PANDAS is an acronym for Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. It is a recently disclosed disorder i.e. 1990s. It is diagnosed if there is a history of abrupt development of a number of neuropsychiatric symptoms associated with a group A streptococcal i.e. the type of bacteria causing strep throat infection. Medication and proper cognitive behavioral therapy are the primary treatments for PANDAS. These days, PANDAS syndrome affecting children in a fast speed.
What is PANDAS syndrome?
Strep throat is normal problem of childhood. Some kids get it again and again, and a simple round of antibiotics usually clears it up. But for few children, the infection triggers strange behavior changes known as PANDAS syndrome.
With PANDAS, a child may seem to turn into a different person overnight. He becomes moody, anxious, aggressive and dealing with body movements which he can’t control. It can be scary, but once your child is diagnosed with PANDAS and starts treatment, it’s likely he’ll make a full recovery. PANDAS is a subtype of pediatric acute-onset neuropsychiatric syndrome (PANS).
Almost 90 percent of acute onset OCD cases are linked to strep infection. Children especially at risk are those who have “occult” or hidden strep infections i.e. children who can be “carriers” of the infection but don’t get symptoms themselves, and hence don’t get treatment. ANDAS is a episodic disorder. Symptoms may disappear for extended periods then reappear, aggravated by a later exposure to strep of some other bacteria or virus. Symptoms may get increasingly severe with multiple recurrences. PANDAS syndrome affecting children severely these days.
PANDAS syndrome involves sudden and mostly major changes in personality, behavior and movement in children following an infection involving Streptococcus pyogenes. Infection can be mild causing just a minor skin infection, while it can go even sever strep throat, scarlet fever and several other illnesses. Strep is found inside the throat and on the surface of the skin. Children receives it when an infected person coughs or sneezes and you breathe in the droplets or touch contaminated surfaces, and then touch your face.
Causes of PANDAS syndrome affecting children
Strep bacteria are very ancient organisms that survive in the human host by hiding from the immune system as long as possible. They hide themselves by putting molecules on their cell wall so that they look nearly identical to molecules found on the child’s heart, joints, skin, and brain tissues. This hiding is called “molecular mimicry” and allows the strep bacteria to evade detection for a long time.
Combined opinion is that PANDAS is in part caused by an autoimmune response to a strep infection. Streptococcus is known to be associated with a number of immune-related disorders, including rheumatic fever, scarlet fever, and acute glomerulonephritis. The strep molecules are known to hide from the host immune system by mimicking host cells. Ultimately, the immune system recognizes the foreign cells, and the antibodies produced attack the bacterium, and unfortunately, some of the host's own cells are attacked as well due to cross-reactivity. In some situations, these antibodies attack brain cells, causing OCD, tics, and the other neuropsychiatric symptoms in PANDAS patients.
PANDAS is mainly considered as a pediatric disorder and typically first appears in childhood from age 3 to puberty. Reactions to strep infections are rare after age 12, but researchers recognize that PANDAS could occur among adolescents too. Though rarely, it is possible that adolescents and adults may have immune-mediated OCD, but this is still not perfectly known.
Most of researchers jointly accept that PANDAS is, just like rheumatic fever, a misdirected immune response to the strep bacteria, which mimics human heart or brain tissue. The immune system attacks the heart mostly in the case of rheumatic fever or brain mostly in the case of PANDAS, causing this array of mental health symptoms.
Symptoms of PANDAS syndrome affecting children
PANDAS syndrome is diagnosed clinically i.e. there are no lab tests that can diagnose PANDAS. Instead, health experts use diagnostic criteria for the diagnosis of PANDAS. At present, the clinical features of the illness are the only way of determining whether a child might have PANDAS. Kindly note, if following symptoms present for more than a week, blood tests may be done to document a preceding strep infection.
