Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep (PANDAS)

What is pediatric autoimmune neuropsychiatric disorder associated with strep (PANDAS)?

Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections, or PANDAS for short, is when obsessive compulsive disorder (OCD) or tic disorder suddenly appears or worsens after a strep infection.

PANDAS is considered to be a pediatric disorder, which means it usually first appears in children from age three to puberty. After a child turns 12, such reactions to strep infection are rare, and it is very unlikely that someone would experience PANDAS for the first time as an adult. It is believed that approximately one in 2,000 children are affected.

What are the symptoms of PANDAS?

PANDAS symptoms are often very dramatic and sudden. They include:

Motor and/or vocal tics
Obsessions
Compulsions
ADHD symptoms, such as being hyperactive and fidgety
Moodiness and irritability
Anxiety attacks
Separation anxiety
Trouble sleeping
Fine motor changes (such as changes in handwriting)
Joint pain

What causes PANDAS?

The strep bacterium is a very ancient organism that survives in humans by hiding from the immune system for as long as possible. It does this by putting molecules on its cell wall that make it look almost exactly like the molecules in normal tissue cells. This is called “molecular mimicry.”

Eventually, the body notices that the molecules on the strep bacteria are foreign, and the immune system kicks in to produce antibodies. However, since the mimicking molecules were so similar to the human host’s molecules, the antibodies react with both the good and bad molecules. This triggers an immune reaction that attacks the molecules that were mimicked. Sometimes the target is the brain, which causes inflammation of the brain. That can result in the development of sudden OCD, anxiety, tics and more.

How is PANDAS diagnosed?

Diagnosing PANDAS necessitates a clinical diagnosis, which means that there are no lab tests that can diagnose it. Clinicians use five criteria for diagnosis:

Presence of OCD and/or a tic disorder
Symptoms start between age 3 years and puberty
There is a positive throat culture for strep, or a history of scarlet fever
The child makes unusual, jerky movements that are not in his/her control
There is a very sudden onset or worsening of symptoms

If the symptoms have been showing for over a week, blood tests may also be done to document that there was a preceding strep infection.

What are the treatments for PANDAS?

PANDAS treatment includes:

Treatment of the strep infection with antibiotics if it is still present
Standard medications and behavioral therapies to treat OCD symptoms
- SSRIs medication and cognitive behavioural therapy (CBT)
Standard medications to treat tic disorder symptoms