PANS (Pediatric Autoimmune Neuropsychiatric Symptoms) NOTES
Source- Alternative Fever Response, Dr. Trifiletti blog post 10/10/13
and
Dr. T’s Reflection on PANDAS Awareness Day 2013, Dr. Trifiletti’s blog post 10/10/13
Alternative Fever Response
1. Infectious agents (Group A Beta hemolytic streptococcus, pneumoccus, coxsackie, mycoplasma,
etc.) lead to an inflammatory response creating significant neuropsychiatric symptoms.
2. This involves a complex immune response including innate and adaptive inflammation pathways.
This is response is extraordinarily complex, yet substantiated by thousands of scientific research
papers.
3. The usual fever response is a result of activity in the hypothalamus. This response does not
involve a breach of the blood brain barrier.
4. Notably, the alternate fever response does not involve breach of the blood brain barrier, either.
5. Also notably, in later stage PANS (Pediatric Acute onset Neuropsychiatric Symptoms), antibodies
(‘molecular mimicry”) become more important than a disease caused by infection.
6. It appears a genetic component of the innate immune system plays a role in alternate fever
response.
7. Alternate fever response involves histamine. This is the link between the immune system and
the brain.
8. Specifically, PANS is a result of histamine dysregulation outside the brain, and histamine
dysregulation/deficiency in the VTN (ventral tuberomammillary nucleus) of the hypothalamus.
9. Essentially, the basal ganglia, thalamus (sensory integration), basal forebrain (rage center), and
cholinergic connections (memory, cognition) are strongly connected to the VTN.
10. Theory- infection->alternate fever response->exacerbation of decreased histamine in
VTN/strongly connected to basal ganglia, thalamus (sensory integration), basal forebrain (rage
center), and cholinergic connections (memory, cognition)->deficiency of histamine 3
(autoreceptor-puts the brakes on dopamine, norepinephrine, serotonin)->brain flooded with
neurotransmitters-> RAGE!
11. SSRI, psychostimulants, 5-HT blockers, Dopamine agonists, N-epi will make it WORSE!
12. Neurons release histamine. Low histamine makes the brakes go off and [possibly initiates a
neurofeedback system which causes] histamine to then flood the synapse, and the brakes go back
on, rage stops.
http://pandasinstitute.org/blog/2013/10/10-17-13
http://pandasinstitute.org/blog/2013/10/10-9-2013