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PANDAS Syndrome: Causes, Symptoms, Diagnosis and Treatment

September 1, 2023

Strep throat is a common infection in most kids; some get it repeatedly. Usually, a course of antibiotics is needed to treat the condition. But rarely, in some children, it triggers a strange behaviour known as PANDAS. The child suffering from it will be aggressive, anxious, may be uncontrolled body motions, etc. It can be pretty scary for parents, but early diagnosis and treatment make them more likely to recover well. Read below to learn more about PANDAS.

What is PANDAS?

Pediatric Autoimmune Neuropsychiatric Disorders Syndrome, PANDAS, is a complex but rare disorder linked to streptococcal infections. It usually affects adolescents and children. While the exact reason for it is unknown, it is said that it can be because the immune system mistakenly targets the brain’s basal ganglia. That results in symptoms of tic disorders like Tourette’s syndrome or OCD. The result of this syndrome is that the child’s quality of life is affected, and the treatment can be challenging.

What are the Symptoms of PANDAS?

The signs and symptoms of PANDAS vary from one child to another, and there can be a combination of neurological and pathological conditions. The symptoms start suddenly and come in episodes. They last a few weeks or days, there may be lapses. The psychological symptoms that have been reported are:

  • Bedwetting
  • Difficulty sleeping
  • Lack of interest in food
  • Changes in mood
  • Irritability or rage
  • Fidgeting
  • Symptoms similar to ADHD
  • OCD-like behaviour
  • Separation anxiety
  • Depression
  • Tics like that of Tourette syndrome

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Neurological symptoms reported are:

  • Changes in motor skills, like problems with handwriting,
  • Difficulty in learning and concentration
  • Poor school performance
  • Sensitivity to sound and light
  • Decreased coordination

Signs and symptoms appear immediately after a strep infection and can be preceded by other signs and symptoms like rashes, fever, or a sore throat. These usually last for about a month to six weeks. There are also cases when the children have this problem without a strep infection. So the onset is unclear, and the symptoms worsen after a streptococcal infection.

What are the Causes of PANDAS in Children?

According to some experts, PANDAS develops when a kid’s immune system generates antibodies to fight off the strep infection-causing bacteria. But the antibodies attack the healthy cells mistakenly in the other tissues as the cells mimic a strep infection.

How rare is PANDAS?

PANDAS is more common in boys than girls, although both can be affected. The exact prevalence is unknown, but it is said that it can occur in one in 200 children. Diagnosis of PANDAS is controversial as the exact mechanism and cause of this syndrome are not fully understood.

Who can get PANDAS?

PANDAS is commonly found in children between 3 and 12 years of age. Some experts say that male children are more at risk than females. The other risk groups are those with frequent scarlet fever or strep throat infections and those with a family history of rheumatic fever or autoimmune disorders.

It is also said that it is highly improbable for teenagers or adults to have neurological or mental symptoms from Streptococcus infections.

PANDAS Diagnosis

The first step is a PANDAS medical examination that includes checking the family and medical history. Then a physical examination is done to determine if the patient has:

  • ADHD or OCD-like symptoms
  • Tics
  • Signs that began between the ages of 3 and 12
  • Worsening symptoms or sudden onset of it for a short period.
  • A connection between the onset of symptoms and streptococcal infection- anti-streptococcal antibodies and cultures confirms this.
  • Link with neurological symptoms like anxiety, hyperactivity, developmental regression, and mood changes.

The diagnosis is usually made by exclusion, which means the doctor rules out other possibilities before coming to a conclusion.

Treatment for PANDAS

It is a combination of treatments that includes immunomodulatory therapy, antibiotics, and behavioral therapy. The treatment plan is personalized based on the child’s needs and adjusted as and when necessary.

  • Antibiotics: Streptococcal infections are treated with antibiotics for 10 to 14 days.
  • Immunomodulation: It includes immunoglobulin, corticosteroids, etc.
  • Behavioral therapy: It is done to manage behavioral issues and OCD-like symptoms.

It is essential to work with a specialist pediatrician, psychiatrist, and neurologist so that the treatment plan is as per the child’s needs. While PANDAS is treatable, the disorder does not have a cure. The child needs follow-up care and close monitoring to prevent relapses and manage symptoms.

Prognosis of PANDAS

It is quite a challenge for children with OCD to handle sudden changes in behaviour and thoughts. Worrying about their health and food can lead to severe contamination fears, resulting in weight loss and anorexia. It can lead to separation anxiety when older children stick with their parents. The children can also have constant panic attacks in the initial stages. These changes are challenging for their families, so continuous understanding and support are needed. The outlook for children depends on their severity and treatment effectiveness. With proper treatment, children can see good improvements.

Does PANDAS go away?

It does so, as the child goes into adulthood.


Is PANDAS lifelong?

PANDAS may take time to cure, but they recover completely after treatment. The symptoms improve after a few months, but there can be ups and downs.

Is PANDAS serious?

PANDAS is not life-threatening, but children with this syndrome have significant ups and downs in the severity of their symptoms of Tics and OCD.

Can you fully recover from PANDAS?

Yes. Children with PANDAS can make a full recovery.

At what age do PANDAS go away?

Research suggests that 95% of kids outgrow this disease by adolescence as they have a more mature immune system.

What happens if PANDAS go untreated?

If PANDAS is not diagnosed or treated, the child may have OCD symptoms that will follow into adulthood and chronic autoimmune disease.

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