PANDAS/PANS Diagnosis and Treatment

What are PANS/PANDAS?

Researchers suspect that PANS and PANDAS result from infections or environmental triggers that cause abnormal activation of the immune system, which then attacks neuronal cells.

PANS Symptoms and PANS Diagnosis

PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome. According to the PANS Research Consortium comprised of physicians and researchers from institutions such as Stanford, Yale, Harvard, Columbia, and National Institute of Mental Health, PANS is a clinical diagnosis requiring OCD and/or restrictive food intake as well as two or more of the following symptoms:
  • anxiety
  • emotional lability
  • depression
  • irritability
  • aggression
  • severely oppositional behaviors
  • behavioral or developmental regression
  • deterioration in school performance, handwriting, or math skills
  • sensory abnormalities
  • sleep disturbances
  • enuresis
  • urinary frequency
Identification of the trigger is not required for a diagnosis of PANS. There is no age requirement.

PANDAS Symptoms and PANDAS Diagnosis

PANDAS is the acronym for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. PANDAS is a subset of PANS. Guidelines for diagnosing PANDAS include:

  1. Presence of OCD and/or tics
  2. Symptoms begin between age three and puberty
  3. Acute-onset and episodic (relapsing-remitting) course
  4. Association with Group A Streptococcal (GAS) infection
  5. Association with Neurological Abnormalities

The diagnosis of PANDAS does not require comorbid neuropsychiatric symptoms beyond OCD or tics, however, they are often present.

PANS/PANDAS Treatment

In 2017, treatment guidelines for PANS and PANDAS were published in a special issue of the Journal of Child and Adolescent Psychopharmacology (JCAP, 2017). Authors of the guidelines include physicians and researchers including Stanford, Yale, Harvard, Columbia, and National Institute of Mental Health and others.

 

Treatment for Mild to Moderate PANS/PANDAS can include:

  • Antibiotics
  • Corticosteroids
  • Anti-Inflammatories
  • Therapy
  • SSRI’s (very low dose)

Treatment for Moderate to Severe PANS/PANDAS can include:

    • Antibiotics
    • Corticosteroids
    • Anti-Inflammatories
    • Therapy
    • SSRI’s (very low dose)
    • IVIG
    • Plasmapheresis

Treatment for Severe to Extreme PANS/PANDAS can include:

  • Long, tapered corticosteroid courses or repeated high dose IV corticosteroids
  • IVIG
  • Plasmapheresis
  • Rituximab
  • Antibiotics and the above

 

From the Neuroimmune Foundation. Can learn more here: https://neuroimmune.org/