Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, or PANDAS for short, was a relatively new term that this writer was not very familiar with more than three weeks ago. For those of you like this writer who were unaware that a neuropsychiatric disorder shared its name with a black and white bear, let me share some information. According to the National Institute of Mental Health (NIMH), PANDAS is a “syndrome” which means it includes a number of disorders and issues that share an origin. This list includes tic disorders, obsessive compulsive disorder, anxiety disorders and some mood/behavior issues (PANDAS, 2015).
The shared origin of the disorders and issues listed above, in regards to PANDAS, results in the child having contracted a streptococcal infection (strep throat/scarlet fever). Strep is an extremely old bacterium that survives very well due to its ability to hide from its host’s immune system. It brilliantly has a biological cloaking system called molecular mimicry. Essentially, it places molecules on the outer portion of its cell wall that make it indistinguishable from molecules found within the host child’s brain, heart, joint and skin tissues. This allows it to avoid discovery and rapidly multiply unimpeded for some time. When the intruders are finally recognized, they are attacked by antibodies created by the immune system. However, due to the molecular mimicry, the antibodies attack not only the strep molecules but host’s tissue molecules that were mimicked. Therefore, some anti-bodies target the host’s brain tissue specifically. The result of the attack on the brain tissue is what is said to be causing the symptoms of PANDAS (Streptococcus. 2015).
The symptoms of PANDAS are vast and can vary from child to child. The symptoms can include: rapid onset or worsening of symptoms already present, a tic disorder and/or OCD, ADHD symptoms (hyperactivity, inattention, fidgety), physical hyperactivity (or unusual, jerky movements that are not in the child’s control), separation anxiety, mood changes (irritability, emotional lability, sadness), sleep disturbance, gross/fine motor changes (such as changes in handwriting or drawing abilities), anorexia or refusal to eat, night-time bed wetting and/or day-time urinary frequency and joint pains. The age if onset is usually anywhere from three years to the beginning of puberty. The child also must have had a positive strep culture or previous history of scarlet fever. It is important to note that the symptoms can go through an episodic course meaning they can cycle in their presence and severity with each new contraction of a streptococcal infection (PANDAS, 2015).
Currently, there is not a lab test used in the diagnosing of PANDAS but, as mentioned above, the child must have had a positive strep culture or previous history of scarlet fever and some combination of the majority symptoms. PANDAS is a clinical diagnosis and must meet a set of specific criteria for the diagnosis to be given. If you believe your child may suffer from the syndrome, then contact your health care provider to discuss your child’s symptoms. Treatment usually consists of one round of antibiotics to eliminate the streptococcal bacterium. Symptoms will then begin to decrease over the course of several days to weeks.
Crystal K. Bray,
WKPIC Doctoral Intern
Works Cited
PANDAS: Fact Sheet about Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. (n.d.). Retrieved November 29, 2015, from http://www.nimh.nih.gov/health/publications/pandas/index.shtml
Streptococcus. (2015). In Encyclopædia Britannica. Retrieved from http://www.britannica.com/science/Streptococcus
Washington, H. (2015, November 3). Catching Madness. Retrieved November 29, 2015, from https://www.psychologytoday.com/articles/201511/catching-madness?collection=1081138
Crystal K. Bray,
WKPIC Doctoral Intern