What are Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections (PANDAS)?
Pediatric autoimmune neuropsychiatric disorders associated with Streptococcus infections (PANDAS) is a neurological condition that affects children who have had a strep bacterial infection. It is characterized by the sudden onset of symptoms that are very similar to those of psychiatric disorders such as obsessive-compulsive disorders (OCD) or tic disorders such as Tourette syndrome.
Symptoms of PANDAS
PANDAS symptoms vary from case to case, but they may include:
- Verbal or physical tics
- Obsessions (intrusive, persistent thoughts)
- Compulsions (difficult-to-resist urges to perform specific actions)
- Separation anxiety
- Mood swings
- Regressive behavior (such as temper tantrums in older children)
- Changes in motor skills such as handwriting
- Problems with attention, focus, or concentration
- Sleep problems
- Bedwetting at night
- Frequent urination during the day
- Decline in school performance
- Joint pain
What Causes Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections (PANDAS)?
Scientists don’t precisely know what causes PANDAS. However, since the condition is always associated with a strep bacteria infection, researchers believe it is triggered by an inappropriate response from the body’s immune system. In this type of condition, called an autoimmune disorder, the immune system attempts to fight off the bacterial infection but mistakes some of the body’s healthy cells for bacteria. When infection-fighting cells mistakenly attack brain cells, psychiatric symptoms result.
Are Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections (PANDAS) Hereditary?
PANDAS likely is not a disorder that a child directly inherits from their parents. However, scientists believe that some children may inherit genetic traits that make them susceptible to the autoimmune reaction that causes PANDAS. The condition probably occurs when the genetic predisposition coincides with external factors, including strep infections.
How Are Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections (PANDAS) Detected?
Early treatment of PANDAS may help lessen the severity of symptoms and prevent significant long-term impacts. Parents should consult a doctor if their child experiences signs of the condition, including:
- Sudden onset of obsessive-compulsive behaviors
- Onset of tics in association with other psychiatric symptoms such as irritability, depression, or anxiety
- Changes in eating habits
- Behavioral changes
How Are Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections (PANDAS) Diagnosed?
There are no tests or exams that can directly diagnose PANDAS. However, if a doctor suspects PANDAS, they may perform several diagnostic steps to look for the characteristic features of the disorder and rule out other possible causes for the symptoms. The diagnostic criteria for PANDAS include:
- OCD and/or tic disorder symptoms are present.
- Symptoms first appear in childhood.
- Symptoms appear suddenly, usually over a few days.
- Symptoms may improve and then worsen.
- Onset or worsening of symptoms coincides with a strep bacteria infection.
- Other neuropsychiatric symptoms (depression, anxiety, etc.) are present.
PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.
How Are Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections (PANDAS) Treated?
PANDAS is usually treated with antibiotics to control the strep infection if it is still active. Other treatment options may be required to treat the neuropsychiatric symptoms of PANDAS. Common treatment approaches include:
- Cognitive-behavioral therapy (CBT)
- Selective serotonin reuptake inhibitor (SSRI) medications to treat OCD symptoms. Children with PANDAS may be especially susceptible to side effects of these medications, so treatment with them should be carefully monitored.
- Medication to treat tic disorder symptoms
- Plasma exchange or immunoglobulin (IVIG) therapies. These treatments carry the risk of significant side effects and are usually used only in the case of severe symptoms that don’t respond to other treatments.
How Do Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections (PANDAS) Progress?
In some cases in which the triggering cause of PANDAS is identified and treated early, symptoms are entirely eliminated by treatment and don’t recur.
In other cases, symptoms may persist and worsen at times, a pattern referred to as episodic. In these cases, symptoms initially appear suddenly over a few days and then gradually improve over weeks or months. The improvement may be sustained unless the child contracts another strep infection, which triggers another worsening of symptoms. The new period of severe symptoms may last as long as several months.
How Are Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections (PANDAS) Prevented?
