PANS & PANDAS

Noticed a sudden onset of anxiety, tics or OCD-type behaviours in your child? It could be PANS - a little-known, but treatable condition.

It is estimated as many as 1 in 200 children may be affected by PANS

— Based on US research by PANDAS Network

What is PANS/PANDAS?

PANS and PANDAS are clinical diagnoses that describe a set of complex neuropsychiatric symptoms that affect children following infection:

  • PANS - Pediatric Acute-onset Neuropsychiatric Syndrome

  • PANDAS - Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections

Both PANS and PANDAS syndrome are characterised by a sudden and dramatic onset of symptoms, which can include anxiety, obsessive-compulsive behaviours (OCD), motor and vocal tics, emotional instability, and cognitive disturbances. It's crucial to note that these symptoms often appear "out of the blue," causing confusion and concern for parents and caregivers, but can often be linked to infection.

Terminology

PANS and PANDAS, while related, are distinct categories: PANS is the umbrella term that refers to cases where the sudden onset of symptoms is triggered by any variety of infections or another inflammatory trigger. PANDAS syndrome is a subcategory of PANS, and refers to cases specifically involving the sudden onset of symptoms following a streptococcal (strep) infection.

Causes and Triggers:

The exact causes of PANS are not yet fully understood. Researchers believe that abnormal immune responses triggered by various infectious agents, environmental factors, or other immune system dysfunctions play a role. Common triggers for PANS include viral or bacterial infections such as streptococcal infections, mycoplasma pneumonia, and Lyme disease but we are increasingly seeing cases following mould exposure and other environmental situations.

Signs & symptoms

The signs and symptoms of PANS/PANDAS can be wide-ranging and vary from child to child.

Some common symptoms include:

  • Sudden and severe anxiety: Children may exhibit extreme fear, panic attacks, or separation anxiety that disrupts daily life.

  • Obsessive-compulsive behaviours (OCD): Uncontrollable and distressing obsessions and compulsions that interfere with daily activities.

  • Motor and vocal tics: Repetitive, involuntary movements and sounds that may resemble Tourette's syndrome but come in a relapsing and remitting pattern.

  • Emotional instability: Mood swings, irritability, and emotional outbursts uncharacteristic of the child's previous behaviour.

  • Cognitive disturbances: Trouble with concentration, memory, and cognitive flexibility, impacting school performance.

Diagnosis & testing

Diagnosing PANS/PANDAS can be challenging due to the complexity of symptoms, the lack of awareness among the medical community, and the lack of specific laboratory tests. Healthcare professionals rely on:

  • Diagnostic Criteria: The sudden onset of symptoms, presence of neuropsychiatric issues, and a potential association with infections are key diagnostic criteria.

  • Medical History: A thorough review of the child's medical history, including recent infections or illnesses, can provide crucial insights.

  • Clinical Evaluation: A detailed evaluation of the child's symptoms and behaviors by a qualified healthcare professional is essential.

Differential Diagnosis

Diagnosis of PANS via a qualified medical doctor is a process of exclusion, which rules out other conditions that mimic PANS/PANDAS symptoms. These may include:

  • Tourette's Syndrome: Similar motor and vocal tics, but without the sudden onset of neuropsychiatric symptoms.

  • Obsessive compulsion disorder (OCD)

  • Autism Spectrum Disorder (ASD): While some symptoms overlap, children with PANS/PANDAS typically have a sudden and acute onset of symptoms, which is not typical of ASD.

  • Generalized Anxiety Disorder (GAD): While anxiety is a component of PANS/PANDAS, the sudden appearance of multiple neuropsychiatric symptoms distinguishes it from GAD.

Testing for PANS and PANDAS

To accurately diagnose PANS/PANDAS, healthcare professionals may use various tests, including:

  • Strep Infection Tests: Throat swabs and blood tests to detect recent or ongoing strep infections.

  • Blood Tests: Measuring markers of inflammation, autoantibodies, and immune system activity.

  • Neuroimaging: Brain imaging such as MRI or PET scans may be used to assess any structural or functional abnormalities.

Naturopathic approach

Conventional treatment options often include the use of antibiotics to address any underlying infections and medications including SSRIs (Selective Serotonin Reuptake Inhibitors) to manage the neuropsychiatric symptoms. While these treatments can be effective for some patients, others may not respond well or experience unwanted side effects. The quest for a natural PANDAS PANS treatment that goes beyond antibiotics and pharmaceuticals has led many to explore naturopathic alternatives.

Naturopathic Approach to PANS/PANDAS Treatment

Naturopathic medicine offers a holistic and patient-centred approach to supporting families with PANS/PANDAS, aiming to address the root causes of the disorder while promoting overall health and well-being. Kate focuses on providing natural PANDAS PANS treatment options that can complement conventional methods.

