Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) occur after an infection, most commonly a strep infection. Brain inflammation occurs when the body’s immune system mistakenly attacks healthy brain cells, leading to autoimmune processes that affect central nervous system function. An affected child generally has a sudden, dramatic change in personality, displayed as obsessive-compulsive disorder (OCD), anxiety, motor tics or other abnormal movements, personality changes, decline in math and handwriting abilities, sensory sensitivities, restrictive eating and more.
The severity of symptoms and the onset of PANDAS/PANS can vary from child to child, but the symptoms usually present suddenly and intensely. Symptoms can get better and then get worse again, presenting in what’s known as an episodic manner.
It is important to note that strep does not cause PANDAS; it’s an associated trigger, just like any and all bacterial and viral infections can be. There is a difference between a trigger and a cause, a fact that is often overlooked when dealing with PANDAS/PANS. The cause of PANDAS/PANS is a hyper-reactive immune system, and that’s where the focus must be if recovery is the goal.
In addition, most kids with PANDAS/PANS experience an acute flare-up from various infections, including viral, bacterial, fungal, and microbial. This is further evidence that PANDAS/PANS is caused from an autoimmune response rather than from strep alone. Because the immune system has been dis-ordered to be hyper-reactive and to “over attack” anything it deems a threat, many PANDAS/PANS symptoms can be triggered by diet, personal care products, and lifestyle choices unrelated to strep. Anything the immune system perceives as toxic or a threat will become the trigger that will unleash a wave of killer T cells in a disordered attack of the basal ganglia of the brain.
Following is an expanded list of ways symptoms can persist together:
Obsessive-Compulsive Disorder (OCD): OCD can manifest in different ways in young children. Learn more here.
Restrictive Eating: This includes selective eating and food refusal. There can be a variety of reasons why the child experiences this, including contamination fears, sensory sensitivities, trouble swallowing, fear of vomiting or weight gain and more. If restrictive eating results in severe weight loss, call your provider immediately.
Tics: Tics are repetitive movements or sounds that can be difficult for a child to control. Motor tics can include eye-blinking, head-jerking, shoulder-shrugging, nose-twitching and facial grimacing. Some motor tics are a series of movements performed in the same order. Vocal tics can include grunting, humming, throat clearing, coughing or repeating words or phrases. Some children are able to suppress tics temporarily, but doing so can cause extreme discomfort. Relief comes through performing the tic.
Emotional Lability: Emotional lability includes not being able to control one’s emotional response, such as uncontrollable crying or laughing. This is a neurological symptom.
Irritability and Aggression.
Behavioral/Developmental Regression: Loss of communication and social skills (i.e., baby talk, sucking fingers, chewing on clothing).
Deterioration in School Performance: This includes deterioration in math skills, inability to concentrate, difficulty retaining information and school refusal. School performance can also be a result of another contributing symptom, such as OCD or severe separation anxiety.
Changes in Handwriting: This includes margin drifts and legibility.
Sensory Sensitivities: This can include being sensitive to touch, sounds and noise. Simple touches may feel like they are hurting. For example, being unable to tolerate the way socks feel or the texture or temperature of certain foods. Sensory processing problems can also cause difficulty in finding an item when it is among a vast selection of items. For example, a child may have a hard time finding a shirt in a full dresser or finding words in a word search.
Somatic Signs: This includes sleeping difficulties, enuresis, frequent urination and bed-wetting.
Severe Separation Anxiety: Separation anxiety in an older child will present differently. For example, a child may be unwilling to leave the house or their bedroom.
Hallucinations: This includes both visual and auditory hallucinations.
Fight or Flight Response: This can be displayed in various ways, like running from parents or extreme fear responses when an event is perceived as stressful and frightening.
Dilated Pupils (mydriasis): This can be intermittent during emotional outbursts.
Rheumatic Pain of Joints.
Urinary Problems: This includes daytime/nighttime wetting accidents or frequent urination.