PANDAS and PANS syndromes in children

PANDAS — Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection is a syndrome that combines all neuropsychiatric symptoms in children with a proven autoimmune nature and association with streptococcal infection.

PANS — Pediatric Acute-onset Neuropsychiatric Syndrome is a syndrome also characterized by neuropsychiatric disorders in children, but for which the etiology (viral, bacterial, or tumor-related) is later specified.

The main etiologic factor of PANDAS syndrome is group A beta-hemolytic streptococcus, which causes angina and scarlet fever. It can persist in the body even outside the acute infection, creating conditions for frequent relapses, which in turn increases the risk of autoimmune damage. The immune system attacks its own tissues, because the streptococcus is characterized by so-called "antigenic mimicry" — the similarity of some bacterial proteins to the body's own proteins.

PANS syndrome is generally similar to PANDAS but can be caused by other factors (herpesviruses, toxoplasmosis, M. pneumoniae, borrelia, influenza, tumors, etc.).

PANS is a pediatric neuropsychiatric syndrome with an acute onset. It is characterized by the onset of obsessive-compulsive disorder (OCD), tics, eating disorders, and other changes. PANDAS is considered a subtype of PANS, but the main difference is that it develops against a streptococcal infection and is most commonly diagnosed in children aged 6-8 years. PANS/PANDAS syndrome affects patients between the ages of 3 and 12 years and is most commonly diagnosed in children aged 6-8 years, with 2.6 times as many boys than girls affected.

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Symptoms

Among distinctive features of PANS/PANDAS syndromes in comparison to other neuropsychiatric disorders is the acute onset of the clinical picture - emerging behavioral and learning disorders against a background of complete well-being.
    • Severe anxiety.
    • Motor hyperactivity, abnormal movements, tics.
    • Sensory disturbances (sensitivity to light or sound, distortion of visual perception, and sometimes visual or auditory hallucinations).
    • Concentration problems and loss of learning ability, especially in math and visual-spatial areas.
    • Rapid urination or an episode of urinary incontinence in adults.
    • Irritability, sometimes with aggression toward relatives.
    • There can also be a sudden onset of depression with suicidal thoughts.
    • Sudden regression in development, including tantrums, "baby babbling," finger sucking, and deterioration in handwriting.
    • Parents can usually remember a day when their child's behavior changed.

However, it should be remembered that the above symptoms are also observed in adults, and panic attacks are also characteristic of them. 

Many scientists and practicing physicians - neurologists and psychiatrists - have pointed out that a variety of psychiatric disorders occur as a result of an infectious disease or as a result of antibodies to brain tissue in adults. Therefore, the application of the PANS/PANDAS diagnostic criteria in adults is now the most pressing issue.

If even some of these symptoms occur, a doctor's consultation is required.

Reasons

PANS/PANDAS syndrome develops as a result of an abnormal immune response to a bacterial or viral infection. As a result of the malfunction, the body produces autoimmune antibodies that have a negative effect on the brain.
To date, it has not been possible to establish exactly why such changes occur because neuropsychiatric disorders do not always accompany infectious pathologies.

The risk of developing PANDAS syndrome is thought to be increased if the child has the flu, mycoplasma pneumonia, or other upper respiratory tract infections, but also experiences severe stress or psycho-emotional distress. The development of PANDAS syndrome is only possible when infected with streptococci.

Diagnostic methods

As part of the diagnosis of PANS/PANDAS syndrome, a medical history is taken and a comprehensive examination is performed. The VIVERE CLINIC performs the full range of necessary laboratory tests, which not only provide an accurate diagnosis but also establish the cause, such as confirming the infectious origin of the neuropsychiatric disorders.

In PANS/PANDAS syndrome, the electroencephalogram (EEG) has specific signs that are not always visible to untrained specialists.
If the cause of the disease cannot be determined, but there is a clinical picture of PANS/PANDAS syndrome, a specific test to confirm the diagnosis, the Cunningham Panel™, must be done.
Madeleine Cunningham, Ph.D., professor of microbiology and immunology at Oklahoma State, has developed a special PANS/PANDAS diagnostic panel that diagnoses specific autoimmune brain enzyme disorders and the presence of antibodies to specific neuronal structures - Cunningham Panel™. VIVERE Neuroimmunology Clinic is an official representative of Moleculera labs, which screens these antibodies. This highly specific assay has proven to be a reliable diagnostic method for the diagnosis of PANS/PANDAS.

The diagnosis of PANS/PANDAS syndrome is made based on the following criteria:

  1. Presence of obsessive-compulsive disorder or tics.
  2. Onset between the ages of 3 years and puberty (may occur in adults).
  3. Acute onset with the unstable improvement of the condition. The disease usually begins a few weeks after the infection, symptom severity reaches a maximum within 1-2 days and slowly declines with periodic worsening of the condition.
  4. Chronological association with streptococcal or other infection.
  5. Other neurological disorders (hypermotor disorders, hyperkinesias).

Prevention

To reduce the risk of developing PANDAS and PANS syndromes in children, infectious diseases must be treated promptly. An important factor is the elimination of foci of chronic infection in cohabiting relatives.
If the child has frequent sore throats and tonsillitis, timely treatment by an ENT doctor is recommended. If the therapy does not give the desired result, it may be necessary to remove the tonsils.

Treatment

At the VIVERE CLINIC Medical Center, doctors take a comprehensive approach to treatment. It is aimed at eliminating the cause, so in most cases, it includes taking etiotropic therapy, immunoglobulins, (inpatient) monoclonal antibodies and other drugs may also be used.
Clinic specialists also use cognitive-behavioral therapy and other techniques that help get rid of autoimmune neuropsychiatric disorders.

Recommendations

If you notice neurological disorders in your child after a sore throat or other bacterial or viral illness, you should make an appointment at the VIVERE CLINIC medical center. Only experienced specialists will be able to determine the exact cause of the symptoms after a comprehensive examination. Early treatment helps not only to get rid of the clinical signs of the pathology but also to prevent possible complications, in particular severe mental disorders.

Cost

The price of diagnosis and treatment of PANS/PANDAS syndrome in children at the VIVERE CLINIC is determined individually in each case, depending on the examinations performed, the need for additional examinations and the treatment program, and its duration. Please contact the clinic manager for a consultation to clarify the cost of services. You may make an appointment over the phone or through our online form.
Your child can also undergo a specialized check-up for PANDAS syndrome, which, in addition to special laboratory tests, includes consultations with a child psychiatrist and immunologist.

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