What is PANDAS : Causes, Symptoms, Treatment, Prognosis

PANDAS refers to a pathological condition found in children called as “Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections.” As the name suggest, this condition develops after a streptococcal infection in which the child develops significant physical and behavioral problems after the infection is treated. PANDAS can develop with even simple conditions like a strep throat or sinusitis. It can also occur following cellulitis and scarlet fever. PANDAS is quite a rare condition and not everyone gets it. It is estimated that this condition occurs in one among 2500 children. The diagnosis of PANDAS or Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections is quite difficult due to the similarity of symptoms to many other different conditions.

As stated above, PANDAS occurs following a streptococcal infection like sinusitis or scarlet fever. The body has its own mechanism in fighting off infection which is done by the immune system of the body. This system first identifies the foreign body in the system and then produces antibodies to fight off the foreign body and eliminate them. While this works for some types of infections, in case of streptococcal infection, the streptococcus bacterium hides itself behind the healthy cells of the body and hence the body is unable to recognize it but ultimately the body is able to identify the bacterium and attack it but during this process a number of healthy cells are also destroyed. Sometimes, these antibodies produced by the body’s immune system attacks the brain cells causing a variety of symptoms like obsessive compulsive disorders, tics and the like which are the classic presenting feature of PANDAS or Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections.

The symptoms of PANDAS are quite similar to those seen in patients with Obsessive Compulsive disorders, attention deficit disorders and tic disorders. Along with this there are several other symptoms associated with PANDAS or Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections. These symptoms are:

• Separation anxiety
• Frequent mood changes
• Sudden change in handwriting
• Frequent bedwetting
• Problems with sleep.

These symptoms tend to get worse during an infection and may get better in between.

There are no specific studies to diagnose PANDAS or Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections apart from investigations to identify a recent strep infection. Apart from this, the diagnosis of PANDAS is made based on the history and examination of the patient. In order to confirmatively diagnose PANDAS, the following criteria should be met.

• The patient should have active symptoms of Obsessive-Compulsive disorder, ADHD and oppositional defiant behaviors
• The onset of symptoms should be sudden or immediately following a strep infection
• These symptoms should be associated with other neurological abnormalities like motor hyperactivity, involuntary jerking movements, anxiety, emotional lability, bedwetting, temper tantrums, personality changes, and problems with calculations
• These symptoms should be observed following a proven beta-hemolytic streptococcal infection which can be proved by culture studies

If these criteria are met and there is clear evidence of a streptococcal infection that preceded following the onset of symptoms confirms the diagnosis of PANDAS or Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections.

The most preferred way to treat PANDAS is by doing a cognitive behavioral therapy. This therapy has been proved to be quite successful in many patients with known diagnosis of PANDAS. For other symptoms of PANDAS or Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections, medications can be used to ease the symptoms depending on the severity of it. The medical therapy is basically focused on treating the obsessive compulsive component of PANDAS and hence the patient may be given SSRI to treat the symptoms of OCD. The next step towards treating PANDAS is to treat the infection that caused the onset of PANDAS or Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections. This is done by use of antibiotics like penicillin, amoxicillin, or azithromycin. For extremely severe cases, use of IVIG has also shown to be of benefit in treating PANDAS along with use of steroids, and plasmapheresis.

When it comes to prognosis, there have been several cases where children have completely recovered from the symptoms of PANDAS or Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections whereas there are also some cases where there has been a worsening of neurological symptoms, especially after each strep infection. It is not possible to predict which children will be completely cured and which will have worsening symptoms PANDAS.