Pandas Syndrome, Symptoms, Treatment, Prognosis & Complications

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) facts

• PANDAS is an acronym for “pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections.”
• It is a fairly recently described disorder (1990s).
• An autoimmune response to a streptococcal infection is the leading theory as to the cause of PANDAS.
• It is diagnosed if there is a history of abrupt development of a number of neuropsychiatric symptoms associated with a group A streptococcal (the type of bacteria causing strep throat) infection.
• Medication and cognitive behavioral therapy (CBT) are the primary treatments for PANDAS.

What is PANDAS?

PANDAS is an acronym that refers to “pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections.” It is diagnosed clinically after a patient develops a number of behavioral and physical symptoms following a streptococcal infection (for example, strep throat, sinusitis, cellulitis, or scarlet fever).

Are PANDAS common?

PANDAS Syndrome is a rare condition. It is believed that approximately one in 2,000 children are affected, though the diagnosis may be overlooked due to some of the common symptoms associated with the disease. In fact, there are some researchers who recommend categorizing PANDAS as a subset of other disorders, which includes similar neuropsychiatric symptoms called CANS (childhood acute neuropsychiatric symptoms) or PANS (pediatric acute-onset neuropsychiatric syndrome).

What is the history of PANDAS?

PANDAS was described in the late 1990s after investigators identified a subgroup of children who developed a sudden onset of obsessive-compulsive disorder (OCD) symptoms, vocal and motor tics, and other behavioral changes. They identified that there was a common association in these children, and that was identified as a recent or active infection with a beta-hemolytic Streptococcus, the bacteria that causes strep throat. Researchers also identified a number of other infectious agents, known to cause significant auto-inflammatory reactions associated with neuropsychiatric symptoms, including influenza, varicella, and even Borrelia burgdorferi (Lyme disease), but the diagnosis of PANDAS is limited to streptococcal infections.

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What is the treatment for PANDAS?

First-line treatments for PANDAS include cognitive behavioral therapy (CBT) and medication, depending on the breadth and severity of symptoms. Currently, the primary medical therapy is focused on controlling the OCD symptoms, and therefore selective serotonin reuptake inhibitor (SSRI) medications are frequently used (fluoxetine [Prozac] and others). The other more acute measure in treating PANDAS is treating the strep infection associated with the symptoms. Antibiotics are the treatment of choice to eradicate an active strep throat infection. Your doctor may prescribe penicillin, amoxicillin (Amoxil), azithromycin (Zithromax), or another antibiotic. For severe and refractory symptoms, the use of other treatments aimed at controlling the immune response have been studied and found to be effective. These include the use of intravenous immunoglobulin, steroids, and plasmapheresis (plasma exchange therapy, in which blood is withdrawn from an individual and the liquid portion is removed and replaced and the blood is transfused back into the individual). For both treatments, the “offending” antibodies are removed. Steroids are less effective, because, although symptoms decrease during the treatment, they return soon after stopping the drug. More studies are needed to be able to recommend immune-modulating therapies without hesitation.

What are complications of PANDAS?

PANDAS has not been associated with the development of heart issues as seen in children with rheumatic fever. Untreated or unrecognized PANDAS may increase the risk of having OCD and tic disorder into adulthood.

What is the prognosis of PANDAS?

Though some children completely recover from PANDAS, there are some who develop persistent neuropsychiatric symptoms or develop worsening symptoms after each strep infection. It is not currently possible to predict which children will be affected or how severely. The mainstay of therapy is to decrease the OCD, tics, or other behaviors that might interfere with daily life and school.

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Is it possible to prevent PANDAS?

For those children diagnosed with PANDAS, there is some evidence that prophylactic antibiotics may play a role in preventing the development of strep infections and therefore the worsening of symptoms. However, there are side effects associated with daily antibiotic treatment, including diarrhea and the development of antibiotic resistance. More studies need to be performed to be sure that the preventive treatment is truly effective. Surgical removal of the tonsils and adenoids has not shown to be effective in preventing PANDAS and is thus not recommended.

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What is mental health?

Although it might seem easy to define mental health as the absence of mental illness, most experts agree that there is more to being mentally healthy. The U.S. Surgeon General has defined mental health as “a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with people, and the ability to adapt to change and to cope with adversity.” The state of being mentally healthy is enviable given the advantages it affords. For example, mentally healthy adults tend to report the fewest health-related limitations of their routine activities, the fewest full or partially missed days of work, and the healthiest social functioning (for example, low helplessness, clear life goals, high resilience, and high levels of intimacy in their lives).

What is mental illness?

Mental illness refers to all of the diagnosable mental disorders. Mental disorders are characterized by abnormalities in thinking, feelings, or behaviors. Highly common, about 46% of Americans can expect to meet the formal diagnostic criteria for some form of anxiety, depressive, behavioral, thought, or substance-abuse disorder during their lifetime.