Is Your Child Being Affected by PANS or PANDAS?

December 8, 2021 Jaban Moore

Is Your Child Being Affected by PANS or PANDAS?

PANS (Pediatric Autoimmune Neuropsychiatric Disorder) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep) are two conditions that affect thousands of children every year. Typically, these conditions seem to construct themselves overnight, several days, or within weeks. Consequently, a seemingly healthy child may experience a rapid decline in behavior, social skills, and developmental skills if affected by one of these conditions.

These conditions are believed to be the result of an immune response to one of a number of bacterial or viral infections that create autoimmune antibodies that affect the brain.

What are the Similarities and Differences between PANS and PANDAS?

Although PANS and PANDAS are similar neuropsychiatric conditions in children, the cause of both conditions is different. PANDAS is a condition triggered by specific bacteria known as Group A Streptococcal bacteria (most commonly seen as strep throat), which disrupts a child’s normal neurologic activity.

PANS is a neuropsychiatric condition that is related to an abundance of other infections and toxicities such as:

Mycoplasma Pneumoniae / Upper Respiratory Infections

Mononucleosis (Mono) / Epstein Barr Virus (EBV)

Mold Toxicities

Lyme / Lyme Co-Infections (specifically Bartonella)

Chicken Pox (Varicella)

Herpes Simplex

Influenza A / Common Cold

Many of these infections/toxicities may be present in a healthy asymptomatic person; however, they may be the “straw that broke the camel’s back” for compromised immune systems. Symptoms may also be exaggerated in children with high loads of toxic chemicals, heavy metals, mold exposure, and a poor gut microbiome.

What are Symptoms of PANS/PANDAS?

Both PANS and PANDAS attack structures of the brain, specifically the basal ganglia. This structure is responsible for “motor control, as well as other roles such as motor learning, executive functions and behaviors, and emotions.” Due to the inflammation rooted at the basal ganglia, this neurologic symptoms such as:

Sudden On-Set Obsessive Compulsive Disorder (OCD)
Separation Anxiety
Restrictive Eating / Eating Disorders
Sensory Amplification or Motor Abnormalities (including Tics and Dysgraphia)
Behavioral Regression
Sudden Deterioration in School Performance
Mood Disorders (Irritability, Aggression, and/or Severe Oppositional Behaviors)
Increased Urinary Frequency / Bed Wetting
Sleep Disturbances (Trouble Falling Asleep or Difficulty Staying Asleep)
Sensitivity to Light
Severe Mood Swings

A 2009 study also stated that supplementary symptoms of PANS/PANDAS include “emotional lability, personality change, bedtime fears and rituals, fidgetiness, irritability, tactile/sensory defensiveness, impulsivity/distractibility, deterioration in handwriting, choreiform movements, oppositional/defiant behaviour and nightmares.”

The Criteria for Diagnosis:

The criteria for diagnosis for PANDAS includes a checked-box for some of the symptoms above - especially sudden on-set OCD and tics. Clinically, PANDAS is age restricted as this condition is seen in children between 3 years old to puberty. PANDAS also requires a history of a known Group Streptococcal A infection. However, it is possible to have PANDAS without a known strep infection as some infections are asymptomatic. Although this is less common, it is possible.

The criteria for diagnosis for PANS includes a checked-box for most of the symptoms above. PANS has no age requirement, however; PANS symptoms typically occur in elementary/middle school children (ages 3-14).

Click here to learn more on the criteria for a PANS/PANDAS diagnosis!

The Brain and Basal Ganglia

Current research theorizes that the brain structure, basal ganglia, is dysfunctional in children with PANS/PANDAS. In the case of PANDAS, the strep bacteria causes an autoimmune encephalitis response. If strep bacteria stays in high levels in the body for more than 3-5 days, the body creates antibodies against the bacteria.However, strep is an ancient bacteria that is well-versed in hiding themselves in children’s hearts, joints, skin, and brain tissues by putting molecules on their cell wall so that they look nearly identical to molecules found in these parts of the body. This process is called “molecular mimicry” and it allows the strep bacteria to be immune to detection for long periods of time.

However, the strep bacteria is eventually seen as a foreign invader to the child’s body and the immune system responds by creating more antibodies. But, due to the “molecular mimicry” by the bacteria, the immune system reacts poorly to both the bacteria and antibodies. This process is known as a “cross reaction.” PANS acts similarly with infections other than strep.

The basal ganglia is the most affected brain structure in this condition. After the immune system poorly responds to itself and the harmful infection, the basal ganglia is the central place for inflammation. Research shows that “magnetic resonance imaging (MRI) in PANDAS has previously demonstrated inflammation in the basal ganglia.”

In cases of this condition, it is thought that serum antibodies cross the blood-brain barrier and cross-react with neuronal antigens that dysregulate the basal ganglia. Since the immune system is acting in self-defense, it is also thought that the neuroglial immune cells in the brain create basal ganglia inflammation. Both of these processes affect the neurons connected to the basal ganglia and if they are not functioning properly this may create abnormalities in motor functions, emotions, behaviors, cognition, memory, and learning.

PANS/PANDAS are Often Misdiagnosed

Unfortunately, these conditions are often misdiagnosed as a mental disorder or a behavioral problem in children. The psychiatric symptoms that develop as a result of PANS/PANDAS can be detrimental. Since these children are dealing with brain inflammation, they become dysfunctional, aggressive, and/or isolate themselves from friends and family. They may develop picky eating habits, body image issues, OCD tendencies, hoarding tendencies, and do the opposite of what they are told to do.

