PANDAS Syndrome – Causes, Symptoms, Treatment, and Prevention

Children and infections go hand-in-hand. They are more susceptible to catching infections as they play outside, go to school, and meet other kids. One common infection found in children is strep infection. Strep infections generally are transmitted in children when they come in contact with an infected person. They get strep infection when they breathe in the air contaminated with nasal secretions or droplets of the infected person’s saliva or touch any surface and then touch their face.

Usually, strep infections are mild and may cause just a sore throat or minor skin infection. However, it can lead to severe throat infection, rheumatic fever, and scarlet fever in some cases. Some kids recover completely from a strep infection, but some develop sudden physiological or physical, or both symptoms. The symptoms start suddenly within a few weeks of strep infection and rapidly worsen within a short time. These are symptoms of PANDAS syndrome. Continue reading to know about PANDAS syndrome, its causes, symptoms, treatment, and preventive measures.

What Is PANDAS or PANS Syndrome?

PANDAS syndrome or PANS disease is the acronym for Pediatric Acute Neuropsychiatric Syndrome. This disorder is mostly associated with streptococcus pyogenes infections. PANDAS syndrome is characterized by sudden and often major changes in behavior, personality, or movement in kids after a strep infection. In extreme cases, PANDAS syndrome rage is also seen in children after a strep infection.

PANDAS syndrome is a rare condition affecting one in 200 children. Due to its rarity and common symptoms associated with it, doctors may sometimes miss to diagnose it or attribute the symptoms to some other disorder.

Causes of PANDAS Syndrome 

As PANDAS syndrome is not a specific disease but rather a group of symptoms, its exact cause is unclear. Group A strep bacteria is considered the major cause of PANDAS syndrome. Many different infections such as strep throat, rheumatic fever, and certain skin infections are caused by Group A Streptococcus bacteria. These infections mimic the child’s body healthy cells to spread. The body finally recognizes them, produces antibodies to kill them. Sometimes these antibodies may also attack the child’s body’s healthy tissues, including those in the brain. Thereby, Group A strep bacteria causes PANDAS syndrome. Hence, most children with PANDAS syndrome have a prior history of strep infection. 

Some children having PANDAS syndrome may have a genetic predisposition that can trigger PANDAS syndrome.

Sign and Symptoms of PANDAS Syndrome

Signs and symptoms of PANDAS syndrome start suddenly in about 4 to 6 weeks after pyogenes infection. The PANDAS syndrome symptoms can be grouped into two categories- psychological symptoms and physical symptoms. Though the symptoms are grouped into two groups, the child will show a mix of symptoms and not just symptoms from one group. The PANDAS syndrome symptoms are:

Psychological Symptoms

• Hyperactivity, fidgeting, or inattention
• OCD (Obsessive-compulsive disorder) and repeated activities
• Clingy behavior or separation anxiety, where the child insists on always being close to the parents or caregiver
• Abrupt mood changes such as sadness, irritability, or in extreme cases, suicidal thoughts.
• Hallucinations 
• Terror-stricken behavior
• Learning disabilities like short-term memory issues

Physical Symptoms

• Tics (unusual or uncontrollable jerky movements)
• Sudden changes in motor skills like handwriting change
• Joint pains
• Frequent urination in the daytime, night-time bed-wetting or both
• Sleep disturbances
• Weight loss and eating problems
• Sensitivity to sound, light, or touch

Risks and Complications of PANDAS Syndrome

After a strep infection, PANDAS syndrome is a disorder generally developed in children between 3 and 12 years of age. However, in rare cases, it can occur in adolescents too. Generally, children with weak immune systems or comorbidities/genetic predisposition or who repeatedly have strep infection are at higher risk of having PANDAS syndrome. Children with PANDAS are at higher risk of developing OCD (obsessive-compulsive disorder), Tourette syndrome, and tic disorders. Complications of PANDAS syndrome result in the child’s inability to function normally in social situations or at school. When not treated or not completely treated, PANDAS syndrome symptoms may worsen and result in permanent cognitive damage in the child. In some children, PANDAs syndrome may become a chronic autoimmune condition. 

