WHAT ARE PANDAS, PANS?
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep (PANDAS) and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) are neuropsychiatric syndromes triggered by a faulty immune system response.
Students may experience symptoms after a “strong stimulant” to the immune system (NIMH, 2012) such as strep infection, flu, or even the common cold. In a student with PANDAS or PANS, the immune system is thought to mistakenly react and cause brain inflammation in the basalganglia region (NIMH, n.d.;
Murphy, Girardi, & Parker-Athill, 2014).
This reaction may cause neurological, psychological, and cognitive symptoms as a result of neurological inflammation
(Chang et al, 2015).
PANDAS and PANS may be treated with anti-inflammatory medications (such as ibuprofen), antibiotics to treat or prevent
infection, and immune-modulating therapies (such as steroids, intravenous immunoglobulin (IVIG), and plasmapheresis (PANDAS Network, 2014). Cognitive-behavioral therapy and additional medications may also be importantcomponents of a student’s treatment plan.
More than other conditions, PANDAS, PANS and related conditions can produce sudden, uneven and unusual symptoms.
PANDAS and PANS may co-occur with other autoimmune disorders, immune deficiency, or other neurological or psychiatric disorders. This can make treatment and management more complex.
☆ DIAGNOSIS:
An abrupt, acute, dramatic onset of obsessive-compulsive disorder or severely restricted food intake.
Concurrent presence of additional neuropsychiatric symptoms with similarly severe and acute onset from at least 2 of the following categories:
· Anxiety.
· Emotional Lability and/or Depression.
· Irritability, Aggression, and/or Severe Oppositional Behaviors.
· Behavioral (Developmental) Regression.
· Sudden Deterioration in School Performance (struggling to focus/ concentrate).
· Motor or Sensory Abnormalities.
· Somatic Signs and Symptoms, including Sleep Disturbances, Enuresis, or Urinary Frequency.
Symptoms are not better explained by a known neurologic or medical disorder.
Age requirement – None
□Sexual or religious obsessions (fear that God hates them or that they have done something morally offensive).
□Aggressive obsessions of harm to oneself.
□Intrusive images, words, music or nonsense sounds (examples: unwanted images, words, or music appear in the mind that do not stop).
□Need to tell, ask, or confess (examples: child needs to tell parent every perceived mistake or sin that day in school; excessive guilt).
□Some patients may experience the abrupt onset of clinical depression. A child might say “I’m not a good person,” but may also become so severe that the depression is accompanied by suicidal ideation. Self-injurious behaviors and suicidal ideation are also common and of particular concern among children with concomitant impulsivity and behavioral regression, as they may injure themselves. The constant battle with their own thoughts and comorbid symptoms may lead to depression until they ask “why is life worth living?”
□A number of factors may contribute to the child’s academic difficulties, including, among others, a shortened attention span, difficulties with concentration or memorization, and other disturbances of cognition and executive functioning. For example, a child previously may have been able to concentrate for hours on an art project, but now can focus for only a few minutes at a time. Math skills often decrease from previous levels, and children have been reported to develop new deficits of visuospatial skills.
□The sensory abnormalities may include a sudden increase in sensitivity to light, noises, smells, tastes, or textures.
□Sleep problems and disturbances of urination and micturition are among the most common physical manifestations of PANS.
PANDAS (like Sydenham chorea) is a semi-acute illness, which means that symptoms can disappear over a period of weeks to months without any intervention. For this reason, “Tincture of time” might be an appropriate therapy for children in the mild to moderate severity range. Since the child could recover on his own, any treatments used to hasten the process must not carry significant risks.
Life on a {ND} Rainbow 