Diagnostic features of PANDAS syndrome:
- Presence of OCD i.e. obsessive compulsive disorder, or a tic disorder, or even both
- Pediatric onset of symptoms i.e. age 3 to puberty
- Episodic course of severe symptoms
- Association with group A Beta-hemolytic strep infection, such as a positive throat culture for strep or history of scarlet fever
- Association with neurological abnormalities, like physical hyperactivity or unusual, jerky movements that are not in the child’s control
- abrupt onset or worsening of symptoms
- attention-deficit/hyperactivity disorder (ADHD), like hyperactivity, inattention, or fidgeting
- Separation anxiety, for example, child is insecure and has difficulty separating from his or her caregivers. Your child, if suffering from PANDAS, may not want to be in a different room in the house from his or her parents.
- Mood swings, such as irritability, sadness, or emotional liability i.e., tendency to laugh or cry that too in the wrong moment.
- Trouble sleeping
- Nighttime bed-wetting, frequent daytime urination, or even both
- Changes in motor skills, like changes in handwriting
- Joint pains
- The changes to child’s personality and behavior are quick and dramatic.
- Tics are sudden movements or sounds your child repeats over and over and can’t control. He may blink a lot or jerk his head.
- Uncontrolled jerky movements
- Developmental regression i.e. temper tantrums or baby talk
- Sensory problems, like being very sensitive to light and possibly seeing or hearing things that aren’t there
- Deterioration in school performance: Sudden decline in math and reading competence, memory and concentration; increase in hyperactivity.
- Suicidal thought
- refusing to eat, which can lead to weight loss
- near catatonic state
Who are at a risk of PANDAS syndrome?
PANDAS is most likely to develop in children between 3 and 12 years old who've had a strep infection within the last four to six weeks. Some possible risk factors include a genetic predisposition and recurrent infections.
Children are more likely to get a strep infection in late fall and early spring, especially when they are in close association with large groups of people. To help prevent strep infection, teach your child not to share eating utensils or drinking glasses, and to wash their hands often. They should also avoid touching their eyes and face whenever possible.
Parents, when notice the symptoms of PANDAS or are concerned that their child has PANDAS, it is recommended that let your child be fully evaluated by a pediatrician immediately. This should include a throat culture for strep infection.
Most children having PANDAS syndrome will first be seen by their pediatrician when symptoms develop. Further they will need a psychiatrist or other mental-health professional who can prescribe medication and provide cognitive behavioral therapy. Other physicians that may aid in the management of PANDAS include a pediatric neurologist or behavioral developmental specialist.
Treatment of PANDAS syndrome affecting children
Very first treatment for PANDAS syndrome include cognitive behavioral therapy (CBT) and medication, depending on the breadth and severity of symptoms. These day, the primary medical therapy is focused on controlling the OCD symptoms, and therefore selective serotonin reuptake inhibitor (SSRI) medications are frequently used i.e. fluoxetine and others.
The other major step in treating PANDAS is treating the strep infection associated with the symptoms. For this, throat culture should be done to document the presence of strep bacteria in the throat. If a properly obtained throat culture is negative, the doctor should make sure that the child doesn’t have an occult strep infection, such as a sinus infection or strep bacteria infecting the anus, vagina, or urethral opening of the penis. Although the latter infections are rare, they have been reported to trigger PANDAS symptoms in some patients and can be particularly problematic because they will linger for longer periods of time and continue to provoke the production of cross-reactive antibodies. The strep bacteria can be harder to eradicate in the sinuses and other sites, so the course of antibiotic treatment may need to be longer than that used for strep throat.
Antibiotics are the treatment of choice to eradicate an active strep throat infection. A pediatrician may prescribe penicillin, amoxicillin, azithromycin, or another antibiotic. For severe symptoms, the use of other treatments are practiced for controlling the immune response and these are found to be effective. These include the use of intravenous immunoglobulin, steroids and plasmapheresis. For treatments, the offending antibodies are removed. Steroids are less effective because symptoms that decrease during the treatment, they return soon after stopping the drug.
Anti-inflammatory drugs can calm the immune system. Your child may get a steroid pill for several days. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may also help.
Guiding tips for parents of children suffering from PANDAS syndrome
Sterilize or replace toothbrushes during and following the antibiotics treatment to make sure that the child is not re-infected with strep. It also might be helpful to ask a health care expert to perform throat cultures on the child’s family members to make sure that no one are strep carriers, who could serve as a source of the strep bacteria.