If you are desperately trying to figure out why your child went from straight A student, star athlete, independent, and fully functional to having OCD, separation anxiety, behavioral regression, verbal or motor tics, becoming completely dysfunctional essentially overnight, this article may hold the answers for helping your child regain their normal life again!
PANS and PANDAS are two similar conditions related to neuropsychiatric changes in children, due to toxic and infectious triggers. PANS stands for Pediatric Acute Neuropsychiatric Syndrome, while PANDAS stands for Pediatric Acute Neuropsychiatric Disorders Associated with Strep. One of the main differences between PANS and PANDAS is that the etiology for PANDAS has been established as Group A Streptococcal (GAS) infections since the 1990s. PANS, which was only coined in 2012, denotes PANDAS-like cases where strep could not be implicated as the cause of symptoms, and often another causal microbe or toxin was detected, such as Bartonella, Epstein-Barr virus, Mycoplasma Pneumoniae, Lyme disease, Varicella Zoster, Influenza A, and even the common cold. There can even be environmental triggers in PANS/PANDAS such as mold exposure, chemicals, or heavy metals.
While the etiology of both conditions differ, the clinical presentation generally manifests identically. Typically, healthy and normally functioning children experience a rapid decrease in appropriate behavior, transforming virtually overnight, within several days or weeks. The hallmarks of PANS/PANDAS children include: the acute onset of OCD, separation anxiety, eating disorders (47%), verbal and motor tics (70%), involuntary body movements, sleep disorders (80%), behavioral regression like baby talk and tantrums (98%), rapid decline in academic performance, math skills and handwriting (90%), ADHD, inattentiveness, hyperactivity, severe mood swings, rage outbursts, aggression, urinary issues (90%), frequent urination, bed-wetting, sensory hypersensitivity or insensitivity (40%), hallucinations (10%), and even suicidal ideation in some extreme cases.
What is PANS/PANDAS?
PANS/PANDAS are autoimmune conditions, meaning the body produces antibodies against a foreign invader but due to molecular mimicry, ends up mistaking its own tissues as the invader and attacks them. In the case of PANS/PANDAS, structures in the brain known as the basal ganglia or "gatekeepers" of the brain are targeted and attacked, causing massive brain inflammation.
In the case of PANDAS, strep causes the autoimmune encephalitis response. If strep lingers for more than 3-5 days, the body creates antibodies against the microbes. However, because of molecular mimicry by the bacteria, the immune system reacts not only to the strep itself but also to the human host molecules that were mimicked and attacks host tissues. This is known as autoimmune "cross-reaction."
The Criteria of PANS
There are many symptoms associated with PANS, but the criteria for diagnosis include:
- A sudden and acute onset of OCD and/or severely restricted food intake.
- Simultaneous presence of similarly acute and severe onset of other neuropsychiatric issues from at least two of the following categories:
- Emotional lability (severe mood swings, intense reactions, dramatic changes in opinions or feelings, depression to the point of suicidal ideation)
- Panic, generalized anxiety, separation anxiety
- Behavioral and/or developmental regression (suddenly acting much younger than their age, baby talk)
- Aggression, irritability, severely oppositional or defiant behavior
- New sensory or motor processing problems (sensitivity to light or noise, dramatic worsening in handwriting and drawing)
- Deteriorating in academic performance (loss of math skills, reading comprehension, ability to focus, hyperactivity)
- Somatic symptoms like frequent urination, bed wetting, sleep disturbances
Functional Medicine Treatment of PANS/PANDAS
Working with a skilled functional medicine practitioner is crucial when healing from PANS/PANDAS. The approach includes:
- Comprehensive lab testing to identify the triggering infection
- Opening drainage pathways
- Addressing parasitic infections
- Addressing mold toxicities and heavy metals
- Targeting the specific triggering infection
- Supporting the nervous system and brain inflammation
- Anti-inflammatory nutrition
- Supporting the gut microbiome
If you believe your child is dealing with PANS or PANDAS, please contact a functional provider. Dr. Jaban Moore, a functional medicine provider, can help you if your child is experiencing these symptoms.