What is PANDAS?
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep (PANDAS) is a diagnosis given to children who have a sudden or abrupt onset of OCD (obsessive compulsive disorder) and/or Tics (involuntary movement disorder) in childhood, following a Group A Beta-hemolytic Streptococcus (GABHS) or ‘strep’ infection. This condition can also involve a sudden onset of symptoms such as anxiety, emotional lability or depression, behavioral changes, poorer school performance, and sensory or motor disturbances. However, it should be noted that not every child has traditional symptoms of a strep infection.
In PANDAS, when a streptococcal infection triggers an autoimmune response, antibodies mistakenly attack brain tissue which increases inflammation, this can induce the sudden onset of movement disorder and neurological behaviors. This means that it isn’t the infection itself causing symptoms, but it is an immune illness and it is the immune attack of the brain causing the symptoms. It’s thought that many children develop an immunity to Group A streptococci (GAS, bacteria found in the throat or on the skin) after puberty, which is why PANDAS is often said to be a pre-pubertal condition, though it’s not impossible for an infection to occur after puberty and PANDAS symptoms to present.
Many conditions have been identified to be associated with PANDAS including: OCD, attention-deficit/hyperactivity disorder (ADHD), mood disorders, separation anxiety, food restriction, vocal and motor tics, frequent urination, and enuresis. The onset of these symptoms can be abrupt, and completely different than children’s behavior prior to the onset of symptoms, which can cause significant stress on both children and their families. The average age of onset is between 4 and 7 years old. If children with PANDAS are exposed to streptococcal infections, this can cause a “flare” in symptoms, often occurring throughout the school year or in the presence of other children, as well as if the child’s family members are carriers of streptococcal infection. Furthermore, symptoms can also be triggered or exacerbated by environmental triggers, including toxins, mycotoxins from mold spores, heavy metals, any immune challenge, allergies, loose teeth (which aggravate oral bacteria and spirochetes), and more.
What is PANS?
Pediatric Autoimmune (Acute-onset) Neuropsychiatric Syndromes (PANS) is a broader categorization when a single specific infectious trigger isn’t identified, and similar symptoms can be triggered by more than one infection. Some of these infections include lyme borreliosis, bartonella, mycoplasma, influenza, coxsackievirus, varicella, human herpesvirus 6, EBV, the common cold, and more.
PANDAS is a form of PANS that is triggered solely by strep; so PANDAS is actually a subset of PANS. While PANDAS is associated with streptococcal infections, we recognize that there are many other infections that can trigger PANS that are non-strep infections, and from our experiences, most children with a strep trigger also have other infectious triggers.
Symptoms of PANS/PANDAS
- Anxiety (specifically separation anxiety)
- Atypical anorexia or disordered eating
- Urinary frequency
- OCD and tics
- Handwriting difficulty
- Change in cognition
- Mood swings and/or depression
- Irritability, aggression, oppositional behaviors
- Behavioral regression (baby talk, throwing tantrums, etc.)
- Sensory or motor abnormalities
How is PANS/PANDAS Diagnosed?
PANS/PANDAS is diagnosed by the patient’s characteristic clinical history and can be aided with laboratory testing, a throat culture and/or testing for anti-neuronal antibodies. While there isn’t a single, definitive test or panel for PANS/PANDAS, practitioners can use basic standard blood tests such as CBC with diff, CMP, Immunoglobulin levels – IgE, IgA, IgM, IgG (including subclasses 1, 2, 3, 4), IL-17, ANA, anti-NMDAr, Ferritin, Vitamin D, Zinc, Copper, B12/folate, CD57, C3a, C4a, as well as viral/bacterial testing (strep throat culture, antistreptolysin O (ASO), anti dNase B, streptozyme if available, comprehensive Lyme disease testing, co-infection testing, Mycoplasma Pneumoniae IgA & IgM, Pneumococcal Antibody titers to assess immune response, Epstein Barr Virus panel, Parvovirus, Coxsackie A & B titers, HHV-6 titers and many more). Specialty testing includes, a Cunningham Panel, comprehensive digestive stool analysis, Micronutrient panel/other Nutritional testing, Organic Acid testing, Genetic testing, mold and mycotoxin testing, MCAS testing, increased intestinal permeability testing, and more. Imaging such as an MRI with Neuroquant, and a 19 channel qEEG brain mapping can also be useful. You’ll find that Newbridge practitioners order and use these labs to help aid both diagnosis and treatment for PANS/PANDAS.
Treatment Options for PANS/PANDAS
At Newbridge, we recognize that each person is an individual with different needs, and thus, the most optimal treatment plan may vary between individuals. With that in mind, the Functional Medicine approach to PANS/PANDAS focuses on identifying and treating the root cause/s, while supporting and helping balance the immune system, not suppressing it. It’s also important to address not just the physical symptoms, but to consider the unique environmental, nutritional, genetic, mental and emotional stressors unique to each person, as these factors can make someone more or less susceptible to illness and disease. Additionally, subsequent flares in symptoms can be caused by environmental and infectious triggers different from the original infection. When treated early and comprehensively using this approach, PANDAS/PANS can remit entirely. Even extremely advanced cases have responded remarkably well and even fully remitted, with comprehensive functional medicine PANDAS/PANS treatment.
