Posted: June 14th, 2023

PANDAS Syndrome: A condition at the root of many childhood behavioral disorders

PANDAS Syndrome: A condition at the root of many childhood behavioral disorders

PANDAS Syndrome is a rare and controversial condition that affects some children after they get a streptococcal infection, such as strep throat or scarlet fever. PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. It is characterized by sudden and severe changes in behavior, mood, and movement that resemble obsessive-compulsive disorder (OCD), Tourette syndrome, or other neuropsychiatric disorders.

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The exact cause and mechanism of PANDAS are not well understood, but some researchers believe that it is due to an abnormal immune response to the strep bacteria. The immune system produces antibodies that mistakenly attack the brain, especially the basal ganglia, which is involved in regulating emotions, impulses, and motor skills. This leads to inflammation and dysfunction in the brain, resulting in the onset or worsening of neuropsychiatric symptoms.

The symptoms of PANDAS usually appear four to six weeks after a strep infection and tend to worsen rapidly within days. They may include:

- Obsessive, compulsive, and repetitive behaviors, such as washing hands, checking things, or counting
- Separation anxiety, fear, and panic attacks
- Incessant screaming, irritability, and frequent mood changes
- Emotional and developmental regression
- Visual or auditory hallucinations
- Depression and suicidal thoughts
- Tics and unusual movements
- Sensitivities to light, sound, and touch
- Deterioration of small motor skills or poor handwriting
- Hyperactivity or an inability to focus
- Memory problems
- Trouble sleeping
- Refusing to eat, which can lead to weight loss
- Joint pain
- Frequent urination and bedwetting

Not all children with PANDAS have all of these symptoms, but they usually have a combination of several physical and psychological symptoms that interfere with their daily functioning and quality of life.

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The diagnosis of PANDAS is based on clinical criteria that include:

- The presence of OCD or tics or both
- The onset or exacerbation of symptoms following a strep infection
- The episodic course of symptoms that fluctuate in severity
- The association of symptoms with neurological abnormalities, such as motor hyperactivity or choreiform movements
- The onset of symptoms before puberty

There is no definitive test for PANDAS, but some tests may help support the diagnosis or rule out other conditions. These tests may include:

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- Throat culture or rapid antigen test to detect strep infection
- Blood tests to measure strep antibodies (anti-streptolysin O or anti-DNase B)
- Brain imaging (MRI or PET scan) to look for signs of inflammation or damage in the basal ganglia
- Neuropsychological testing to assess cognitive, emotional, and behavioral functioning

The treatment of PANDAS aims to address both the strep infection and the neuropsychiatric symptoms. The treatment options may include:

- Antibiotics to eradicate the strep bacteria and prevent recurrence of infection
- Anti-inflammatory drugs (such as ibuprofen) or steroids (such as prednisone) to reduce inflammation in the brain
- Immune therapies (such as intravenous immunoglobulin or plasmapheresis) to remove harmful antibodies from the blood
- Psychiatric medications (such as selective serotonin reuptake inhibitors or antipsychotics) to manage OCD, tics, anxiety, depression, or other symptoms
- Cognitive-behavioral therapy (CBT) to help children cope with their thoughts and behaviors and learn strategies to reduce their distress
- Family therapy to provide education and support to parents and siblings and improve communication and problem-solving skills

The prognosis of PANDAS varies depending on the severity of symptoms, the response to treatment, and the frequency of strep infections. Some children may experience a complete remission of symptoms after treatment, while others may have residual or recurrent symptoms that require ongoing management. Some factors that may improve the outcome are early diagnosis and treatment, prevention of strep infections through hygiene measures or prophylactic antibiotics, and regular follow-up with a multidisciplinary team of health professionals.

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PANDAS Syndrome is a challenging condition that can have a significant impact on children's physical, mental, emotional, and social development. However, with proper diagnosis and treatment, many children can recover from their symptoms and lead normal and fulfilling lives.

References:

[1] Healthline. (n.d.). PANDAS Syndrome: Symptoms, Causes, Diagnosis, and Treatment. Retrieved from https://www.healthline.com/health/pandas-syndrome

[2] Cleveland Clinic. (n.d.). PANDAS Syndrome: What It Is, Causes, Symptoms & Treatment. Retrieved from https://my.clevelandclinic.org/health/diseases/23553-pandas-syndrome

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[3] Verywell Health. (2023, August 30). How Serious Is PANDAS Syndrome? Retrieved from https://www.verywellhealth.com/pandas-syndrome-5217633

[4] MSN. (n.d.). Expert Answers on PANDAS Syndrome. Retrieved from https://microsoftstart.msn.com/en-us/health/ask-professionals/expert-answers-on-pandassyndrome/hp-pandassyndrome?questionid=f7il17in&type=condition&source=bingmainline_conditionqna

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