PANDAS ( Paediatric Autuimmune Neuropsychiatric Disorder associated with group A Streptococcus)
At Stonegate Medical Clinic, we offer a specific PANDAS consultation with our Paediatric Consultant
What is PANDAS?
PANDAS ( Paediatric Autuimmune Neuropsychiatric Disorder associated with group A Streptococcus) is a group of disorders seen in the paediatric population which consist of either tics or obsessive compulsive disorder either exacerbated or brought on by a common bacterial infection called Group A streptococcus (GAS). This infection may present with a sore throat or chest infection.
What is PANS?
PANS (Paediatric acute-onset neuropsychiatric syndrome) describes a clinical syndrome that may be caused by noninfectious or infectious triggers. Proposed diagnostic criteria for PANS include: the sudden onset of OCD or severely restricted food intake, severe neuropsychiatric symptoms (eg, anxiety, depression, emotional lability, etc) or symptoms not better explained by a known neurologic or medical disorder. The key words in this are “sudden onset”. Symptoms appear dramatically and there is a rapid shift in the child’s behaviour
Is PANDAS Common?
PANDAS 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).
How does this occur?
This group of disorders is thought to occur after the body produces an antibody to fight a common everyday infection. This antibody then goes on to stimulate a part of the brain involved with movement control (or regulation of obsessive compulsive behaviours) which in turn results in the abnormal movement, noise, feeling or compulsion.
Signs and Symptoms:
PANDAS symptoms typically start abruptly, almost as if a switch has been thrown. Symptoms include tics, sleep disturbance, obsessive compulsive behaviour, deterioration in handwriting, eating disorders (including anorexia but the problems appear to be more centred on difficulty in coordinating swallowing), behavioural regression and urinary incontinence. By definition these occur following a streptococcal infection, which then results in the stimulation of antibodies that stimulates the part of the brain involved in movement and behaviour regulation (the basal ganglia). Examination of the child reveals a child who is “trapped” or “psychologically burdened”. They may have reduced muscle power and may show abnormal movements.
Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is defined by the rapid onset of obsessive–compulsive disorder (OCD) or eating restrictions and comorbid symptoms from at least two of seven categories:
- Anxiety (particularly separation anxiety)
- Emotional lability or depression
- Aggression, and/or severely oppositional behaviors
- Deterioration in school performance related to ADHD-like behaviors, memory deficits, and cognitive changes
- Sensory or motor abnormalities
- Somatic signs and symptoms, including sleep disturbances, enuresis, or urinary frequency (Swedo et al. 2012; Chang et al. 2015). Acute onset cases that are triggered by Group A streptococcal infections may meet diagnostic criteria for both PANS and PANDAS.
There can be several stages of treatment to consider including antibiotics and possibly cognitive behavioural therapy. The Consultant will be able to discuss the best way forward for your child and create a suitable treatment plan for you to consider.