What Every Practitioner Should Know About PANDAS & PANS
What Is It?:
The acronym PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorder Associated
with Strep. PANS stands for Pediatric Acute Neuropsychiatric Syndrome. Both are conditions
where an infection (bacterial or viral) triggers the immune system to mistakenly attack areas in the
brain (whose molecular structure is similar to that of the infectious agent). This autoimmune
reaction creates a host of symptoms which appear on the surface (and are often mistaken) to be
mental health issues.
Trigger Phrases:
-- Personality Change
-- New or dramatically increasing:
*OCD (obsessive thoughts/rituals/compulsions)
*Anxiety/Separation Anxiety
*Emotional Lability (Rages/Tantruming/Crying, etc.)
-- Tics (physical or verbal)/ Involuntary Choreiform movements
-- Anorexia (notice motivation – eg. Body image vs. germ/poisoning phobias)
Often accompanied by (one or more of the following):
-- Deterioration in academic performance, inability to concentrate, difficulty retaining information,
and school
refusal. (often math skills noticeably impacted)
-- Handwriting regression
-- Executive functioning problems
-- Sensory sensitivities
-- Urination frequency
-- Pupil dilation
-- Hallucinations
Common Misdiagnoses (symptoms vs. illness):
*OCD (“garden variety”)
*Depression
*Anxiety Disorder
*PDD (in younger children)
*Anorexia
*Tourette’s Syndrome
*Oppositional/Defiant Disorder
*ADD/ADHD
*Schizophrenia (or prodromal)
*Bi-Polar
Sally J. Plone, MA., LMHC
3 Essex Green Drive, Peabody
sjplone@me.com
1163 Walnut St., Newton
617-593-7344
Myths & Misconceptions:
-- Only happens with strep
-- Only happens overnight
-- Only happens with pre-pubescent children
Diagnostic Lab Tests:
-- Determine Strep Load
*Throat swab (non-rapid)
*Blood titers (D-Nase; ASO) determines strep living elsewhere in body (stomach, skin,
anus, etc.)
-- Other infections (mycoplasma pneumonia, Lyme, varicella, herpes simplex, and more…)
*Western blot (for Lyme)
* CD4 (measures generally over-reactive immune response)
*IgG – subclass 1, 2, 3,
*IgA and IgM
-- Cunningham Panel (http://www.moleculera.com/testing/) measures antibody titers against four
neuronal antigens to determine the likelihood of autoimmune activity
Treatment:
Medical:
Antibiotics or Antivirals (long-term One course isn’t close to enough.)
Steroids (short term -- addresses brain inflammation)
Tonsillectomy/Adenoidectomy (get rid of “safe haven” for strep)
IVIG (Intravenous immunoglobulin replaces “rogue” antibodies.)
Plasmapheresis -- auto-antibodies are removed from the blood system itself in a hospital setting
Mass General now has a PANDAS clinic within its OCD Program. They do evaluation and
treatment. Contact: 617-724-0198 pdownes@partners.org
Clinical:
CBT/ERP – some report positive results
Counseling – for child and family often traumatized by the illness on many levels
Support for families -- http://www.nepandasparents.com; pandasnetwork.org
Sally J. Plone, MA., LMHC
3 Essex Green Drive, Peabody
sjplone@me.com
1163 Walnut St., Newton
617-593-7344