The best way to prevent PANDAS is to avoid strep infections, and the best way to steer clear of infections is to practice good hygiene habits and encourage them in your child. Good preventive practices include:
- Wash hands before you eat or prepare food
- Wash hands after using the bathroom
- Don’t share food, drinks, or utensils when someone in the house is sick
- Cover your mouth and nose with a tissue of the inside of your elbow when you sneeze or cough
- Use antibiotics according to your doctor’s direction when they’re prescribed for an infection
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections (PANDAS) Caregiver Tips
- Learn about PANDAS. The disorder is not well understood, and people in your child’s life likely won’t understand the impact PANDAS has on them. Educate yourself about the condition’s effects so you can be an effective advocate for your child.
- Be diligent about protecting your child. Practice good hygiene habits to help prevent future strep infections, and carefully follow all your doctor’s instructions concerning antibiotics and other medications.
- Get support from other families who are living with PANDAS. Online support groups can put you in touch with other people who understand the challenges the disorder poses.
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections (PANDAS) Brain Science
In an autoimmune disorder such as PANDAS, antibodies attack specific healthy cells because molecules on the surface of these cells are identical or similar to molecules on the surface of the bacteria that the antibodies are trying to fight. The confusion causes the antibodies to attempt to destroy healthy cells as if they were bacteria.
Recent research has attempted to identify which brain cells are attacked by antibodies in the case of PANDAS. One study found that specific nerve cells called cholinergic interneurons in part of the brain called the basal ganglia appear to be affected by a strep-induced autoimmune reaction than other brain cells are. Although it’s not yet clear how damage to cholinergic interneurons may cause PANDAS symptoms, previous studies have found that strep-related damage to the cholinergic interneurons has been associated with Tourette syndrome in previous studies.
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections (PANDAS) Research
Title: Trial of Naproxen Sodium for the Treatment of OCD in Children With PANDAS
Principal investigator: Kyle Williams, MD PhD
Massachusetts General Hospital
This project aims to rigorously evaluate a potential treatment for inflammation-related Obsessive-Compulsive Disorder (OCD) symptoms in children. To accomplish this goal, the investigators will conduct a double-blind, randomized, placebo-controlled trial of Naproxen Sodium, a nonsteroidal anti-inflammatory drug (NSAID) in participants diagnosed with Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections (PANDAS). This research fills a gap in the empirical evidence base for the treatment of PANDAS and will add to a growing literature of empirically-derived practices for PANDAS.
The investigators propose systematically evaluating the effects of naproxen sodium on anti-obsessional and behavioral improvement and conducting the first randomized controlled trial of naproxen sodium in treating children with PANDAS. The study will involve an 8-week, double-blinded randomized controlled trial to evaluate the efficacy of naproxen sodium (10mg/kg, by mouth, twice a day) versus placebo to treat OCD symptoms in children with PANDAS. The investigators will acquire completed data on 44 children with PANDAS for this pilot study (i.e., 22 randomized to active treatment; 22 randomized to placebo). The outcome will be assessed comparing pre-and post-treatment OCD symptom severity using a standardized, clinician-administered interview assessing OCD symptoms by an independent rater blind to treatment assignment.
Title: Neurobiologic, Immunologic, and Rheumatologic Markers in Youth With PANS
Principal investigator: Joanne Cheung
Palo Alto, CA
This study investigates the neurologic, immunologic, and rheumatologic markers of Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). PANS is a condition characterized by the abrupt, dramatic onset of obsessive-compulsive disorder (OCD) and/or eating restriction accompanied by equally abrupt and severe co-morbid neuropsychiatric symptoms, which include anxiety, emotional lability, depression, irritability, aggression, oppositionality, deterioration in school performance, behavioral (developmental) regression, sensory amplification, movement abnormalities, sleep disturbance, and urinary frequency. PANS is thought to be caused by infection, inflammation, or alternate triggers associated with a brain response that leads to these symptoms. The purpose of this study is to examine specific neurologic, immunologic, rheumatologic, and genomic components in children with the acute-onset of psychiatric symptoms. This research may begin to uncover a much larger story of autoimmune processes involved in childhood psychiatric disorders. In addition, by better understanding the etiologic components of the psychiatric phenomenon, future treatments may be better targeted to underlying causes.
The investigators will recruit 500 children, 1-18 years old, at onset with PANS/PANDAS. They will be treatment-naive and within one month of onset/exacerbation. The 500 children with PANS will be gender- and age-matched to 100 healthy children to allow examination of immunologic, neurologic, genomic, and behavioral differences between these two groups of children.