PANDAS Syndrome (Symptoms,Causes and Treatment)

Children typically affected with PANDAS syndrome, also known as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, are between the ages of 3 and 14. The inflammation in the brain is thought to be the outcome of an autoimmune reaction brought on by a streptococcal infection.

Following a streptococcal infection, the symptoms of PANDAS syndrome might include the sudden onset of obsessive-compulsive disorder (OCD), tic disorders, anxiety, emotional instability, and behavioral changes. The signs and symptoms could fluctuate and be severe enough to affect a child’s day-to-day activities.

The existence of recent streptococcal infection and autoimmune antibodies are confirmed through laboratory testing, together with a patient’s clinical symptoms, medical history, and other factors.

Antibiotics to treat the streptococcal infection and immune-modulating medications, including steroids or intravenous immunoglobulin (IVIG) therapy, are frequently used to treat PANDAS syndrome. Psychotropic drugs and behavioral therapy may also be suggested in some circumstances.

Even though PANDAS syndrome is a rare disorder, it is crucial to get medical help if a child exhibits rapid changes in their behavior or obsessive-compulsive symptoms after contracting a streptococcal infection. The symptoms of the child can be improved and long-term consequences can be avoided with early identification and treatment.

This article covers the following topics :

PANDAS syndrome: what is it?

Obsessive-compulsive disorder (OCD), tic disorders, anxiety, emotional instability, and behavioral changes all appear suddenly after a streptococcal infection. This condition is known as PANDAS syndrome. The symptoms may come and go and may be severe enough to interfere with a child’s day-to-day activities.

It’s unclear what exactly causes PANDAS syndrome. The basal ganglia, a region of the brain that regulates behavior and movement, are thought to be mistakenly attacked by an immune response brought on by a streptococcal infection. The symptoms of PANDAS syndrome may be caused by inflammation in the basal ganglia.

PANDAS syndrome symptoms might resemble those of other disorders, such as Tourette syndrome, making a diagnosis challenging. The existence of recent streptococcal infection and autoimmune antibodies are confirmed through laboratory testing, together with a patient’s clinical symptoms, medical history, and other factors.

Antibiotics to treat the streptococcal infection and immune-modulating medications, including steroids or intravenous immunoglobulin (IVIG) therapy, are frequently used to treat PANDAS syndrome. To treat the symptoms, behavioral therapy and psychotropic drugs may also be suggested in some circumstances.

Uncertainty exists over the PANDAS syndrome’s long-term prognosis. While some kids may totally heal from the disease, others can still have symptoms. Rarely, the PANDAS syndrome might result in OCD or chronic tic disorders.

One who develops PANDAS syndrome?

Typically, children between the ages of 3 and 14 are affected with PANDAS syndrome. Boys are more likely than females to have it. There are several different estimates of the prevalence of PANDAS syndrome, which is a relatively uncommon illness. According to some research, it affects 1% or less of kids who have obsessive-compulsive disorder (OCD) or tic disorders. However, according to some studies, it might only affect a small percentage of kids and be far less common. PANDAS syndrome is more prevalent in children with a history of recurrent strep infections and typically develops after a streptococcal infection, such as strep throat or scarlet fever.

Can adults or teenagers develop PANDAS syndrome?

Although PANDAS syndrome typically affects children, certain examples of adults and teenagers getting the disorder have been documented. Although less frequent than in childhood, the advent of PANDAS symptoms in adolescence or adults should be noted. The symptoms of PANDAS in elderly people may also be less distinct and may overlap with those of other psychiatric or neurological disorders, making a diagnosis difficult. To comprehend PANDAS in older people, more study is required.

How widespread is the PANDAS syndrome?

The illness known as PANDAS syndrome is thought to be rather uncommon. Although estimates of its frequency vary greatly, it is generally accepted that children with obsessive-compulsive disorder (OCD) or tic disorders are only slightly more likely to be affected. It may impact 1% of kids with OCD or tics, according to some studies, although other research points to a far lower prevalence. It is significant to highlight that PANDAS syndrome is still being discussed as to whether or not it exists as a unique medical illness recognized by all medical practitioners. To comprehend the true prevalence of PANDAS syndrome, more study is required.

What are the PANDAS syndrome’s symptoms and warning signs?

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) syndrome is characterized by sudden onset of obsessive-compulsive disorder (OCD) symptoms, tics, or both, following a streptococcal infection (typically strep throat or scarlet fever). The symptoms and signs of PANDAS can vary greatly between individuals. Behavioral regression or deterioration (e.g., bedwetting, separation anxiety), emotional instability, impatience, or mood swings are some other PANDAS syndrome symptoms and indicators that may occur.

Sleep disruptions (insomnia, night terrors)

*Behavioral or developmental regression or worsening *Sensory processing impairments (e.g., sensitivity to light, sound, or touch)

*Hyperactivity or inattention *Cognitive or developmental delays

Antibiotics, nonsteroidal anti-inflammatory medications (NSAIDs), or other therapies may aggravate or alleviate symptoms, which might change over time and in response to them.

It is crucial to understand that PANDAS syndrome cannot be diagnosed by a layperson and that not all cases of OCD or tics after a streptococcal infection are PANDAS syndrome. In addition, not all medical experts agree on the definition or existence of PANDAS syndrome, which is still a novel and contentious diagnosis.

