PANS & PANDAS

Did you know that PANS is suspected as a culprit in up to 25% of all pediatric OCD diagnoses?  Beyond that, it is estimated to be much more prevalent than initially believed and may occur in as many as 1 in 200 individuals.   

You are the parent or caregiver of a child, teenager, or even an adult whose life has forever been changed.  You remember the day or month that everything started to change.  Suddenly, your precious child started to display behavioral, emotional, social, motor and cognitive changes.  This may have occurred during the first years of life or later into the teenage years.  The one thing you know for sure is that there was a specific event: infection or adverse reaction.  

You may have received a diagnosis and are looking for treatment, or you are trying to figure out exactly what is wrong.  Either way, your ultimate goal is to not only better understand what is going on but to see if there is any hope.

I am going first to address those who are searching for an answer.  From our experience, after the changes occurred you brought your child to receive help and were given the diagnosis of autism.  The only problem is that as you participate in autism groups, you see that your kid does not seem like the rest of the autistic kids.  Even more noticeable are the drastic changes you see when your child is sick.  If you have tried different diets and have removed inflammatory foods, you may have noticed that when your child has any food that causes inflammation the symptoms increase as well.

Signs and symptoms like that usually point in one direction.  That is a problem with the immune system.  Any neurological process, especially those with a major immune component can have varying symptoms based off of sleep, stress, illnesses, and diet.


What Exactly is PANS/PANDAS

PANS is an acronym for Pediatric Acute-Onset Neuropsychiatric Syndrome.  PANDAS is an acronym for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.  The main difference between these two is that PANDAS is explicitly identified using an ASO (antistreptolysin O) lab test that reveals an unresolved strep infection as the primary cause.  PANS, on the other hand, may or may not have an identifiable infectious cause.  From this point, I am going to use the term PANS to describe both of them.

While there may be an infectious organism or a specific event that triggers the development of PANS, the origin itself is immune based.  What ends up happening is an organism or chemical enters through the blood-brain barrier.  The immune system does not like this and becomes overactive.  During this period of overactivity, it becomes confused and actually starts labeling brain tissue as bad.  The region attacked is predominantly the basal ganglia, which is a relay system responsible for regulating emotions, cognition, movement, sensory control, and much more.  Specific symptoms that are commonly seen are listed below.

Common Symptoms

  • Obsessive-compulsive
  • Motor Tics
  • Vocal Tics
  • Irritability
  • Mood Swings
  • Focus or Attention Diminished
  • Academic/Cognitive Difficulties
  • Motor Coordination and Function Loss






How We Reach a Diagnosis

Following a very careful and detailed history of events, we start searching for an answer.  If we suspect PANS, we will start by looking for any signs of unresolved infections such as Strep, Epstein-Barr, and Mycoplasma Pneumonia to name a few.  It is important to note once again that not all cases of PANS have an identifiable organism and for this reason, we will run an advanced lab to identify if brain autoimmunity is present.  We utilize the Cunningham Panel which is developed by Moleculera labs out of the University of Oklahoma.  

Integrative Treatment for PANS

Our multi-disciplinary team is well equipped to evaluate and off therapies for PANS.  Labs typically are not the only diagnostics we perform.  Depending upon the severity of present symptoms we will utilize in-office diagnostics to assess the functionality of different brain regions.  Overall our goal is to bring symmetry in function back to the brain.

In PANS some areas are grossly over firing and are not being inhibited by higher areas.  Our specific therapies utilizing rTMS (repetitive transcranial magnetic stimulation), eye movements, impulse control, coordination, and balance training are all intended to do this.

Beyond neurological stimulation, if there are any identifiable infectious organisms present it will be treated.  The treatment does not stop there as this is an autoimmune disease.  All autoimmune treatments we perform are focused on identifying the factors that are negatively impacting the immune system.

PANS Specific Factors
  • Diet
  • Gut Health
  • Detoxification
  • Sleep
  • Stress
  • Nutritional Imbalances

A major part of the treatment is utilizing diet and lifestyle to regulate the immune system.  Diet plays a major role in all autoimmune diseases and is a major contributor to not only the severity but ability to improve.  In many patient’s diet needs to be supplemented using specific supplements to improve nutritional status to reduce inflammation, repair the gut, and support the brain.  The last thing that is becoming more commonly used is IVIG (intravenous immunoglobulin) therapy.

I want to stress that this is a life-long process.  The treatment that alleviates symptoms may need to be continued long-term, but diet and stress reduction techniques should be permanent.  One of the things you may notice are that poor sleep, stress, infection, and diet will cause a flare-up of symptoms.  This does not necessarily mean you are going backward long-term, but it will usually last till the contributing factors are corrected



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