PANDAS Syndrome

PANDAS is short for “pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections.” It describes a group of conditions thought to affect some children who’ve had strep infections, like strep throat or scarlet fever. Overall, PANDAS seems to be rare.

Some parents have reported the sudden onset of tics, obsessive-compulsive behavior and other symptoms in their child after strep infections. Most of these kids are between the ages of 3 and 12.

PANDAS overlaps with another condition called pediatric acute-onset neuropsychiatric syndrome (PANS). They both have a key feature of an abrupt onset of obsessive-compulsive disorder (OCD). But PANS may be due to infections other than strep.

Researchers continue to study this syndrome. For some experts, PANDAS is controversial as a medical diagnosis because it:

• Has vague diagnostic criteria
• Has symptoms that overlap with other conditions
• Lacks evidence of a clear underlying cause

Even if healthcare providers don’t agree on all aspects of PANDAS, your child’s symptoms are real. Providers take sudden behavioral and neurological changes seriously. A thorough evaluation from medical specialists can guide the most helpful treatment for your child.

Symptoms of PANDAS syndrome

PANDAS symptoms and signs appear to vary widely from child to child. They can involve a combination of psychological and neurological changes. The symptoms are thought to start suddenly and occur in episodes. They seem to last for a few days or weeks, then go away and return.

Psychological symptoms that may occur with PANDAS include:

• Obsessive-compulsive disorder-like behavior
• Tics, like those of Tourette syndrome
• Disinterest in food, similar to avoidant/restrictive food intake disorder
• Anxiety or depression
• Bedwetting
• Changes in mood or personality, especially sudden rage or irritability
• Difficulty sleeping
• Fidgeting and symptoms similar to attention-deficit/hyperactivity disorder (ADHD)
• Separation anxiety

Neurological symptoms that may occur with PANDAS include:

• Changes in motor skills (muscle movements), such as problems with handwriting
• Difficulty concentrating or learning
• Poor performance in school
• Reduced coordination
• Sensitivity to light and sound

PANDAS causes

Researchers haven’t found a clear cause of PANDAS syndrome. The main theory is that it’s an autoimmune disease. As your child’s immune system fights off a group A streptococcal infection, it may mistakenly attack healthy cells in their brain. This may lead to the neurological and psychiatric symptoms of PANDAS.

Some experts think PANDAS may actually be a form of Sydenham chorea.

Risk factors

Some researchers think children may be at a higher risk of PANDAS if they have:

• Frequent group A streptococcal infections, such as strep throat or scarlet fever
• Family history of autoimmune diseases or rheumatic fever
• Certain gene changes related to immune system function

Complications

Without treatment, OCD, tics and other neuropsychiatric conditions may get worse. They may persist into adulthood. Talk therapies and medications can help your child manage these conditions.

How doctors diagnose PANDAS

Healthcare providers vary in how they approach PANDAS. There isn’t a specific test to diagnose it. But it’s important to get help for your child’s symptoms.

A provider will do a physical exam and ask about your child’s symptoms. Much of the diagnostic process involves ruling out other possible causes of the symptoms. To do this, your child’s provider may recommend certain lab tests and/or brain imaging tests. They may refer you to specialists.

The proposed diagnostic criteria for PANDAS include:

• Presence of obsessive-compulsive disorder and/or tic disorder
• Sudden onset of symptoms in children between 3 years of age and puberty
• Symptoms that come and go in episodes
• Previous or current streptococcal infection
• Neurological abnormalities

How is it treated?

There aren’t any treatments for PANDAS approved by the U.S. Food and Drug Administration (FDA). If your child has an active strep infection, their provider will likely prescribe antibiotics.

Regardless of the underlying cause, the goal is to manage symptoms. Certain therapies can help with OCD symptoms and tics, like:

• Cognitive behavioral therapy (CBT)
• Exposure and response prevention (ERP) therapy
• Habit reversal training

Researchers are studying other possible treatments. Your child may be able to join a clinical trial involving one of these therapies:

• Steroids
• IVIG
• Plasmapheresis

How can I help my child?

OCD, tics and behavioral challenges can affect your child’s ability to function day to day. Because of that, it may help to focus on treating each symptom they have. Several studies show that talk therapies can decrease the frequency and severity of these symptoms. Psychiatric medication may also help.

Take care of yourself, too. Sudden changes in your child can be stressful. You may feel like you have a different child. And it can be frustrating not to feel heard. If you’re getting overwhelmed, seek help from a mental health provider.

Can this be prevented?

There’s no guaranteed way to prevent PANDAS. But everyday hygiene habits can help lower the risk of infections that may cause it.

Encourage your child to practice good hygiene by:

• Covering their nose and mouth with a tissue or their elbow when they cough or sneeze
• Not sharing food, drinks or personal items, such as toothbrushes
• Washing their hands frequently and using hand sanitizer