PANS & PANDAS: Recognizing Symptoms in Children

PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are conditions where a child suddenly develops severe neuropsychiatric symptoms due to an immune response. PANDAS was officially recognized in 2010 and it is associated with streptococcal infection. Since then, the definition has broadened and now includes other infections and triggers, hence PANS. Common triggers for PANS include Mycoplasma, Lyme disease, and other tick-borne illness viruses like influenza, Covid and environmental triggers like allergies, and these are mentioning just a few. Regardless of what the original trigger is, these conditions involve the immune system attacking the brain, leading to sudden and dramatic behavioral changes.

There are a variety of different symptoms that are included in the diagnostic criteria. Not every child will experience all of these symptoms and not all of these symptoms are needed for a diagnosis. Sudden and often severe onset of OCD and tics are common. Some examples are, that the child must wash hands excessively, count things, organize toys, change clothes, or wipe excessively after using the bathroom. Tics can be vocal or motor, involuntary and repetitive, or a combination of these. Throat clearing, blinking, and head jerks are common symptoms of motor tics. Sudden shouts or repetitive sounds/words can be a vocal tic. The key feature here is that the child cannot control the tics, they may be able to suppress, but they are usually completely involuntary.

Emotional and behavioral changes are often alarming to parents. This can feel like the child has a completely different character. Anger, rage, and intense mood swings can occur. Debilitating anxiety, panic attacks, and sudden separation anxiety can surface. This can be scary for the child as well as the parent. What happened to my child?

Sensory-processing challenges might appear. Sensitivity to light, sounds, and smells can be intense. Sudden loss of or deterioration of handwriting is common and strongly suggestive of PANS/PANDAS. Losing already learned motor skills and coordination tells us that the brain is under attack. Brain fog, difficulty concentrating, and trouble remembering things can make school difficult. The child might fall behind in class which is frustrating for the entire family. Food restrictions or fear around food becomes a daily battle. Sleep disturbances are common as well as urinary issues, i.e. bedwetting or urgency without infection. One of the scariest symptoms a child can experience is hallucinations, both auditory and visual. Auditory hallucinations can be intrusive.

If your child experiences a sudden change in behavior, especially after an illness, PANS/PANDAS is a possibility. Diagnosis is clinical which means there are no tests that directly will tell if the child has this syndrome, the doctor will do an evaluation and use symptom criteria to help with diagnosis. Treatment plans are always tailored to the child’s needs. Treatment includes dietary changes, anti-inflammatory therapies, immune support, homeopathy, and some pharmaceuticals to help manage symptoms.

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