PANDAS – A Guide for Physicians and Parents

Strep throat is one of those common childhood illnesses that can usually be treated with a simple round of antibiotics, but sometimes it can have greater ramifications for the child. Some children can develop sudden physical and psychiatric symptoms a few weeks after infection, a condition called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).

While the true prevalence of PANDAS is not known, the U.S. PANDAS Network estimates that one in 200 children are affected, typically between the ages of four and nine years old.¹ In this blog, we will take a look at the symptoms of PANDAS, how to diagnose PANDAS, and what treatments are available.

Symptoms of PANDAS

The onset of PANDAS symptoms is usually about four to six weeks after infection with strep. These include behaviors similar to obsessive-compulsive disorder and Tourette’s, which can then worsen within a couple of days.²

There are both psychological and physical symptoms that manifest with PANDAS. This is an episodic condition, which means that symptoms may disappear for a while and then recur later, especially with another strep infection.³

These symptoms include the following⁴:

Obsessive, compulsive, and repetitive behaviors
Separation anxiety, fear, and panic attacks.
Incessant screaming, irritability, and frequent mood changes
Tics and unusual movements,
Sensitivities to light, sound, and touch
Hyperactivity, inability focus, and memory problems
Joint pain, depression, and sleep problems
Lack of interest in food, leading to weight loss
Between three years old and puberty
Sudden onset or worsening of already existing symptoms, with symptoms becoming more severe for periods of time
Presence of obsessive-compulsive behaviors, tic disorder, or both
Evidence of other neuropsychiatric symptoms, such as hyperactivity, mood changes, developmental regression, or anxiety
Previous or current strep-A infection, confirmed by a throat culture or blood test

Diagnosing PANDAS

Because there’s no specific test to identify it, and the symptoms can indicate other disorders, PANDAS is not easy to diagnose. If there are any unusual symptoms after the strep infection, make an appointment with your pediatrician to conduct a strep test or a blood test to rule out anything else.⁵

According to Healthline, diagnosing PANDAS requires “a careful medical history and physical examination.” The diagnosis has to meet a certain level of criteria to qualify for PANDAS⁶:

Treating PANDAS

PANDAS treatment involves addressing both the physical and psychiatric symptoms, starting with ensuring that the strep infection is completely gone.⁷

Early treatment for PANDAS is ideal because it can minimize future relapses, which can increase the duration and intensity of symptoms down the road. If treated early, children with PANDAS can go into remission entirely. If left untreated, PANDAS can cause permanent debilitation and can even become encephalitic. ⁸

Treating PANDAS can address different aspects of the disease – antibiotics can help control or reduce symptoms, while other treatments like intravenous immunoglobin replacement (IVIG) therapy can help to address any underlying infections and autoimmune reaction that causes PANDAS. IVIG, which is an off-label use, involves the use of an immunoglobulin solution to treat immune deficiencies, which some physicians and researchers believe can address the encephalitic-like inflammation.⁹

PANDAS Outlook

The prognosis for children with PANDAS depends on several factors, most notably how quickly they were diagnosed. ¹⁰ Any delay in diagnosis allows symptoms to settle in and become harder to treat. While remission periods are fairly common, there can be flare ups of symptoms that are shorter, less intense, and more manageable as children receive appropriate treatment.

This is a challenging condition, but it’s important to know that complete recovery is possible with early diagnosis and proper treatment. Outside of medical treatment, there are many ways that families can create a supportive, peaceful environment that helps their child manage PANDAS symptoms. It’s important to establish routines and maintain consistent daily schedules to provide stability during the unpredictable flares of symptoms. Predictability is a strong ally in these situations.

Being emotionally supportive helps the child to understand that their symptoms are not their fault and that treatment can help them. Any reassurance that providers or parents can provide a supportive environment for healing and understanding. Family counseling and even support groups are great for additional resources.

Educational support is also important because it encourages transparency between parents and teachers about the child’s condition to ensure that they understand the full scope of the diagnosis and the nature of these behavioral changes.¹¹

PANDAS is a challenging condition for children to be diagnosed with, but it’s important to remember that there is hope with an early diagnosis and comprehensive treatment plan. With an OSOM Strep A Test from SEKISUI Diagnostics, providers can conduct strep tests to determine further a diagnosis for children experiencing these symptoms.

References