Understanding PANS and PANDAS: Symptoms, Diagnosis, and Treatment

Introduction

Paediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) are complex and often misunderstood conditions affecting children. These syndromes are characterised by a sudden onset of obsessive-compulsive symptoms (OCD) and other neuropsychiatric issues following infections or immune system dysfunctions.

What are PANS/PANDAS?

PANS (Paediatric Acute-onset Neuropsychiatric Syndrome)
PANS is a broad diagnosis that includes a variety of triggers leading to a sudden onset of neuropsychiatric symptoms. These triggers can include infections, metabolic disturbances, and other inflammatory reactions. The hallmark of PANS is the abrupt development of OCD or eating restrictions, accompanied by at least two additional psychiatric symptoms.
PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)
PANDAS is considered a subset of PANS and specifically involves a sudden onset of symptoms following a streptococcal infection, such as strep throat. PANDAS is characterised by the rapid development of OCD or tic disorders, along with other psychiatric symptoms, following a streptococcal infection.

Symptoms of PANS and PANDAS

Both PANS and PANDAS present with a sudden and severe onset of symptoms. Key symptoms include:
• Obsessive-Compulsive Disorder (OCD): Sudden onset of intrusive thoughts and compulsive behaviours.
• Tics: Sudden, repetitive movements or vocalisations.
• Anxiety: Generalized anxiety, separation anxiety, and panic attacks.
• Mood Changes: Depression, irritability, and emotional changes.
• Behavioural Regression: Sudden regression in behaviour, including temper tantrums and baby talk.
• Sleep Disturbances: Difficulty falling or staying asleep, and nightmares.
• Cognitive Changes: Decline in academic performance, difficulties with concentration and memory.
• Urinary Issues: Increased frequency, urgency, or bedwetting.
• Eating Disorders: Sudden food restrictions or anorexia.

Causes and Triggers

The exact cause of PANS and PANDAS is not fully understood, but they are believed to involve an abnormal immune response to infections. In PANDAS, the immune system mistakenly attacks the brain following a streptococcal infection, leading to inflammation and neuropsychiatric symptoms. PANS can be triggered by various infections (including mycoplasma pneumonia, Lyme disease, and influenza), as well as other immune-related conditions.
Diagnosis

Diagnosing PANS and PANDAS can be challenging due to their complex presentation and the need to rule out other conditions. A thorough clinical evaluation is essential, which includes:
• Medical History: Detailed history of the onset and progression of symptoms.
• Physical Examination: Comprehensive physical and neurological examination.
• Laboratory Tests: Blood tests to check for infections, immune markers, and inflammatory markers. In the case of PANDAS, a throat culture or rapid strep test may be performed.
• Psychiatric Evaluation: Assessment by a mental health professional to evaluate neuropsychiatric symptoms.

The Functional Medicine Approach to supporting children with PANS/PANDAS

Supporting children with PANS and PANDAS involves addressing the underlying cause, managing symptoms, and supporting the immune system. Key components of how we support children with PANS/PANDAS include:
1. Herbal Antimicrobials: Herbal antimicrobials can be used to prevent the recurrence of streptococcal infections.
2. Anti-Inflammatory support: Micro-immunotherapy, and herbal anti-inflammatories can help reduce brain inflammation.
3. Immunomodulatory Therapies: Micro-immunotherapy can help to modulate the immune response.
4. Anti-histamines and mast cell stabilisers: To support children with PANS and PANDAS to calm the mast cells and reduce excess histamine.

Prognosis

The prognosis for children with PANS and PANDAS varies. With early and appropriate support many children experience significant improvement in symptoms. However, some children may have relapses, particularly if they are exposed to new infections or stressors. Long-term follow-up and a multidisciplinary approach are essential for managing these conditions effectively.

Conclusion

PANS and PANDAS are complex neuropsychiatric syndromes that require a comprehensive and individualised approach to diagnosis and treatment. By addressing the underlying causes and providing holistic support, children with these conditions can achieve significant improvements in their quality of life. Awareness and understanding of PANS and PANDAS are crucial for early intervention and effective management.