PANDAS & PANS

Introduction

The gradual or sudden onset of psychiatric symptoms in children such as anxiety, irrational fears, extreme emotions or outbursts, obsessive compulsive disorder, attention disorders, or tics, are suggested to arise from an autoimmune response affecting the brain. These symptoms arise secondary to inflammation in the brain that is attributed to the condition known as pediatric autoimmune neuropsychiatric syndrome(PANS). If not treated it may persist through adolescence and even into adulthood. One of the most common presentations of PANS is from a bacteria called “Group A streptococcus” causing a form known as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections or PANDAS.

Treatment

Patients suffering from PANS or PANDAS will show sudden onset of OCD with or without tics, with any of the following symptoms: difficulty with eating, anxiety or irrational fears, extreme changes in mood such as depression or outbursts of anger, aggressive behavior, regressive types of behavior, oppositional behaviors at home and or school inconsistent with history, sensory or movement problems, sleep problems, bed-wetting, and even suicidal or self-harm ideations. Many of these symptoms are extreme and usually clearly suggestive of PANDAS or PANS. In milder cases a child may only present with an increase in anxiety or irrational fears. We assume all children with any degree of emotional, attentional, and behavioral concerns to have PANS until labs confirm otherwise.

Research is pursuing the hypothesis of PANDAS being similar to rheumatic fever, another autoimmune disease triggered by strep infections, with antibodies attacking the brain instead of the heart or joints. Streptococcal bacteria produce antibodies that attack similar-looking proteins in the heart, joints, or brain, leading to mitral valve damage or carditis, arthritis, or PANDAS respectively. In PANDAS, tics, OCD, or other neuropsychiatric symptoms are produced in a similar manner with the antibodies attacking the basal ganglia, an area of the brain believed to be responsible for the symptoms.

Current medical models are struggling to understand and find effective treatments, and even disregard the reality of the symptoms when children present to pediatric, psychiatric, or family practices. This is an extreme injustice though, to those who suffer, when effective therapies are able and known to change the symptoms within a few weeks with proper diagnosis and treatment. The first step is to recognize that a child presenting with any symptoms of a psychiatric nature, particularly with a sudden onset, should be evaluated immediately for PANS and PANDAS.

Laboratory testing will often reveal antibodies to strep or Streptolysin O Ab (but not always) and antibodies to Anti-Dnase (it appears always when symptoms are present, but Lyme must also be ruled out). An elevated Anti-Dnase antibody test is diagnostic of PANDAS and leads to treatment with subsequent improvement in symptoms, confirming the initial clinical diagnosis. If symptoms appear to act like PANS or PANDAS and strep testing is negative, celiac disease and mold exposure(biotoxin illness) hould be ruled out as well.

Standard treatment for children suspected of PANDAS is generally the same as the standard treatments for Tourettes or OCD and can include cognitive behavioral therapy and medications to reduce the expression of symptoms. These only deal with the surface symptoms and provide no benefit in treating the root issues or reestablishing previous or normal behavior. Antibiotic dosing of penicillin or azithromycin does show reductions in lab values over time when regularly evaluated. Response to therapy, as evidenced by reductions or improvement in neuropsychiatric symptoms, should follow improvement or reductions in lab values associated with Strep and anti-Dnase antibodies.

In addition to the antibiotics, a yeast or anticandidal protocol will be recommended to keep yeast and candida overgrowth to a minimum while on the antibiotics. Dependent on testing or other pertinent histories, gluten and white refined sugar avoidance will be recommended, along with other herbal or natural immune and inflammation support protocols to reduce symptoms and enhance recovery.

There appears to be a significant increase in either clinical recognition, diagnosis, or cases of PANDAS. Our current observations have found a correlation of PANDAS with CIRS or chronic inflammatory response syndrome (aka biotoxin illness). The theory is that those who are reactive to mold and/or biotoxins will have an increased risk of a “leaky” brain barrier allowing the Strep to crossover and produce antibodies leading to the symptoms of PANDAS. We theorize additionally that those at risk for a more porous blood-brain barrier, in addition, have an increased porosity in the gastrointestinal tract, and may also likely show to be reactive to gluten, candida or yeast species, and possibly white refined sugar. Gluten, sugar, gut dysbiosis, and candida overgrowth are all linked to reduced immune vigilance and decreased gut barrier function. If this is the case, evaluation of PANDAS should include gluten intolerance or IgG evaluation, HLA testing for CIRS or mold reactivity, and antibody testing against Candida components. We believe a strong correlation will exist suggesting that a gluten-rich, and sugar abundant diet, increases the risk and symptoms of PANDAS significantly.

Inflammation from PANS or PANDAS is observable within QEEG or brain maps. Brain maps provide descriptions of electrical brain patterns including Delta, Theta, Alpha, and Beta brain waves. PANDAS generally shows inflammation in Delta brain waves while eyes are closed. It is believed that when inflammation presents in the brain, that it disrupts the normal rhythms or electric patterns resulting in the neuropsychiatric symptoms observed in PANDAS. With the evidence suggestive of brain inflammation, Neurofeedback therapy has been successfully applied with the benefit of reducing inflammation in the brain and returning the patient back to the previous personality baseline before the onset of the PANDAS symptoms. Neurofeedback helps the brain reboot back to its previous state of health or brainwave balance. Neurofeedback is best done with the patient under treatment with prescription or herbal therapies designed to eliminate the strep infection and balance immune response. This can include dietary recommendations, specific cleanses, and immune and neurological support as previously described.

We hope this is helpful for you and invite you to not get overwhelmed with what you think you’re not doing or don’t know. We welcome you to call us with any questions or concerns you may have about PANS and PANDAS.