PANS/PANDAS

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder associated with Acute Streptococcal Infection)

In 1998, Dr Susan Swedo at the NIMH noticed that some children with strep throat infection went on to develop some unusual behaviors such as obsessive compulsive behaviors, motor/vocal tics and anxiety so she described the syndrome of PANDAS.

in 2012, a consortium was convened to evaluate what had been learned about this unusual condition and it was renamed PANS (Pediatric Acute-onset Neuropsychiatric Syndrome). PANS is now the general term to describe these post-infectious behaviors and PANDAS is reserved just for patients that have streptococcal infection as the cause.

The diagnosis requires at least one of the two major criteria (patients can have both) and at least 2 of a list of 7 minor criteria. A classic presentation is often abrupt and dramatic in onset:

Major Criteria:

1: Obsessive-Compulsive Behaviors

2: Food aversion/avoidance/restriction

Minor Criteria:

1: Anxiety

2: Emotional Lability/Depression

3: Irritability, Severe Oppositional Behavior

4: Regressional behaviors 

5: Deterioration in academic performance

6: Sensory/motor abnormalities: motor/vocal tics, sensory overload, dysgraphism

7: Somatic signs/symptoms: urinary issues, sleep problems, abdominal pain, dilated pupils

There is ongoing research across the US investigating this challenging condition. While strep throat infection is known to be linked to this syndrome, there are other infections that seem also to trigger onset of PANS behavors such as influenza, walking pneumonia and viral gastroenteritis.

PANS is a collection of observed behaviors and there is no lab test that can “rule it in or rule it out”. Some patients can have minor flares of behaviors for years and then suddenly escalate to severe symptoms and others can be totally normal until suddenly they are severely impaired.

Dr. Fox has known about and believed in this condition since the year 2000 when a mother brought her teenage son into the office with a print out of Dr. Swedo’s paper describing this syndrome. Prior to that, Dr. Fox had never known about this condition but Chaz and his mother proved its validity over the course of the next few years. Since 2016, Dr. Fox takes a functional approach to helping her patients with PANS including both prescription medications and herbal treatments as approprite for the individual patient. She most vigorously searches to discover the root causation for this syndrome.