Kate’s approach to treating PANS/PANDAS focuses on:

  1. Immune Support: A core component of PANS is the immune system’s response to infection/triggers, that become misdirected and target brain tissue. Strengthening the immune system is crucial and Kate provides tailored strategies to enhance immune function and reduce the risk of symptom recurrence.

  2. Gut Health: With the gut being an important site of our immune system, gut health plays an important role in the long-term resolution of PANS.

  3. Genetics: Genetic predisposition may play a role in some cases, making certain individuals more susceptible. Kate will use nutrigenomic testing to assess a child’s capacity for antioxidant production, neurotransmitter synthesis and clearance, detoxification and nutrient status.

  4. Infections: Viral or bacterial infections, particularly strep infections, can trigger immune responses that affect the brain.

  5. Environmental Factors: Environmental triggers, such as mould, toxins or stress, can exacerbate symptoms.

  6. Nutrition: Kate recognises the impact of diet on overall health and well-being and will work with you to develop strategies that support your child's specific needs.

While every patient's journey is unique, a naturopathic approach provides a comprehensive treatment plan that aligns with your child's specific needs and reduces overwhelm for the whole family. By addressing the underlying causes and focusing on natural remedies, we aim to support the healing process and help your child achieve complete resolution from PANS/PANDAS.

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Additional resources

  1. PANS Australia Support Group - Australian based PANS/PANDAS support group

  2. ASPIRE - US PANS advocacy group

References:

  1. Swedo, S. E., Leckman, J. F., & Rose, N. R. (2012). From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS (Pediatric Acute-onset Neuropsychiatric Syndrome). Pediatric Therapeutics. Link

  2. Murphy, T. K., Storch, E. A., & Lewin, A. B. (2010). Clinical factors associated with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. Journal of Pediatrics. Link

  3. Cooperstock, M. S., Swedo, S. E., & Pasternack, M. S. (2017). Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part I—Psychiatric and Behavioral Interventions. Journal of Child and Adolescent Psychopharmacology. Link

  4. Frankovich, J., Thienemann, M., Pearlstein, J., Crable, A., Brown, K., Chang, K., ... & Swedo, S. (2015). Multidisciplinary Clinic Dedicated to Treating Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome: Presenting Characteristics of the First 47 Consecutive Patients. Journal of Child and Adolescent Psychopharmacology. Link

  5. Williams, K. A., Swedo, S. E., Farmer, C. A., Grantz, H., Grant, P. J., Doshi, V., ... & Leckman, J. F. (2020). Randomized, Controlled Trial of Intravenous Immunoglobulin for Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections. Journal of the American Academy of Child & Adolescent Psychiatry. Link

  6. Chang K, Frankovich J, Cooperstock M, Cunningham M, Latimer E, Murphy T, Pasternack M, Thienemann M, Williams K, Walter J, Swedo S. (2015). Clinical Evaluation of Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Recommendations from the 2013 PANS Consensus Conference. Journal of Child and Adolescent Psychopharmacology. Link

  7. Swedo S, Frankovich J, and Murphy T. (2017) Overview of Treatment of Pediatric Acute-onset Neuropsychiatric Syndrome. Journal of Child and Adolescent Psychopharmacology. Link

  8. Thienemann M, Murphy T, Leckman J, Shaw R, Williams K, Kapphahn C, Frankovich J, Geller D, Bernstein G, Chang K, Elia J, and Swedo S. (2017). Clinical Management of Pediatric Acute-onset Neuropsychiatric Syndrome: Part I - Psychiatric and Behavioral Interventions. Journal of Child and Adolescent Psychopharmacology. Link.

  9. Frankovich J, Swedo S, Murphy T, Dale R, Agalliu D, Williams K, Daines M, Hornig M, Chugani H, Sanger T, Muscal E, Pasternack M, Cooperstock M, Gans H, Zhang Y, Cunningham M, Bernstein G, Bromberg R, Willett T, Brown K, Farhadian B, Chang K, Geller D, Hernandez J, Sherr J, Shaw R, Latimer E, Leckman J, Thienemann M, and PANS/PANDAS Consortium. (2017). Clinical Management of Pediatric Acute-onset Neuropsychiatric Syndrome: Part II - Use of Immunomodulatory Therapies. Journal of Child and Adolescent Psychopharmacology. Link

Hi, I’m Kate

I’m a degree-qualified naturopath with a passion [or maybe obsession] for anything related to the brain: how it works, why things go wrong, and what we can do to support it.

I work with kids, from toddlers to adolescents, supporting conditions such as anxiety, PANS & PANDAS, OCD, ADHD, behavioural issues, sleep difficulties and conditions of the gut-brain axis.

I love research and science, and I want to understand deeply the how and the why of the ways our bodies work, but also respect and incorporate traditional naturopathic knowledge such as herbal medicine and functional testing when appropriate.

Outside my clinic time, I am busy being a mother to two children and two dogs, living and playing on Wurundjeri land in North Warrandyte.