As a holistic & integrative pediatrician, I see many children with behavioral and psychological issues. A significant part of my evaluation for these patients includes a work up to see if there is the presence of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) or PANS (Pediatric Acute-onset Neuropsychiatric Syndrome).
PANDAS is a complex disorder that can occur suddenly and appears to be more common in boys. The symptoms can be behavioral and physical, and can be debilitating.
The National Institute of Mental Health states that PANDAS is used to describe a subset of children and adolescents who have Obsessive Compulsive Disorders and/or tic disorders whose conditions worsen following strep infections such as Strep throat and Scarlet Fever. PANS, or Pediatric Acute-onset Neuropsychiatric Syndrome, is a newer term used to describe the larger class of acute-onset OCD cases and includes all cases of abrupt onset – not just those associated with strep infections.
There are many possible causes for PANS that can include the following: Lyme Disease and co-infections (Bartonella, Babesia, Ehrlichia, etc), Viral infections (Epstein Barr Virus, Cytomegalovirus, Coxsackie, Influenza, etc), and Other Bacteria (including Staphylococcus, Mycoplasma infections).
Symptoms of PANDAS/PANS:
- Severe separation anxiety
- Generalized anxiety which may progress to episodes of panic and a ‘terror-stricken look’,
- Hyperactivity, abnormal movements, and a sense of restlessness
- Sensory abnormalities, including hypersensitivity to light or sounds, distortions of visual perceptions, and occasionally, visual or auditory hallucinations
- Concentration difficulties and loss of academic abilities, particularly in math and visual-spatial areas such as hand-writing
- Increased urinary frequency and a new onset of bed-wetting
- Irritability and emotional lability. Abrupt onset of depression can also occur, with thoughts about suicide.
- Developmental regression, including temper tantrums, "baby talk" and handwriting deterioration
PANDAS Treatment and Management of Symptoms
The management and treatment of PANDAS/PANS depends on the severity of symptoms.
All treatments are individualized and depend on the root cause of inflammation. For mild symptoms we usually use the following interventions to control and treat symptoms: antibiotics, other antimicrobials (anti-virals, anti-fungals, anti-parasitics and herbals), anti-inflammatories (Ibuprofen, Low dose Naltrexone,steroids) and a tincture of time.
For moderate and severe symptoms, we use the all of the above treatment options. There can be a significant impact on a child’s immune system, so some children with moderate to severe symptoms may need immune-modulatory therapy like IVIG or plasmapharesis. Many children need the help of counseling in the form of Cognitive behavior therapy to adjust to symptoms. Families may also consider family or group therapy to help cope with the symptoms their child is experiencing. In some cases, psychotropic medications may be useful, but should be selected carefully. My motto for all interventions is “Start Low, Go Slow”. Prior to the start of psychotropic medications, I usually perform pharmaco-genetic lab testing to see which medications would be most appropriate for the symptoms.
Lorelle Bradley, MD, FAAP is Board Certified in Pediatrics and Holistic and Integrative Medicine, and is a Fellow of the American Academy of Pediatrics. She has over seventeen years experience as a pediatrician, and has made an ongoing commitment to lifelong learning and advocacy for children. She believes that children are barometers of family dynamics and sees the vital role of genetics, environment, nutrition, and toxic exposures as contributing factors to the overall health of a child.