PANDAS Syndrome

What is PANDAS syndrome?

PANDAS is short for “pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections.” It describes a group of conditions thought to affect select children who’ve strep infections, such as strep throat or scarlet fever. There have been some reports of the development of tics, obsessive-compulsive behavior and other mental and neurological symptoms after PANDAS, although a clear link hasn’t yet been established.

Who gets PANDAS syndrome?

Of those who’ve reported symptoms after PANDAS, most are between the ages of 3 and 12. Some healthcare providers think it’s more common in children assigned male at birth than those assigned female at birth. They also think that a child 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.

Can teenagers or adults get PANDAS syndrome?

Some researchers think it’s very uncommon for teenagers or adults to have mental or neurological symptoms from strep infections. Some researchers are looking into the potential long-term effects of these illnesses.

How common is PANDAS syndrome?

Some research shows that PANDAS is a rare condition.

What are the symptoms and signs of PANDAS syndrome?

Symptoms and signs of PANDAS have been reported to vary widely from child to child and can involve a combination of psychological and neurological conditions. 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 have been reported to occur with PANDAS have included:

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

Neurological symptoms that have been reported to be associated 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.

What causes PANDAS syndrome?

Some believe that PANDAS occurs when your child’s immune system produces antibodies to fight the bacteria that caused a strep infection. But the antibodies may also mistakenly attack healthy cells in other tissues because the cells mimic those of the strep infection. Some believe that antibodies affect tissues in your child’s brain, leading to the psychological and neurological symptoms sometimes reported.

Are PANS and PANDAS syndrome the same thing?

PANS stands for “pediatric acute-onset neuropsychiatric syndrome.” Some providers think PANDAS is a type of PANS. Both are thought by those individuals to cause similar symptoms that come on suddenly. But PANDAS is thought to be related to a strep infection, whereas PANS is thought to result from other infections such as Lyme disease or influenza.

How is PANDAS syndrome diagnosed?

There isn’t a test to diagnose PANDAS. A healthcare provider will perform a physical exam and evaluate your child’s symptoms.

How is PANDAS syndrome treated?

Treatment for PANDAS may include:

• Antibiotics: Children with an active strep infection, including symptoms characteristic of the infection (such as fever, sore throat, pain with swallowing), need antibiotics.
• Cognitive behavioral therapy (CBT): CBT is a form of psychotherapy. It can help your child better manage mental and emotional difficulties.

How can I prevent PANDAS syndrome?

The best way to prevent any illness thought to be associated with an infection is to prevent the infection from occurring in the first place. 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 whenever possible.

What’s the outlook for a child with PANDAS syndrome?

Focusing on cognitive behavioral therapy for behavioral problems and habit reversal training for tics helps decrease the frequency of symptoms and provides children with the coping skills they need to succeed.

A note from Cleveland Clinic

PANDAS stands for “pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections.” Some providers think it represents a group of psychological and neurological problems that may develop in children who’ve had strep infections. The most common symptoms reported are tics and obsessive-compulsive disorder-like behavior. Treatment includes antibiotics for an active strep infection with symptoms, cognitive behavioral therapy for behavioral and psychiatric disorders, and habit reversal training for tics.