PANDAS Disease

What Is PANDAS Disease?

PANDAS disease is a rare but serious condition that affects children following a streptococcal (strep) infection, such as strep throat or scarlet fever. In some cases, the child’s immune system mistakenly attacks parts of the brain, particularly areas that control movement and behavior.

This autoimmune reaction can trigger a sudden onset of obsessive-compulsive behaviors (OCD), motor or vocal tics, anxiety or other mood and behavior changes that seem to appear “overnight.”

While the symptoms may be alarming, many children recover with timely diagnosis and a comprehensive treatment plan that addresses both the infection and its neurological effects.

What Causes PANDAS Disease?

PANDAS develops when the body’s immune response to a strep infection targets healthy brain tissue by mistake. This misdirected immune activity can cause inflammation in areas of the brain responsible for emotions and movement control, such as the basal ganglia.

Risk factors include:

• Recent or recurrent strep throat or scarlet fever infections
• A genetic predisposition to autoimmune disorders
• A family history of autoimmune or neuropsychiatric conditions

PANDAS most commonly affects children between the ages of 3 and 12 and often follows a symptom-free period after a strep infection.

Signs and Symptoms of PANDAS Disease

The hallmark feature of PANDAS is the sudden onset or worsening of neuropsychiatric symptoms following a strep infection. Symptoms may include:

Behavioral and Emotional Changes:

• Sudden development of OCD behaviors, such as excessive washing, checking or counting
• Anxiety or panic attacks
• Mood swings, irritability or depression
• Separation anxiety or regression in previously learned behaviors

Neurological and Physical Symptoms:

• Motor or vocal tics, such as involuntary movements or sounds
• Sudden decline in handwriting or fine motor skills
• Sleep disturbances
• Sensitivity to light, sound or touch
• Frequent urination or new bedwetting

Symptoms often appear quickly, sometimes within 24 to 48 hours after a strep infection, and can fluctuate in intensity.

How Is PANDAS Diagnosed?

There is no single test for PANDAS, so diagnosis involves a combination of clinical evaluation, lab testing and medical history.

A health care provider may:

• Review the child’s symptoms and timeline, especially any abrupt changes in mood or behavior.
• Perform a throat culture or blood test to confirm a recent or current strep infection.
• Rule out other neurological or psychiatric conditions that may cause similar symptoms.

Because PANDAS symptoms overlap with conditions such as Tourette syndrome or primary OCD, diagnosis is best made by a pediatrician, neurologist or child psychiatrist experienced in autoimmune disorders.

How to Treat PANDAS Disease

Treatment focuses on addressing the underlying infection, reducing inflammation and managing behavioral symptoms.

Medical Treatment:

• Antibiotics: To eliminate the strep bacteria causing the immune response.
  
• Anti-inflammatory medications: Such as NSAIDs or corticosteroids, to reduce brain inflammation.
  
• Immune-modulating therapies: In severe or chronic cases, treatments like IVIG (intravenous immunoglobulin) or plasma exchange may be recommended.

Behavioral and Supportive Care:

• Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP): Help children manage OCD and anxiety symptoms.
  
• Family therapy and school support: To improve coping strategies and academic success.
  
• Nutritional support and stress management: To strengthen the immune system and reduce flare-ups.

With early and coordinated care, most children with PANDAS experience significant improvement or full recovery.

How to Reduce the Risk of PANDAS

Because PANDAS is linked to strep infections, prevention centers around early diagnosis and treatment of strep throat.

Helpful strategies include:

• Teaching children good hand hygiene and cough etiquette.
• Treating strep infections promptly with antibiotics prescribed by a health care provider.
• Avoiding close contact with individuals known to have strep throat.
• Following up with your child’s provider if new behavioral symptoms appear after an illness.

If your child experiences sudden behavioral or neurological changes after a strep infection, contact your primary care provider. Early evaluation and treatment can make a lasting difference in recovery and long-term well-being.

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