PANDAS Syndrome Explained

PANDAS Syndrome is a rather complicated disorder primarily applicable in children.

Its complete form is Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.

According to a neuropsychiatrist in Patna Bihar - It has to do with the sudden changes in behavior in a child after a strep infection.

Knowing what causes PANDAS and understanding its signs, symptoms, diagnosis, and treatment helps parents or caregivers know the appropriate response.

It is thought that PANDAS develops mainly due to infection with Streptococcus A, the very same bacteria that cause sore throat and scarlet fever, among others.

In some particular children, the immune apparatus does not stop working after the infection has been cleared; that is, the immune apparatus misidentifies healthy brain tissue as foreign and starts to attack it, especially in the areas of the brain called the basal ganglia, which are involved in fundamental movement, behavior, and emotion.

This autoimmune reaction creates inflammatory changes inside the brain and leads to sudden alterations in a child's mind and emotionality.

Current knowledge does not address the issue of why this happens in some and not in others. Genetic predisposition triggered by environmental means has been implicated.

Most affected are children between the ages of 3 and 12 years. Hence, this age range is at risk during the normal growth of children.

The most complicated aspect of PANDAS is the symptoms presented: they can occur suddenly or rapidly.

Very often, a child who seemed all right just a few days ago now suddenly displays bizarre and even alarming sets of behaviors.

Symptoms appear at least days to weeks following a strep infection and may include:

• Obsessions-compulsions, such as washing hands many times or checking;
• Increased anxiety or unreasonable fears;
• Mood changes, irritability, or aggression;
• Motor or vocal tics, such as blinking, grunting, or throat-clearing;
• New bedwetting or loss of bladder control;
• Difficulty concentrating, hyperactivity, or falling behind in school;
• Change of appetite or sleep.

Most of the time, such signs direct parents to seek the services of a psychiatric professional, not understanding that the probable underlying cause has medical as well as infectious etiologies.

PANDAS diagnosis is indeed complicated because many of the symptoms look similar to those of Tourette's syndrome, attention deficit hyperactivity disorder, or anxiety disorders.

A few criteria act as very important bulwarks of assistance for the physician toward diagnosis:

• A drastic onset of either OCD or tics, or a sudden behavioral change.
• Evidence of a recent strep infection, possibly demonstrated by throat swab culture or blood tests.
• Other causes for the above symptoms cannot be determined by any other specific known medical or neurological condition.
• Usually, this involves a thorough medical history with questions about recent strep infections and neurological and psychological evaluations. Imaging tests could be done to rule out other possible presentations.

In the past two or so decades, research on PANDAS has grown, and evidence almost suggests an autoimmune theory triggered by bacterial infection. Recent brain imaging technologies, such as MRI, have revealed inflammatory processes in children with PANDAS within their basal ganglia.

A few investigators had also tried correlating such antibodies with interference with the Blood-Brain Barrier (BBB) by antibodies that are produced in response to infections of Streptococcus. Other studies have concentrated on genetic predisposition and differences in immune response profiling that may be of help in determining the reasons some children develop PANDAS after having strep.

Although quite a way from achieving this goal, helpful hints are leading toward more elaborate, better treatment options.

The good news about PANDAS is that it becomes treatable, especially when early diagnosis is made.

Medical and psychological means are usually combined into treatment plans, which involve:

• Antibiotics to eradicate any remaining strep infection.
• Anti-inflammatory drugs (e.g., ibuprofen, corticosteroids) to treat inflammation of the brain.
• Therapy like Cognitive Behavioral Therapy (CBT) to relieve symptoms from OCD, anxiety, or tics.
• Advanced and sometimes, recurrent or severe cases, may include treatment with IVIG (Intravenous Immunoglobulin) or plasmapheresis to reset the immune system.

Early intervention may reduce the limits and avoid further flare-ups. Follow-up care and emotional support are vital for the recovery process.

Many parents ask: How long does PANDAS syndrome last? Duration varies among children; some children become completely recovered after a single episode, especially if treated very early, while others may have subsequent episodes triggered by secondary infections or high-stress circumstances.

Usually, symptoms eventually fade with age. Early treatment, emotional support, and medical follow-up could all greatly help improve the prognosis.

How common is PANDAS syndrome? It is a rare syndrome; it is like a needle in a haystack. There is a growing level of awareness of PANDAS among pediatricians, neurologists, and mental health practitioners. Some estimates put the incidence somewhere in the range of one in two hundred children with PANDAS, but better diagnostic modalities and research will eventually address this issue in detail.

Increased awareness among parents and health providers of the symptoms would thus facilitate the diagnosis that was previously not reached.

PANDAS Syndrome deeply traumatizes families, as it manifests suddenly and intensely in children. However, children can be healed with prompt diagnosis and treatment, and can lead their lives normally. Continuous research has renewed hope and understanding regarding possible causes of PANDAS, thus giving hope to many more families.