If a child is suffering from these symptoms if they have satisfactory nutrition, socialization, sleep, and parenting, they are likely suffering from a neurologic issue that may be caused by PANS/PANDAS. When correctly diagnosed and treated, the symptoms will significantly decrease or go completely into remission.

Why Do Some Children Get PANS/PANDAS While Others Don’t?

Not every child that has a strep infection develops PANDAS and not every child that has experienced one of the listed root causes of PANS develops PANS. Reasons a child may develop PANS/PANDAS may be due to:

Strain Differences in Strep: There are over 150 strains of strep bacteria. Only 10-12 of these strains cause strep throat, acute rheumatic fever and Sydenham chorea, the medical models of PANDAS, so it is hypothesized that certain strains of strep trigger PANDAS symptoms.
Genetic Vulnerability: Gene mutations such as the MTHFR mutation makes it harder for the body to detoxify infections and toxicities. A 2018 study states that an “MTHFR mutation also can increase environmental risks for psychiatric disorders, such as major depressive disorder through interaction between genetic and epigenetic factors.” If a child experiences a genetic vulnerability, this may cause their toxin bucket to be higher than others and cause a trigger in PANS/PANDAS in sight of an infection.

Location of Infection: In case of PANDAS, strep infections typically occur in the throat, tonsils, bladder, and anus. Although “strep throat” infections are the most common trigger, PANDAS has been reported to occur in association with perianal strep infections. Additional animal research suggests that strep bacteria in the nasal cavity may influence neuroimmune cells along the cranial nerves. This provides a gateway for infection to cause basal ganglia/brain inflammation.

Click here to read our article on children with chronic illnesses!

A Full Toxic Bucket: In terms of chronic illness, there is typically not one root cause, there are multiple. These root causes may be bacterial/viral infections, parasites, mold toxicities, Lyme disease/Lyme co-infections, a poor gut microbiome, heavy metal toxicities, and emotional trauma. If a child has one or more of those root causes, they are at a higher risk of developing PANS/PANDAS.

Click here to read our article on childhood emotional trauma in relation to chronic illness!

Testing for PANS/PANDAS

Testing may be helpful for a clinical diagnosis and treatments for symptoms of PANS/PANDAS. These tests include:

The Cunningham Panel: This antibody test provides insight into how a child’s immune system is functioning. It measures the levels of certain autoantibodies (responsible for causing the symptoms) circulating in a child’s bloodstream. The higher the levels of these antibodies, the higher the likelihood that the child’s symptoms are due to an infection. While this is the traditional test for PANS/PANDAS, it may be expensive and may miss antibodies. We are not able to order this test at my clinic.

Blood Antibody Tests (PANDAS): Antibodies for strep include ACHO, anti-strep dNase B, and ASO.

Rey-Osterrieth Complex Figure Test: This test is a common neuropsychological assessment tool. According to a 2021 study, this tool aims to look at “the visuo-constructional ability and visual memory of neuropsychiatric disorders, including copying and recall tests. By drawing the complex figure, the functional decline of a patient in multiple cognitive dimensions can be assessed, including attention and concentration, fine-motor coordination, visuospatial perception, non-verbal memory, planning and organization, and spatial orientation.”

Symptom Analysis and Medical History: If there are symptoms matching the diagnostic criteria following a strep infection and/or a child’s behavior rapidly declined, the trained practitioner may treat the child for PANS/PANDAS with opening drainage pathways, detoxing the body of existing infections/toxicities, and maintain a healthy diet.
Neural Zoomer: The Neural Zoomer measures immune reactivity to structures, tissues, cells, and chemicals in the brain and peripheral nervous system. This test can detect underlying inflammatory responses that may be causing symptoms related to mood, memory, aging, balance, nervous function, movement, pain, and more. If you were diagnosed with or suspect neurological inflammation or autoimmune disease, you may benefit from this panel. I prefer this test and order it often for clients.

Addressing PANS/PANDAS:

Antibiotics are commonly used among allopathic medical treatments. Although they have the ability to provide relief and remission for cases of PANS/PANDAS, it does not always work long term if the root cause is not addressed. We look for the root cause and treat infections/toxicities on an individual basis and create a tailored protocol that is aimed to put PANS/PANDAS into remission

If you believe you are dealing with chronic illness, please contact a functional provider. Dr. Jaban Moore, a functional medicine provider, can help you if you are experiencing chronic symptoms.

Please reach out if you are interested in taking your health back! You can give our office a call at (816) 889-9801.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6401534/

https://pubmed.ncbi.nlm.nih.gov/9464208/

https://pubmed.ncbi.nlm.nih.gov/28538981/

https://jamanetwork.com/journals/jamapediatrics/article-abstract/191735

https://pubmed.ncbi.nlm.nih.gov/27464318/

https://pubmed.ncbi.nlm.nih.gov/15590039/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340805/

https://pubmed.ncbi.nlm.nih.gov/8335653/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6423671/

https://www.longdom.org/open-access/from-research-subgroup-to-clinical-syndrome-modifying-the-pandas-criteria-to-describe-pans-pediatric-acute-onset-neuropsychiatr.pdf