PANDAS / PANS
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, known as PANDAS, takes place when a streptococcal infection triggers a misdirected immune response in the body. This results in inflammation, particularly in the brain, which can cause the patient’s life to change. Symptoms of a wide variety may surface, including OCD, anxiety, tics, personality changes, declines in math and handwriting abilities, sensory sensitivities, and restrictive eating. According to the PANDAS Network, this group of disorders affects as many as 1 in 200 children.
PANDAS Criteria
This disorder is indicated primarily by a sudden, acute, and debilitating onset of anxiety and mood lability. This is accompanied by Obsessive Compulsive behavior and/or motor tics, with all these symptoms beginning immediately after a streptococcal-A (GABHS) infection, or within 4-6 months following infection treated with antibiotics. Antibiotics are not always fully effective in eradicating the Strep bacteria, and pediatricians do not often know the latent variability of these types of infections. Other criteria typical of a clinical diagnosis of PANDAS are pre-pubertal onset, an abrupt or relapsing-remitting course of symptom severity, and association with other neuropsychiatric symptoms.
PANS Differentiation
PANS is differentiated from PANDAS by the linkage to a streptococcal-A (GABHS) infection. It was first introduced in 2012 by Dr. Susan Swedo. When Strep is not a factor in the onset of these symptoms, the NIMH states that practitioners should investigate the possibility of Pediatric Acute-onset Neuropsychiatric Syndromes (PANS). When an infectious trigger, environmental factors, and other possible triggers create a misdirected immune response, inflammation can occur in a child’s brain. Consequently, new behaviors begin to surface in the child, such as OCD, severe restrictive eating, anxiety, tics, personality changes, decline in math and writing abilities, and sensory sensitivities.
Autoimmune Encephalitis
Encephalitis is an inflammation of the brain resulting from a viral or bacterial infection that causes the immune system to erroneously attacks healthy brain cells. Neurologic and psychiatric symptoms begin to surface and develop within less than three months; after ruling out other possible causes of any symptoms, an MRI can aid diagnosing a patient with Autoimmune Encephalitis. AE differs from PANDAS and PANS in that these symptoms elevate more dangerously and rapidly.
Neurological symptoms may include:
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Impaired memory
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Diminished cognition
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Abnormal movements
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Seizures
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Problems with balance, speech, or vision
Psychiatric symptoms may include:
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Psychosis
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Aggression
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Panic attacks
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Fear
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Euphoria
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Compulsive or inappropriate behaviors