What is PANDAS?
PANDAS stands for Pediatric AutoImmune Neuropsychiatric Disorders Associated with Streptococcal Infections. PANDAS is hypothesized to be caused by strep bacteria, which can hide from a child’s immune system by mimicking healthy cells in the skin, heart, joints, and brain tissue. The cause of PANDAS is an active area of research.
PANDAS symptoms typically involve a sudden onset or worsening of tics and/or Obsessive-Compulsive Disorder (OCD) in children in the immediate aftermath of a streptococcal infection. While many children may experience strep throat, OCD, or tics, PANDAS is diagnosed when there is a close relationship found between the onset/severity of these symptoms and a streptococcal infection.
PANDAS is typically treated using a combination of medications and therapy, though less common treatments like a blood plasma exchange or intravenous immunoglobulin therapy may also be recommended for severe cases. It is important for parents of PANDAS patients to work with a pediatrician and a licensed mental health care provider familiar with PANDAS treatments to determine the best options for your child.
PANDAS is related to the less specific diagnosis of PANS: Pediatric Acute-Onset Neuropsychiatric Syndrome. PANS and PANDAS share the same symptoms and sudden onset, but a PANS diagnosis is used when the infectious trigger is unknown while a PANDAS diagnosis indicates that a streptococcal infection has been identified as the trigger.
Is PANDAS a real diagnosis?
Yes, PANDAS is a real diagnosis and has been since 1998. Since symptoms of PANDAS may overlap with more common pediatric diagnoses like OCD, autism, and ADHD, some doctors are reluctant to consider PANDAS an independent diagnosis. However, more than twenty years of research have clearly established that PANDAS is not a hoax and requires specific treatment.
Can adults get PANDAS?
The diagnosis of PANDAS has an age requirement ranging from 3 years old to puberty. While cases of acute-onset OCD in adolescents and adults following bacterial infections have been reported, no official diagnosis of an adult-onset autoimmune neuropsychiatric disorder associated with streptococcal infections has been established. However, there is no age requirement for a PANS diagnosis so teenagers and adults who meet the other diagnostic criteria for PANDAS may receive a PANS diagnosis instead.
How can I tell the difference between PANDAS and childhood-onset OCD?
For a diagnosis of PANDAS, your child must have a recent history of strep throat and a sudden onset of symptoms—tics, restrictive eating, and obsessive-compulsive behaviors often appear in PANDAS patients overnight. If your child starts exhibiting these symptoms more gradually or has no recent history of strep throat, it is more likely that they are experiencing symptoms of another psychiatric condition.
My child had strep throat recently. Should I be worried about PANDAS?
The CDC estimates that several million cases of strep throat occur every year, but the PANDAS Network reports that only 1 in every 200 children goes on to develop PANDAS after a strep throat infection. If you do not notice a sudden onset of psychiatric symptoms in your child in conjunction with a strep throat infection, you do not need to worry about PANDAS.
I think my child has PANDAS. What should I do?
To find a medical provider with knowledge about PANDAS, contact the International OCD Foundation or the PANDAS Physicians Network. Should your child receive a diagnosis, a combination of treatments and medication should improve their symptoms over time. While much is still unknown about PANDAS, current treatments are highly effective and most children with PANDAS recover fully in a matter of weeks, though it may take several months for symptoms to subside.
- “PANDAS—Questions and Answers”, NIMH
- “A Survey of Pediatric Acute-Onset Neuropsychiatric Syndrome Characteristics and Course”, Journal of Child and Adolescent Psychopharmacology
- “A Psychiatrist's Guide To PANS & PANDAS” by Suruchi Chandra, MD
- “Q & A: Sudden symptoms are first sign of PANS and PANDAS”, Stanford Children’s Health