What is PANDAS?
PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection. It is a newly recognized disorder in which children have OCD and Tourette's-like symptoms that occur due to a strep infection.
PANDAS is a disorder that typically begins in early childhood (ages 4-10). PANDAS symptoms include tics, obsessions and compulsions, mood swings, temper tantrums, attention difficulties, hyperactivity, impulsivity, and unusual movements called choreiform movements. PANDAS has an episodic course which comes and goes with the strep infection. However, the child may or may not have strep symptoms so it is often difficult to tell if you are dealing with PANDAS or not. In fact, many individuals never experience acute strep symptoms, and exacerbations can occur immediately following or several weeks after acute strep symptoms disappear. Symptom exacerbations are often rapid and dramatic, while symptom remissions are often slower.
How is PANDAS different from OCD or Tourette's?
OCD and Tourette's symptoms wax and wane unpredictably with gradual onset, while PANDAS usually has a dramatic, severe, or "out of the blue" onset. Parents of children with PANDAS often report that one day their child was fine, and the next day they woke up to a child exhibiting multiple severe symptoms.
What causes PANDAS?
PANDAS is caused when the bacterial Streptococcal pathogen triggers an acute neuropsychiatric disease. Usually, when the body detects a bacterial infection, the autoimmune system creates antibodies to fight the infection. In the case of PANDAS, the strep infection causes antibodies to be created, but instead of only attacking the strep, the antibodies also cross the blood-brain barrier and attack the Basal Ganglia. This causes swelling in the caudate, putamen, and globus pallidus parts of the brain and causes the PANDAS symptoms.
Most children will get strep in their lifetime but will never develop PANDAS. However, some children, due to genetic and environmental factors, will develop PANDAS.
How do you treat PANDAS?
PANDAS is best treated with a combination of medication and psychological therapy. Medication treatments work both on the symptoms and the cause of PANDAS. Tricyclic Antidepressants, SSRIs, and Neuroleptics are used to treat the symptoms of PANDAS. The individual symptoms of PANDAS are treated with cognitive-behavioral therapy.
Antibiotics are used to treat the underlying infectious cause of PANDAS. In severe cases, more drastic infection treatment options are considered such as plasmapheresis, intravenous immunoglobulin, and/or prophylactic penicillin, but these are still being researched.
PANDAS Links
National Institute of Mental Health PANDAS site
Articles published about PANDAS