How Is PANDAS Syndrome Diagnosed?

The specific test for PANDAS syndrome is not there. It is diagnosed clinically. The doctor asks for the history of the child’s illness and does a physical examination to diagnose PANDAS syndrome. Some common criteria for diagnosing PANDAS syndrome are:

• Recent Streptococcal aureus or strep infection in the child or another similar infection such as scarlet fever
• The child is of age 3 years to puberty
• Presence of OCD (obsessive-compulsive disorder) symptoms, a tic disorder, oppositional behavior, clingy behavior, or ADHD(attention deficit hyperactivity disorder) symptoms
• Abrupt onset of OCD (obsessive-compulsive disorder) symptoms or a tic disorder or oppositional behavior or ADHD symptoms or variation in symptom intensity after strep infection in the child
• The child has abnormal or uncontrollable jerky movements, anxiety, sudden personality change, or inability to write or do math

Treatment of PANDAS Syndrome 

As PANDAS syndrome is a group of symptoms, the treatment is not restricted to medications and includes therapy. The treatment of PANDAS syndrome may include:

1. Medication

Antibiotics will be given to the child to cure Streptococcus bacterial infection. Medications also are given to ease the symptoms of OCD and tics. Initially, the doctor may prescribe a low dose medication as the kids with PANDAS syndrome may be sensitive to popular medication like SSRI (selective serotonin reuptake inhibitor). They will gradually increase the medication dosage after constantly monitoring the symptoms. 

2. Therapy

Behavior therapy may be recommended for the child to cope and help manage obsessive behavior or anxiety. It helps the child to develop coping strategies to manage the psychological symptoms. 

3. Experimental Therapies 

When medication doesn’t work or other treatments aren’t effective, experimental therapies such as immunoglobulin therapy and plasma exchange can work on PANDAS syndrome. As these experimental therapies can have side effects, the doctors generally recommend them in severe PANDAS syndrome cases. 

4. Family Therapy 

Family therapy helps prepare family members, so the child with PANDAS syndrome can support the child during the taxing time of treatment. The child affected with PANDAS syndrome is undergoing physical and psychological changes; they need all the support and understanding of the family members to cope with them.

5. Disability Accommodation 

Children with PANDAS syndrome may need disability accommodation at their home or school. So the parents need to prep their home and talk to the school about their child’s special needs.

Prevention of PANDAS Syndrome

As the popular adage goes, “prevention is better than cure.” So, preventing PANDAS syndrome is better than curing it with medication. Medication can cure PANDAS syndrome. However, it will take considerable time to cure it effectively. So, the easiest way to protect your children from PANDAS syndrome is the prevention of strep infections in them. Here are some tips to prevent PANDAS syndrome in your children:

• Washing their hands thoroughly before meals and after coming from playground, school, or any outside place
• Teach them not to share their items with others, such as drinking utensils, towels, clothes, etc., with others
• Instruct them to cover their mouth and nose when they sneeze or cough
• Isolate anyone in your family suffering from strep infections and make sure the children stay away from them

What Is the Outlook of PANDAS Syndrome? 

As PANDAS syndrome was not identified until the year 1988, therefore long-term studies on it aren’t available. However, it doesn’t imply that it is not completely treatable. Though, in some cases, the PANDAS symptoms may return if the child gets strep infection again. Some children respond quicker to antibiotics than others and recover without any long-term complications. In a few cases, it becomes an ongoing problem requiring periodic antibiotics or managing the infection.

Having PANDAS syndrome in a child is taxing for both the child and the parents. The sudden behavioral or personality changes are challenging. Therefore, the child needs proper medication, extra care, and support to cope with the physiological changes.

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