Paediatric acute-onset neuropsychiatric syndrome (PANS)  is a clinical diagnosis given to children who have a dramatic – sometimes overnight – onset of neuropsychiatric symptoms including obsessions/compulsions or food restriction. They are often diagnosed with obsessive-compulsive disorder (OCD) or an eating disorder, but the sudden onset of symptoms separates PANS from these other disorders. In addition, they may have symptoms of depression, irritability, anxiety, and have difficulty with schoolwork. The cause of PANS is unknown in most cases but is thought to be triggered by infections, metabolic disturbances, and other inflammatory reactions. (Source:  med.stanford.edu/pans.html)

Paediatric autoimmune neuropsychiatric disorder associated with streptococcal disease (PANDAS) like PANS, children with PANDAS have an acute onset – within 2 to 3 days – of neuropsychiatric symptoms, specifically OCD or tics (involuntary, purposeless movements). However, PANDAS patients test positive for a recent streptococcal infection, such as strep throat, peri-anal strep or scarlet fever. Like PANS patients, they also may suffer from uncontrollable emotions, irritability, anxiety and loss of academic ability and handwriting skills. Although PANDAS was identified as a medical syndrome more than a decade before PANS, it has been classified as a subset of PANS. To date, PANDAS is the only known subset of PANS, but we may discover more causes in the future. (Source:  med.stanford.edu/pans.html)

Unfortunately, most children with PANS/PANDAS are misdiagnosed as having psychiatric illness, behaviour problems, or parenting/family dynamic concerns. Many go through a number of psychiatric medications and therapies with minimal improvement, and many progressively get worse. A diagnosis of PANS or PANDAS should be considered whenever symptoms of OCD, tics, and eating restrictions start suddenly and are accompanied by other emotional and behavioural changes, frequent urination, motor abnormalities and/or handwriting changes. PANS/ PANDAS is also characterised by a relapse and remission pattern—children with PANS/PANDAS seem to have dramatic ups and downs in their symptoms, and an increased severity of symptoms is often correlated to a return of infection. (Source: Understanding PANS & PANDAS)

The proposed theory for PANS and PANDAS postulates that serum antibodies produced against infectious and non-infectious agents cross the blood–brain barrier (BBB) and cross-react with neuronal antigens. These antibodies then elicit injury and cause dysregulation to basal ganglia functions producing a variety of neurological and psychiatric manifestations. Anti-neuronal antibodies produced include anti-lysoganglioside, anti-tubulin, and anti-dopamine D1 and D2 receptor antibodies. Their effects on the brain include alterations to the enzyme tyrosine hydroxylase, resulting in increased synthesis of dopamine. In addition, dopaminergic and glutamatergic transmission and regulation are affected due to an increase in receptor sensitivity caused by antibody stimulation. Increased dopamine and glutamate in the basal ganglia may be responsible for the overstimulation and the many psychiatric symptoms associated with PANDAS. (Source: Understanding PANS & PANDAS)

See also Cunningham Panel and What is PANDAS/PANS?

My Kid is Not Crazy: A search for hope in the face of misdiagnosis from 4 The Kids Films on Vimeo.

PANS evaluation and management:

 

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