While there aren’t definitive guidelines for treating PANDAS, many children and families resort to more integrative and holistic modalities to support whole-body wellness and restoration. At Newbridge, we utilize a variety of treatment modalities to support the whole body and enhance immune function.
Herbs and/or Antibiotics
Treatment for PANDAS often includes the use of herbs and/or antibiotics to treat the GAS infection. If other infectious triggers are identified, we can target those antigens more specifically. In a Functional Medicine approach to PANS/PANDAS, both pharmaceutical and botanical antimicrobials can play a role in treatment. Herbs suppress opportunistic pathogens, but without destroying non-harmful flora, which provides a significant advantage over pharmaceutical antibiotics which target both pathogenic and beneficial bacteria. This further necessitates the need for an anti-inflammatory, whole-food based diet to support the gut, along with a restorative protocol to replenish the lost bacteria. Antimicrobial herbs can also be used prophylactically without the same consequences seen with antibiotics.
Low Dose Immunotherapy (LDI) is used to help modulate the immune system’s response to infections, such as strep. LDI promotes specific immune tolerance to target antigens to stop inappropriate and unnecessary immune reactivity. LDI also works well for patients who are more sensitive to herbs and/or antibiotics, and in conjunction with antimicrobials if tolerated.
Integrative and Functional Nutrition
Nutrition is imperative to optimize gut function and restore microbial diversity within the gut as it comprises 70-80% of the immune system and neurotransmitter function. It’s extremely important to seal the gut lining to prevent the bidirectional connection to the brain from becoming leaky and permeable to different proteins and pathogens, including those that can trigger brain inflammation. Stool testing can be a key component to targeting dysbiosis and move toward gut healing. Additionally, extracts from food, botanicals, and specific probiotics may have properties that help promote healthy levels of beneficial bacteria, and promote the balance of other infectious agents in the gut including molds, viruses, fungi and bacteria. These compounds can be used alongside conventional and functional medical treatment, potentially lessening adverse outcomes and improving overall efficacy. Working with our integrative and functional dietitian, Rachel Wood, can help get your child on the right track with a therapeutic nutrition plan.
Far Infrared Sauna
Far infrared saunas help to increase body temperature and can be beneficial in supporting detoxification, a key component to recovering from PANS/PANDAS. Far infrared light is absorbed by the skin and can provide immune support throughout the healing process by increasing circulation, which allows other treatment modalities to reach all areas of the body in a more efficient manner.
CBT was first developed by Dr. Anthony Smith in Idaho, and is based on principles of neurophysiology. CBT uses Muscle Response Testing (MRT) to obtain feedback from your body concerning “health stressors” that may be causing problems. These stressors can include allergies, pathogenic organisms, toxins, and physiological dysfunctions. Once a stressor has been revealed, your CBT practitioner can then relay this information to your brain. This is accomplished by the gentle stimulation of specific neurovascular “reflex points” on your cranium and upper body. As soon as your brain accurately recognizes the stressor, it can begin to correct it.
Lymph Drainage Therapy (LDT)
Lymph Drainage Therapy (LDT) is a manual therapy that supports the body’s ability to flush toxins and inflammatory cells. Brain inflammation is at the heart of many PANDAS symptoms. When LDT is used in conjunction with other treatments, it supports the body’s natural abilities to heal itself. Anxiety, obsessive compulsive thoughts and behaviors are also associated with PANDAS. LDT also supports the calming branch of the automatic nervous system and promotes a calm, alert state, reducing anxiety and the resulting obsessive thinking and behavior.
Our PANS/PANDAS Providers
Stephanie is a board-certified Pediatric Nurse Practitioner with over 25 years experience in inpatient and outpatient primary care, pulmonology, asthma, early childhood screening, and neurodevelopmental disorders. She has a special interest in Autism, ADHD, PANS/PANDAS, Autoimmune disease, and other complex chronic pediatric conditions.
Karn is a Physician Assistant with over 25 years of experience. She has a passion for helping children with Autism, PANS/PANDAS, and ADHD. In 2011, Karn began focusing on Autism, PANDAS/PANS and ADD/ADHD in clinical practice. She is a member of the PANDAS Physician Network.
- Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases
- Tonsillectomies and adenoidectomies do not prevent the onset of pediatric autoimmune neuropsychiatric disorder associated with group A streptococcus
- Mimicry and autoantibody-mediated neuronal cell signaling in Sydenham chorea
- Antibody-mediated neuronal cell signaling in behavior and movement disorders
- From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS (Pediatric Acute-onset Neuropsychiatric Syndrome)
- Toward a Neurobiology of Obsessive-Compulsive Disorder
- Neuroimaging and frontal-subcortical circuitry in obsessive-compulsive disorder
- Comparison of clinical characteristics of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and childhood Obsessive-Compulsive Disorder
- Anti-basal ganglia antibodies: a possible diagnostic utility in idiopathic movement disorders?
- Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)
- PANDAS Network: What is PANDAS