PANDAS/PANS

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections

PANDAS is the name of a condition used to describe children who demonstrate obsessive-compulsive behaviors and/or tics after a strep infection. The acronym stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with streptococcal Infections. More recently, the term PANS, or Pediatric Autoimmune Neuropsychiatric Disorders, has been applied to similar neuropsychiatric symptoms developing in children as a result of other infections. These infections include Coxsackie virus, Lyme, Candida, and Mycoplasma pneumoniae, as well as other bacterial, viral and fungal infections. The syndromes describe children who present with acute symptoms, and go from typical behavior to having mild to severe neurological symptoms almost overnight. In addition to verbal and/or physical tics, and obsessive behaviors, children may develop sudden fears, aversions to eating, mood swings, separation anxiety, and even have suicidal tendencies.

Why are these syndromes considered to be autoimmune conditions? There is a subset of children who, when they get an infection, inappropriately develop antibodies to their own nervous system. These antibodies then begin to attack their own tissues. There are many historically known syndromes that develop as an autoimmune condition post infection, such as Rheumatoid arthritis, Sydenham’s chorea and Guillain-Barre. The inappropriate immune response is a result that of the body producing antibodies to fight the infection. At the same time the immune system also produces antibodies to fight tissues with similar molecular shape, such as the brain.

PANDAS/PANS was first reported in 1998. The rate of prevalence in children is presumed to be dramatically underestimated due to the misdiagnosis of other neuropsychiatric disorders. The naturopathic doctors at the Nardella Clinic in Calgary have extensive training in the detection and treatment of PANDAS/PANS.

Diagnosis

The diagnosis of PANDAS and PANS is considered a clinical diagnosis. To be diagnosed with PANDAS a child must meet the following criteria:

• Presence of obsessive-compulsive disorder and/or a tic disorder
• Pediatric onset of symptoms (age 3 years to puberty)
• Episodic course of symptom severity (symptoms will increase and decrease in severity)
• Association with group A Beta-hemolytic streptococcal infection
• Association with neurological abnormalities

As more research is done on PANDAS/PANS, more laboratory tests are being developed that are helpful in the detection of these conditions. Diagnostic tests that our Calgary naturopathic doctors find helpful include:

1. Strep Antibody tests

Two antibodies are measure to evaluate if the patient has recently been infected with group-A streptococcus. These two tests are:

• Antistrepolysin O (ASO) titer, which rises 3-6 weeks after a strep infection
• Antistreptococcal DNAase B (AntiDNAse-B) titer, which rises 6-8 weeks after infection.

2. Strep throat, nasal or rectal swabs

Swabs taken from the throat, rectum and nasal passages can be cultured to detect the presence of group-a streptococcal.

3. Cunningham Panel

The Cunningham panel is a cutting-edge diagnostic test that measures the presence of 5 markers in the blood that are associated with a neurological autoimmune response. These 5 markers are:

• Lysoganglioside
• Tubulin
• Dopamine receptor D1
• Dopamine receptor D2
• Calcium/calmodulin-dependent protein kinase activity

4. Lyme disease and Co-infection testing

Lyme disease testing involves a variety of methods to detect the presence of the bacteria Borrelia Burgdorferi and other co-infections. For more information please see Lyme Disease Diagnosis.

5. Viral panels

6. Cytokine testing

Cytokine testing is used to evaluate pro-inflammatory and anti-inflammatory markers that regulate our immune system. Presence of certain cytokines can indicate chronic infections or autoimmune responses and help to support the diagnosis of an autoimmune neurological response.

7. Neurotransmitter testing

Neurotransmitters are the messengers in our brain that control mood, learning, behavior, sleep and attention. Infections that result in an autoimmune response to the neurological system cause neurological inflammation, and imbalances of a child’s neurotransmitters. Measuring levels of neurotransmitters in the urine helps to identify treatments that can rebalance our neurological system and improve symptoms.

Treatment

Naturopathic treatment of post-infection autoimmune conditions require three components:

1. Treatment of the infection
2. Reduction of the autoimmune response
3. Repairing damage cause from the autoinflammation

There are many standard medical treatments that have been proposed to help to treat PANDAS/PANS including:

1. Antibiotic therapy: some children may require prophylactic antibiotics to prevent infection and future recurrence
2. Intramuscular or intravenous immunoglobulins (IMIG/IVIG)
3. SSRIs (Selective serotonin reuptake inhibitors)

Naturopathic and biomedical treatments excel at supporting a child’s immune system, reducing inflammation, treating chronic infections and repairing damage. Our naturopathic doctors of the Nardella Clinic in Calgary work with you and your child to develop an individualized treatment plan to address your child’s unique needs.