PANS & Lyme Disease – Dr. Moorcroft

Section 3: PANS and Lyme Disease

ASPIRE talks with Tom Moorcroft, DO about some of the most frequently asked questions on Lyme disease and tick-borne illness including Bartonella and Babesia. This article is divided into 4 separate sections.

  • Section 3: PANS & Lyme Disease
    • Relationship Between Lyme and PANS, or Pediatric Acute-onset Neuropsychiatric Disorder

The Lyme Disease and PANS Connection

Do I have patients with Lyme triggered PANS?  Do I have patients whose Lyme does not trigger PANS symptoms but does exacerbate the severity of pre-existing conditions or make it more difficult to recover and get back to their baseline?

Relationship Between Lyme and PANS, or Pediatric Acute-onset Neuropsychiatric Disorder

  • PANS is an autoimmune condition. It is an infection-induced or infection triggered autoimmune encephalitis or brain inflammation.
  • Three Scenarios
    • PANS is triggered by a non-tick borne illness; patient gets Lyme, symptoms re-ignite inflammatory process because immune system is already hyper-alert
    • PANS is triggered by Lyme disease; then secondary flares are triggered by a non-tick borne illness
    • PANS triggered by a non-tick borne illness, patient gets Lyme but they remain separate issues – rarely seen

I think there are a couple of things that happen. PANS is an autoimmune condition. It is an infection-induced or infection triggered autoimmune encephalitis or brain inflammation. PANS is an inflammatory process in the brain, not necessarily characterized by brain inflammation I could see on an MRI. For example, if you hit your knee hard enough that it swells and hurts, this is one form of inflammation. Or you could hit it and see no visible swelling but it still hurts. In this case, there is inflammation, just not visible. Likewise, we can have a brain with bad encephalitis that’s big and swollen but we can also have less inflammation that is still causing problems.

To bring it back to PANS, if you have recurrent strep in your throat and your nose, then we’ve have some evidence that your own immune cells that are supposed to work against strep, build up in the nose and go up olfactory nerve (nerve of smell) into the brain, cause breakdown of the blood-brain barrier and can cause inflammation. But an MRI of the brain would look pretty normal. I might need to look at some other types of scans to find some changes in metabolism. This is not a gross inflammation; this is more akin to the inflammation that hurts but is not really visible. PANS is an infection triggered process that causes our body to attack itself, which is autoimmunity, and then we see the inflammation.

There are three scenarios that we see. One scenario I rarely see is when patients with PANS are getting better, but then they get acute Lyme, so they are dealing with the acute Lyme on top of the PANS but they remain separate entities.

Another scenario is when strep or another infection is the initial trigger that starts the autoimmune inflammatory process. Lyme or another insult retriggers symptoms by re-igniting the inflammatory process, as the immune system is already hyper-alert and overreacts. I have many patients whose initial symptoms were triggered by strep or even mycoplasma, and then they get Lyme.

The third scenario is when Lyme can cause PANS; Lyme could be the infection that initially triggers autoimmunity that leads to PANS symptoms. Then secondary flares can be triggered by influenza, mycoplasma or strep. When another infection causes a secondary exacerbation, it doesn’t mean the Lyme is worse; it means that the subsequent trigger made the autoimmune inflammatory process worse. So, now we have two potential triggers to look at. When a patient experiences a secondary flare, it can be hard to determine if the Lyme is worse or if there is a potential secondary trigger to discover and treat. This is when testing and retesting makes a big difference. Having two or more active infections can make it more difficult to recover from and get back to the baseline.

Relationship Between Lyme and PANS ASPIRE MoorcroftIn all three scenarios, it is so important to look at what we’re doing at home. Again, we need to work on sleep, go outside, get fresh air and sunshine, move our bodies, and we need to eat foods lots of plants, remove sugar and processed foods, and we need to take time to chill out and relax. It can be challenging to get kids tuned into something; there’s a lot of online meditation or even just breathing exercises. They can do 90 seconds; they don’t have to do half an hour or an hour. Or you can do something less structured, something that helps them focus, like an art project, or even sit down and talk at dinner for even three minutes to start. It depends on where they are behaviorally and what their symptom severity is. At some point, make it a routine, and those little things can really make a big difference.

Section Links to Overview of Lyme & Tick-Borne Illness – Dr. Moorcroft


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            One comment to PANS & Lyme Disease – Dr. Moorcroft

            1. Rachel Morici-Leirer
              May 1, 2021

              Thank you for this concise and easy to understand explanation of the complexities of Lyme. As a parent, this information is so needed as I navigate the healing process with my Lyme/PANS child.


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