, bartonella, coxsackie virus(Cross et al., 2021; Mabrouk & Eapen, 2007; Martino et al., 2009; Mell et al., 2005).
Did you know?
Patients with PANS and PANDAS are oftentimes misdiagnosed with a psychiatric illness or behavioral disorder, when the symptoms may be the result of a treatable autoimmune dysfunction.
If you child is struggling with PANS or PANDAS, please know that you are not alone and there is help. Please reach out to our clinicians at Well Mind Body if you have any questions.
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References:
Alexander, A. A. Z., Patel, N. J., Southammakosane, C. A., & Mortensen, M. M. (2011). Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): An indication for tonsillectomy. International Journal of Pediatric Otorhinolaryngology, 75(6), 872–873. https://doi.org/10.1016/j.ijporl.2011.03.006
Aman, M., Coelho, J. S., Lin, B., Lu, C., Westwell-Roper, C., Best, J. R., & Stewart, S. E. (2022). Prevalence of pediatric acute-onset neuropsychiatric syndrome (PANS) in children and adolescents with eating disorders. Journal of Eating Disorders, 10(1), 194. https://doi.org/10.1186/s40337-022-00707-6
Bernstein, G. A., Victor, A. M., Pipal, A. J., & Williams, K. A. (2010). Comparison of Clinical Characteristics of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections and Childhood Obsessive-Compulsive Disorder. Journal of Child and Adolescent Psychopharmacology, 20(4), 333–340. https://doi.org/10.1089/cap.2010.0034
Brown, K., Farmer, C., Farhadian, B., Hernandez, J., Thienemann, M., & Frankovich, J. (2017). Pediatric Acute-Onset Neuropsychiatric Syndrome Response to Oral Corticosteroid Bursts: An Observational Study of Patients in an Academic Community-Based PANS Clinic. Journal of Child and Adolescent Psychopharmacology, 27(7), 629–639. https://doi.org/10.1089/cap.2016.0139
Chang, K., Frankovich, J., Cooperstock, M., Cunningham, M. W., Latimer, M. E., Murphy, T. K., Pasternack, M., Thienemann, M., Williams, K., Walter, J., Swedo, S. E., & From the PANS Collaborative Consortium. (2015). Clinical Evaluation of Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Recommendations from the 2013 PANS Consensus Conference. Journal of Child and Adolescent Psychopharmacology, 25(1), 3–13. https://doi.org/10.1089/cap.2014.0084
Cross, A., Bouboulis, D., Shimasaki, C., & Jones, C. R. (2021). Case Report: PANDAS and Persistent Lyme Disease With Neuropsychiatric Symptoms: Treatment, Resolution, and Recovery. Frontiers in Psychiatry, 12, 505941. https://doi.org/10.3389/fpsyt.2021.505941
Frankovich, J., Thienemann, M., Rana, S., & Chang, K. (2015). Five Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome of Differing Etiologies. Journal of Child and Adolescent Psychopharmacology, 25(1), 31–37. https://doi.org/10.1089/cap.2014.0056
Gamucci, A., Uccella, S., Sciarretta, L., D’Apruzzo, M., Calevo, M. G., Mancardi, M. M., Veneselli, E., & De Grandis, E. (2019). PANDAS and PANS: Clinical, Neuropsychological, and Biological Characterization of a Monocentric Series of Patients and Proposal for a Diagnostic Protocol. Journal of Child and Adolescent Psychopharmacology, 29(4), 305–312. https://doi.org/10.1089/cap.2018.0087
Hesselmark, E., & Bejerot, S. (2019). Patient Satisfaction and Treatments Offered to Swedish Patients with Suspected Pediatric Acute-Onset Neuropsychiatric Syndrome and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. Journal of Child and Adolescent Psychopharmacology, 29(8), 634–641. https://doi.org/10.1089/cap.2018.0141
Mabrouk, A. A., & Eapen, V. (2007). Challenges in the Identification and Treatment of PANDAS: A Case Series. Journal of Tropical Pediatrics, 55(1), 46–48. https://doi.org/10.1093/tropej/fmn039
Martino, D., Defazio, G., & Giovannoni, G. (2009). The PANDAS subgroup of tic disorders and childhood-onset obsessive–compulsive disorder. Journal of Psychosomatic Research, 67(6), 547–557. https://doi.org/10.1016/j.jpsychores.2009.07.004
Mell, L. K., Davis, R. L., & Owens, D. (2005). Association Between Streptococcal Infection and Obsessive-Compulsive Disorder, Tourette’s Syndrome, and Tic Disorder. Pediatrics, 116(1), 56–60. https://doi.org/10.1542/peds.2004-2058
Pranzatelli, M. R., Tate, E. D., & Allison, T. J. (2017). Case-control, exploratory study of cerebrospinal fluid chemokines/cytokines and lymphocyte subsets in childhood Tourette syndrome with positive streptococcal markers. Cytokine, 96, 49–53. https://doi.org/10.1016/j.cyto.2017.03.003
What is PANS? (2023). PANDAS Physicians Network. https://www.pandasppn.org/seeingyourfirstchild/#:~:text=An%20initial%20complaint%20may%20be,anxiety%20or%20OCD%20type%20worries.
