Understanding PANS and PANDAS: Sudden-Onset Neuropsychiatric Disorders in Children

PANS and PANDAS

PANS (Paediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are related conditions that involve a sudden and acute onset of intense and often debilitating symptoms, which can include obsessive-compulsive behaviours, tics, and other neuropsychiatric manifestations in children. This condition is distressing and bewildering for the children and their families, particularly of not promptly recognised an treated.

PANDAS is a subset of PANS, specifically triggered by streptococcal (strep) infection such as strep throat. An autoimmune response causes inflammation in the brain, leading to the abrupt presentation of neuropsychiatric symptoms. Children with PANDAS may exhibit sudden, severe OCD behaviours, motor or vocal tics, and a decline in academic performance.

PANS, in Hong Kong, is usually triggered by MP (Mycoplasma Pneumoniae). The sudden onset is similar to PANDAS, including OCD, tics, anxiety, mood swings, and changes in school performance. In general tics are less of a feature of PANS.

Both Strep and MP can be intracellular, which causes an autoimmune reaction leading to inflammation of the basal ganglia of the brain, a type of neuroinflammation.

Medical treatment targets the inflammation using NSAID’s and other anti-inflammatories, my preferred anti-inflammatory is Low Dose Naltrexone. Some children need Intravenous Immunoglobulin / IVIG which requires hospital admission. It is also necessary to treat the underlying infection which may require a relatively long course of antibiotics, often Doxycycline.

PANS/PANDAS is becoming increasingly recognised with much of the research being carried out at Yale and Stanford. The Pandas Physicians Network is an excellent source of information on diagnosis and treatment and has a list of research papers.