PANS/PANDAS
What is PANS/PANDAS?
PANS (formerly PANDAS) is an acronym for Pediatric Acute-onset Neuropsychiatric Syndrome. Many publications illustrate a link between acute/febrile illnesses and abrupt onset of obsessive-compulsive disorder (OCD), tics, and neuropsychiatric symptoms, supporting this controversial diagnosis.
The neuropsychiatric symptoms of PANS/PANDAS may include anxiety, emotional lability, depression, irritability, behavioral regression, oppositional behaviors, deterioration in school performance, sleep disturbances, bed wetting, or urinary frequency.
When the symptoms cannot be better explained by known disorders such as Sydenham’s chorea or Tourette’s syndrome, a diagnosis of PANS may be made.
The former acronym of PANDAS referenced a subset of PANS patients with an abrupt onset of OCD and tics following a streptococcal bacterial infection and was considered to be autoimmune in nature. The PANDAS autoimmune process begins when the child’s immune system attacks its own brain tissue suddenly and dramatically after a strep throat infection or scarlet fever (i.e. strep throat with a red, rough, fine sandpaper-like rash). The diagnosis has since been expanded to PANS to include a broader range of infectious triggers, as well as non-infectious etiologies if the criteria are met for “abrupt onset.”
Learn more about PANDAS at http://pandasnetwork.org/.
Symptoms that begin after an acute infection and may be associated with PANS/PANDAS :
- Obsessive-compulsive disorder
- Tics (motor and verbal)
- Sensory Processing Disorder
- ADD/ADHD
- Age regression
- Choreiform movements
- Hyperactivity
- Mood fluctuations
- Urinary incontinence, urgency and increased frequency (daytime or nighttime)
- Mood fluctuations
- Changes in handwriting
- Personality changes
- Oppositional Defiant Disorder
- Deterioration in math skills
- Separation anxiety
- Depression
- Rages
- Anorexia
If any of these symptoms are consistent with your experience, schedule a call with Dr. Oskin.
PANS/PANDAS DIAGNOSIS AND EVALUATION
The PANS/PANDAS diagnosis is currently made through a laboratory blood test combined with clinical history. Some standard laboratory blood tests may be helpful if the child’s clinical history indicates the sudden and drastic onset of tics and/or OCD symptoms after a strep throat or other infection.
If tics and OCD behaviors start during an acute case of sore throat, the child should receive a rapid strep test and throat culture to rule out an acute strep infection. Treat the strep infection appropriately and if the acute infection has resolved but the tics and OCD behaviors persist, then it can be helpful to test for immune markers to see if a recent streptococcus infection may be related to the timing of the onset of PANDAS symptoms.
Consult with Dr. Oskin if you think your child may suffer from PANDAS.
CONVENTIONAL TREATMENT
PANS/PANDAS still has not been universally accepted by the conventional medical community. Current treatments for PANS include long-term prophylactic antibiotics, short-term corticosteroids, intravenous immunoglobulin (IVIG) and plasmaphoresis, selective serotonin reuptake inhibitors (SSRI’s), and cognitive behavioral therapy.
Alternative and naturopathic physicians treating PANS have proposed treating yeast and gastrointestinal infections, adding treatments such as curcumin, food allergy elimination, and additional immune-supportive treatments. The use of some of these medications is currently considered off-label and experimental as it is an area of ongoing research.
HOMEOPATHIC TREATMENT
Dr. Oskin uses homeopathy as a safe and effective treatment for the treatment of PANS/PANDAS, without harmful side effects.
Homeopathy tends to help the most with tics, OCD behaviors, sensory processing problems, tantrums, violent behaviors, hyperactivity, ADD/ADHD, mood fluctuations, and separation anxiety.
Because homeopathy is a holistic therapy, when we treat children with PANS/PANDAS, we are also treating the whole body. If the child also suffers from other problems such as chronic recurrent ear infections, allergies, digestive problems, or other health concerns, these issues too may be helped by comprehensive homeopathic treatment.
Read this article by Dr. Oskin with a case series of PANS/PANDAS cases treated safely and effectively with homeopathy.
REFERENCES:
Aggarwal BB, Harikumar KB. Potential therapeutic effects of curcumin, the anti-inflammatory agent, against eurodegenerative, cardiovascular, pulmonary, metabolic, autoimmune and neoplastic diseases. Int J Biochem Cell Biol. 2009;41(1):40-59. Emedicinehealth.com
Garvey MA, Snider LA, Leitman SF, Werden R, Swedo SE. Treatment of Sydenham’s chorea with intravenous immunoglobulin, plasma exchange, or prednisone. J Child Neurol. 2005;20(5):424-42 http://pandasnetwork.org/
Kondo K, Kabasawa T. Improvement in Gilles de la Tourette syndrome after corticosteroid therapy. Ann Neurol 1978;4:387.
Matarazzo EB. Tourette’s syndrome treated with ACTH and prednisone: Report of two cases. J Child Adolesc Psychopharmacol 1992;2:215-26. Medscape.org
Pavone P, Bianchini R, Parano E, et al. Anti-brain antibodies in PANDAS versus uncomplicated streptococcal infection. Pediatr Neurol. 2004;30(2):107-110.
Perlmutter SJ, Leitman SF, Garvey MA, et al. Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood. Lancet. 1999;354(9185):1153-1158.
Pigott TA, Seay SM: A review of the efficacy of selective serotonin reuptake inhibitors in obsessive-compulsive disorder. JClin Psychiatry 1999, 60:101-6. 82. Biondi M, Picardi A: Increased
Rondeau, Steve. PANDAS: An Immune-Mediated Mental Illness. NDNR. December 2010: Vol 6, Issue 12, pp. 1-4.
Snider LA, Lougee L, Slattery M, Grant P, Swedo SE. Antibiotics prophylaxis with azithromycin or penicillin for childhood-onset neuropsychiatric disorders. Biol Psychiatry. 2005;57(7):788-792.
Storch EA, Murphy TK, Geffken GR, et al. Cognitivebehavioral therapy for PANDAS-related obsessive compulsive disorder: findings from a preliminary waitlist controlled open trial. J Am Acad Child Adolesc Psychiatry. 2006;45(10):1171-1178.
Swedo SE, Leckman JF, Rose NR. From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS (Pediatric Acute-onset Neuropsychiatric Syndrome). Pediatr Therapeut. 2012;2(2):113.
Swedo SE, Leonard HL, Garvey M, et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry. 1998;155(2):264-271
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