PANS and PANDAS: Understanding the Causes, Symptoms, and Treatment

Most individuals know that it’s important to treat strep throat. If it remains untreated, it can eventually lead to rheumatic heart disease or congestive heart failure. But that’s not all. There are several mental health consequences that most people are unaware of, and they can greatly impact a child’s life.

Look at Henry, for example. At age 10, Henry was struggling with anxiety, depression, ADD/ADHD, and Tourette’s (a tic disorder). He was taking three psychiatric medications to cope with these mental health conditions.

His parents, who were going through a divorce, initially blamed his symptoms on the family stress. But his grandfather had been a patient at Amen Clinics, and he encouraged them to schedule a visit for Henry to get a brain SPECT scan. That brain scan revealed something Henry’s previous physicians had never considered: PANS/PANDAS.

WHAT IS PANS/PANDAS?

Over two decades ago, the National Institute of Mental Health (NIMH) issued a report saying that strep throat could cause the sudden onset of OCD and Tourette’s in kids, adolescents, and teens. They called this new syndrome pediatric autoimmune neuropsychiatric disorders associated with strep (PANDAS).

Neuroscientists eventually realized that strep throat is not the only infectious disease that can lead to mental health issues. Because of this, they began labeling the condition PANS (pediatric acute-onset neuropsychiatric syndrome). The onset of this syndrome can occur rapidly.

According to Dr. Susan Swedo at the National Institute of Mental Health, “Parents will describe children with PANS as overcome by a ‘ferocious’ onset of obsessive thoughts, compulsive rituals, and overwhelming fears. Clinicians should consider PANS when children or adolescents present with such acute-onset of OCD or eating restrictions in the absence of a clear link to strep.”

SIGNS AND SYMPTOMS OF PANS/PANDAS

Henry’s symptoms are some of the most common signs of PANS/PANDAS. However, it’s important to understand that this condition can cause a wide variety of emotional and behavioral symptoms, such as:

• Obsessive thoughts and compulsive behaviors (commonly seen in OCD)
• Severe anxiety
• Panic attacks
• Phobias
• Attention problems and/or hyperactivity (commonly seen in ADD/ADHD)
• Tics (motor or vocal)
• Restrictive eating habits
• Oppositional behavior (commonly seen in oppositional defiant disorder or ODD)
• Depression or moodiness
• Aggression or anger
• Sensory sensitivities 

In general, PANS/PANDAS symptoms begin suddenly and do not resolve on their own.

PANS/PANDAS AND THE BRAIN

Functional brain-imaging shows that PANS/PANDAS affects the way the brain functions. SPECT is a functional brain-imaging technology that measures blood flow and activity in the brain. It shows areas of the brain with healthy activity as well as areas with underactivity or overactivity.

Henry’s SPECT scan revealed overactivity throughout his brain, a pattern that is consistent with inflammation. Additional testing confirmed that the youngster had Lyme disease as well as PANDAS.

Healthy Active SPECT Scan

An “active” SPECT scan shows the areas of the brain with the most activity, which are seen in white in this image. In the healthy brain, the most active area is in the cerebellum at the back/bottom part of the brain.

Henry’s Active SPECT scan    

Overall increased activity, looking inflamed

INFECTIONS AND MENTAL HEALTH PROBLEMS

PANS/PANDAS can be caused by numerous infections, including:

• Strep throat
• Borrelia burgdorferi (Lyme disease)
• Mycoplasma pneumoniae (walking pneumonia)
• Herpes simplex
• Common cold
• Influenza
• Mononucleosis
• Epstein-Barr

Emerging research suggests that infection with COVID-19 may also trigger the onset of PANDS/PANDAS or may worsen existing symptoms.

In a fascinating study from researchers in Denmark, patients who had infections had a higher incidence of schizophrenia and affective disorders, such as clinical depression. This occurred even in those people who didn’t require hospitalization.

The researchers didn’t know if the mental health issues were caused by the infections or by taking antibiotics. Infections attack brain tissue and antibiotics alter gut bacteria, both of which increase the risk of mental health problems.

HEALING FROM PANS/PANDAS

If a child has PANS/PANDAS, there is hope for healing. First, it’s critical to get tested for common infections. In addition, brain imaging with SPECT scans can offer invaluable information that leads to a more accurate and complete diagnosis.

Seeing an integrative medicine (also called functional medicine) physician can be helpful in order to diagnose and effectively treat any underlying infections.

Medical treatments for PANS/PANDAS include:

• Medications: Antibiotics, anti-inflammatory medications, and steroids may be prescribed.
• Intravenous immunoglobulin (IVIG): IVIG is a treatment in which human antibodies are delivered intravenously. In one study published in The Lancet, this treatment resulted in a 45% reduction in symptom severity in children with PANS/PANDAS after just one month.
• Plasmapheresis: This treatment involves separating plasma from blood with a machine then returning the blood to the patient. According to the same study from The Lancet mentioned above, plasma exchange led to a 58% decrease in the severity of PANS/PANDAS symptoms.

Natural treatments for PANS/PANDAS include:

• Elimination diet: Research shows that poor gut health may play a role in PANS/PANDAS. For this reason, supporting gut health is crucial. For 30 days, eliminate the following potential allergens from your child’s diet: gluten, dairy, sugar, soy, corn, artificial dyes, additives, and preservatives. See if there is any improvement in their symptoms. Then gradually reintroduce foods one by one to see if they trigger reactions.

• Avoiding environmental toxins: Experts suggest that mold, chemicals in common household cleaners, smoke, volatile organic compounds (VOCs) in rugs and carpeting, and other toxins found in homes can contribute to PANS/PANDAS symptoms. Removing any toxins from your home may benefit a child with this condition. For example, avoid harsh chemical cleaners, choose personal care products that are free of toxic chemicals, and consider removing carpeting or rugs, if necessary.
• Stress-management techniques: Teaching a child with PANS/PANDAS to self-soothe can be a powerful tool. Specific techniques that calm stress include deep belly breathing, listening to calming music, prayer or meditation, and warming the hands with the mind. One of the easiest stress busters for kids is laughter. To spark laughter, watch a comedy or look at a few funny videos online with them.

• Nutraceuticals: Research shows that kids with PANS/PANDAS may be lacking in key nutrients, so it’s important to take a multivitamin/mineral. As an example, a 2018 study found reduced levels of vitamin D in children with the syndrome. Taking a vitamin D supplement to optimize levels is recommended. Other supplements that support the brain and gut include omega-3 fatty acids and probiotics. 

For 10-year-old Henry, a combination of antibiotics and a brain healthy lifestyle led to major improvements. After one year, Henry’s father said he acquired four grade levels of learning and seemed like a completely new child.

Henry was able to stop taking all his psychiatric medications. For Henry and his family, getting a SPECT scan was the difference maker in finding an accurate diagnosis and a targeted treatment plan that worked.

OCD, anxiety, tics, and other mental health issues associated with PANS/PANDAS can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.