PANDAS syndrome: Symptoms, underlying factors, therapeutic approaches, and additional insights
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) is a complex autoimmune condition that primarily affects prepubescent children. Characterised by a sudden onset of neuropsychiatric symptoms, PANDAS is often triggered by group A streptococcal infections [5].
Common Symptoms
The condition is marked by a sudden and severe worsening of obsessive-compulsive disorder (OCD) symptoms and motor and vocal tics. Emotional instability, including depression, mania, irritability, rapid mood shifts, rage episodes, and emotional lability are also common [1][5]. Neurocognitive issues such as difficulties with executive functioning, visual-spatial memory, fine motor skills, deteriorated handwriting, and fluctuating school performance are also observed [1]. Somatic symptoms, including urinary frequency, polyuria, and secondary enuresis unrelated to infection or anxiety, are also prevalent [1].
Causes
PANDAS is primarily triggered by infections with group A streptococcus, though other infectious agents like Mycoplasma pneumoniae, influenza virus, Epstein–Barr virus, and Borrelia burgdorferi can also be involved [5]. It is believed to be an autoimmune disorder, potentially with increased risk if a parent (especially the mother) has an autoimmune disease [5]. The precise pathogenesis remains under investigation, but it is thought that antibodies generated during infection mistakenly attack brain regions involved in behavior and movement [5].
Treatment Options
Effective management of PANDAS relies on a multidisciplinary approach, targeting both the underlying immune dysfunction and the neuropsychiatric symptoms. Medication treatments include anti-inflammatory drugs such as corticosteroids or NSAIDs to reduce immune-related inflammation, psychiatric medications like selective serotonin reuptake inhibitors (SSRIs) to alleviate anxiety, OCD, and depression symptoms, and atypical antipsychotics for severe symptoms such as hallucinations or delusions [2].
Therapeutic interventions include cognitive-behavioral therapy (CBT) to manage OCD, anxiety, and mood symptoms, occupational therapy to improve cognitive and motor skills and help with daily functioning, and family therapy and support groups for emotional support and coping strategies [2].
In many cases, symptoms can wax and wane, with improvement between episodes; treatment also focuses on managing flare-ups promptly and preventing further streptococcal infections [3].
In summary, PANDAS is a complex pediatric autoimmune syndrome triggered by streptococcal infection, with sudden neuropsychiatric and somatic symptoms. Diagnosis is clinical with supporting history of infection. Effective management relies on immune modulation, psychiatric treatment, and supportive therapies [1][2][3][5].
It is important to note that many children respond well to antibiotics, but when antibiotic treatment does not help, the child may need therapy and other ongoing support to manage their symptoms. A potentially related condition called Sydenham chorea appears after rheumatic fever, which is a heart condition that can develop with certain untreated strep infections. PANDAS can cause tics in movement and speech, including syndromes such as Tourette's syndrome.
Anecdotal evidence suggests that symptoms may disappear in adulthood, but long-term studies are virtually nonexistent. Children with PANDAS may have a history of strep infections, such as strep throat. Symptoms of PANDAS syndrome appear suddenly, rather than developing gradually over time.
Doctors rely on a child's symptoms and medical history to diagnose PANDAS. A child must meet the age requirement for PANDAS, as symptoms tend to manifest between the ages of 3 years and puberty. If a doctor recommends removing the tonsils because of tonsillitis, parents or caregivers should discuss the risks and benefits with them and also consult the doctor who is treating the child's PANDAS.
Parents or caregivers who suspect that a child may have PANDAS syndrome should find a pediatrician who specialises in PANDAS, strep infections, or childhood mental health symptoms. The doctor will search for evidence of OCD, tics, or both.
- Despite the common use of antibiotics for treating group A streptococcal infections, children with PANDAS may require additional therapy and support, including psychiatric medications and therapeutic interventions like cognitive-behavioral therapy and occupational therapy.
- The sudden onset of symptoms such as severe OCD, motor tics, and emotional instability in children may indicate Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS), a condition primarily linked to group A streptococcal infections but also convalescent by other infectious agents.
- Mental health issues, including obsessive-compulsive disorder (OCD), depression, and emotional lability, are often associated with PANDAS, a complex pediatric autoimmune syndrome, underscoring the importance of integrating mental health considerations, such as science-based treatments and support, in its management.
