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Understanding PANS / PANDAS: Recognizing Symptoms and Exploring Treatment Options

Writer's picture: Rachel RothRachel Roth

Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) are increasingly recognized conditions impacting children's mental health. These disorders can creep in suddenly or be recognized gradually, leaving parents and caregivers scrambling for answers. In this blog post, we will break down the characteristics of PANS and PANDAS, highlight their primary symptoms, and explore effective treatment options.


Defining PANS and PANDAS


PANS is characterized by a sudden and severe surge of psychiatric symptoms in children, such as anxiety, obsessive-compulsive behaviors, and disruptions in cognitive function. PANDAS, a specific subset of PANS, arises from streptococcal infections. Collectively, these disorders can drastically change a child's life and challenge family dynamics.


Recent studies have found that the onset of PANS or PANDAS often results from an autoimmune response. Here, the immune system mistakenly attacks the brain, causing both psychiatric and neurological symptoms. For instance, a study found that about 50% of children with PANDAS showed a notable improvement in symptoms after antibiotic treatment.


Spotting the Symptoms


Recognizing the symptoms of PANS and PANDAS can be difficult, especially since they may resemble other psychiatric or medical conditions. Here are the key signs to look for:


Rapid Onset of Psychiatric Symptoms


A defining trait of PANS and PANDAS is the abrupt emergence of psychiatric symptoms. Children may go from being happy and engaged to suddenly anxious, irritable, or withdrawn. For example, a child who previously enjoyed school might suddenly refuse to attend or participate in activities.


Neurological Symptoms


Many affected children experience neurological issues, including lip smacking or other tics, loss of coordination, or changes in handwriting. These symptoms can seem to arise almost overnight. For instance, a child's ability to ride a bicycle or complete homework may decline dramatically.


Sleep Disturbances


Sleep problems are frequent in children with these conditions. Research indicates that nearly 80% of children experience sleep disruptions. This might include insomnia, nightmares, or daytime sleepiness. Parents should monitor these changes closely, as they can exacerbate emotional challenges.


Changes in Appetite and Behavior


Watch for sudden shifts in appetite or routine. A child may refuse meals or begin overeating. They might struggle with schoolwork or social interactions. One survey found that around 65% of parents reported significant changes in their child’s eating habits during the onset of PANS or PANDAS.


Regressive Behaviors


Affected children may revert to earlier developmental milestones. For instance, a child who was potty-trained may start having accidents, or a previously independent child may become overly clingy. This regression can create additional stress for families.


Investigating Treatment Options


Timely intervention is crucial for managing PANS or PANDAS. While treatments can vary widely, a combination of approaches often yields the best results.


Medication Management


Healthcare providers may prescribe medications tailored to specific symptoms. There are three pillars of treatment that usually need to be done together in order to succeed in treatment. These are: treating the infection, calming the immune response, and psychiatric care.


Treating Underlying Infections


If streptococcal infections trigger PANDAS, antibiotics can lead to a notable improvement in symptoms, sometimes within days. Amoxicillin and azithromycin are examples of commonly used medications. Treatment can last 14 days, 30 days, or even months.


Calming the Immune Response


Treatment-level doses of Ibuprofen (dosed by weight) can be used to calm inflammatory responses. Prednisone has more side effects but can be stronger in cases that Ibuprofen does not work. Again, crafting an individual plan is key here.


Psychiatric Medications and Psychotherapy


Options include anti-obsessional medications (eg clomipramine) for obsessive-compulsive behaviors and sometimes very small doses of anti-psychotics. I have not had too much success with SSRIs or guanfacine, though these are considered options as well. The key is to develop a personalized medication protocol.


ERP (exposure and response prevention) and Cognitive-behavioral therapy (CBT) have been shown to be effective for children facing anxiety and obsessive-compulsive symptoms due to PANS or PANDAS. A trained therapist can teach children coping strategies to manage emotions. Equally important if not more is for the parents to enter therapy individually or as a couple to help strengthen the bond between the parents in dealing with the stress that an ill child puts on the relationship. This allow parents to set a calm, confident tone in the house and can be the most important part in managing anxiety and OCD in a child.


Dietary and Lifestyle Changes


Many families find symptom relief through balanced nutrition and healthy lifestyle habits. Incorporating more fruits, vegetables, and whole grains while ensuring regular exercise can boost overall well-being. Some research suggests that a diet low in processed sugars, flours, and dairy may help lessen anxiety symptoms in some children. Pro tip: Aim for a consistent sleep schedule to enhance sleep quality.


Building Support Networks


Engaging with support groups can offer invaluable resources for families navigating PANS or PANDAS. Sharing experiences and treatment strategies can ease feelings of isolation. Online communities and local support networks can connect families with others who understand the journey.


Navigating PANS and PANDAS


PANS and PANDAS can dramatically alter a child’s daily life and the lives of their families. Early identification of symptoms and proactive treatment approaches are essential in managing these disorders. Positive outcomes are certainly possible!


As you become familiar with the signs and symptoms, and connect with a trusted doctor familiar with PANDs, you can take steps to ensure your child receives necessary support. With the right support, children can overcome these obstacles, leading fulfilling and healthy lives.

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