Why does PANDAS syndrome occur?

It’s unclear what exactly causes PANDAS syndrome. It is thought to be an autoimmune condition, though, in which the immune system incorrectly creates antibodies that attack healthy brain cells, notably the basal ganglia, which regulates behavior and movement. It is believed that a streptococcal infection, such as strep throat or scarlet fever, causes these antibodies to be produced. PANDAS syndrome can occasionally be brought on by other infections, such as mycoplasma pneumonia. The symptoms of PANDAS syndrome can be brought on by the immunological response, which can lead to inflammation in the brain.

PANDAS syndrome and PANS syndrome are they synonymous?

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) syndrome and PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) are similar but distinct disorders.

A form of PANS known as PANDAS focuses on symptoms that are brought on by a streptococcal infection. PANS, on the other hand, can be brought on by different infections or non-infectious causes such chemicals in the environment or metabolic abnormalities.

Both PANS and PANDAS feature abrupt and significant changes in children’s behavior, mood, and cognitive performance; symptoms can appear quickly over the period of days to weeks. Obsessive-compulsive traits, tics, anxiety, and other neuropsychiatric signs and symptoms could be present.

While the precise causes of PANS and PANDAS are yet unknown, both disorders are believed to be caused by an immune response that is dysregulated and results in inflammation of the brain. Antibiotics, anti-inflammatory drugs, and behavioral treatments may all be used to treat these illnesses.

What is the diagnosis of PANDAS syndrome?

By taking into account the patient’s medical history, symptoms, and ruling out any other potential causes of symptoms, PANDAS syndrome is identified. PANDAS syndrome diagnostic standards comprise:

1-Obsessive-compulsive disorder (OCD) or tic disorder presence

2-Sudden OCD or tic onset or worsening, with symptoms appearing in a period of days to weeks.

3-Symptoms that accompany or coincide with a streptococcal infection

4-Additional neurologic or psychiatric symptoms such emotional instability, anxiety, or depression

A diagnosis of PANDAS syndrome may also be supported by diagnostic tests. Laboratory tests to identify streptococcal infection, imaging studies to rule out other illnesses that may present with similar symptoms, and neuropsychological testing to gauge cognitive and behavioral functioning can all be included in this.

Because PANDAS syndrome is a novel diagnosis, there is still significant debate concerning the standards and procedure for diagnosis. Revisions to the criteria have been made by certain specialists, and research is still being done to better diagnose and treat PANDAS condition.

In what ways is PANDAS syndrome treated?

PANDAS syndrome is managed using a triage approach of drugs, treatments, and supportive care. The main objectives of treatment are to lessen symptoms and stop relapses.

The therapy program may consist of:

1-Antibiotics: Antibiotics like penicillin, azithromycin, or cephalosporin may be recommended to treat the underlying infection that sets off the immunological response.

2-Immunomodulatory therapy: In some circumstances, it may be necessary to suppress or regulate the immune system in order to stop the autoimmune reaction. Steroids, plasma exchange, and intravenous immunoglobulin (IVIG) use are examples of this.

3-Cognitive-behavioral therapy (CBT): CBT has the potential to be helpful in treating the mental health issues related to PANDAS, such as anxiety and compulsive behavior.

4-Supportive care is important because PANDAS syndrome can be upsetting for both parents and children. Some of the stress and worry related to the disorder might be reduced with the use of emotional support and information about the condition.

5-Treatment of co-existing conditions: The child will receive the proper care if they have any additional underlying conditions, such as ADHD or depression.

It is significant to remember that prompt diagnosis and treatment are essential for preventing PANDAS syndrome complications and long-term repercussions.

In some circumstances, symptoms might continue in spite of treatment, necessitating long-term symptom management for the child. To ensure the child’s general wellbeing, follow-up treatment and regular observation are crucial.

How can PANDAS syndrome be avoided?

Unfortunately, because the precise origin of PANDAS syndrome is yet unknown, there is presently no treatment to prevent it. The risk of having PANDAS syndrome may be decreased by taking measures to prevent infections, such as maintaining excellent cleanliness, as it is thought to be associated to some diseases. Working closely with your child’s doctor to treat symptoms and stop new episodes if PANDAS has already been diagnosed in your child may also be beneficial.

What is a child with PANDAS syndrome’s prognosis?

The severity of symptoms, age of onset, and the promptness of diagnosis and therapy all affect a child’s prognosis for PANDAS syndrome. While some children with PANDAS syndrome could only have minor symptoms that go away quickly with therapy, others might have more serious and persistent symptoms.

In general, higher outcomes are linked to early diagnosis and treatment. The majority of kids with PANDAS syndrome react favorably to treatment, which frequently entails psychosocial and behavioral interventions along with antibiotics and/or immunomodulatory therapy. However, despite receiving treatment, some kids may still experience relapses or persistent symptoms, which can be stressful and difficult for the kid and their family.

To help manage their symptoms and enhance their quality of life, children with PANDAS syndrome should get regular monitoring and support from healthcare practitioners, particularly mental health specialists. Many kids with PANDAS syndrome can have happy, fulfilling lives with the right care and assistance.