Sensory and Motor Abnormalities is one of the main categories of symptoms PANS PANDAS patients can experience.
Like all PANS PANDAS symptoms, motor abnormalities can look different from patient to patient.
Some signs of Motor Abnormalities:
- Choreiform movements, i.e., piano fingers. Not large chorea movements as seen in Sydenham chorea
- Hyperactivity (also linked to ADHD-like Symptoms)
- Akathisia – A movement disorder that makes it difficult to stay still and causes urges to move that are not controllable. Examples are fidgeting, pacing, crossing and uncrossing legs, etc.
- Handwriting deterioration – dysgraphia
There are two sets of Sensory Abnormalities seen in PANS PANDAS. One is what looks like Sensory Processing Disorder (SPD), and the other is Hallucinations.
Sensory Processing Symptoms
Some PANS PANDAS patients have sudden sensory avoidance symptoms while others have sensory-seeking behaviors.
Sensory processing is when the nervous system cannot correctly receive messages from the senses or is unable to provide the appropriate behavioral or motor response. Difficulty in processing sensations creates challenges in every task, creating issues with pain, sound, touch, and feeling and can lead to problems that result in behavior issues, anxiety, depression, and many issues with school work and daily living. Some over-respond (sensory avoidance) to sensations while others may under-respond. Over-responders (sensory seeking) can find even the slightest input, visual or auditory, unbearable. Under-responders may show little to no response to sensory input and be slow to respond to sensation.
Some of the signs of SPD are below:
- Food refusal – certain textures or smells are refused (see more about PANS & Restrictive Eating)
- Extreme irritability when wearing certain clothes
- Resistant to cuddling. Infants arch and pull away from people holding them.
- Unaware they have bumped into objects unless done with force
- Slow to respond to pain
- Overly sensitive to stimulation: touch, noise, smells, etc
- Constantly in motion, body moving, running constantly
- Craves roughhousing
- Uses inappropriate force to handle objects
- Slouches in chairs. Looks floppy.
- Difficulty playing with toys requiring dexterity
- Difficulty learning new motor skills
- Handwriting skills are difficult
- Babies have difficulty self-soothing
- Clumsy. Doesn’t have a good sense of the relationship between body and space around them.
- Slow to perform tasks
Patients with PANS PANDAS can have visual hallucinations. These typically manifest as objects that move or change size or as frightening images. Often hallucinations last for a brief period but can last for hours or longer.
According to Dr. Frankovich*, 36% of PANS patients have visual and/or auditory hallucinations. These patients are predominately dealing with higher disease severity. Hallucinations are transient in 83% of those patients. Hallucinations present as non-threatening voices/figures, 6% have delusions, and 6% have thought disorganization. Hallucinations cause a higher caregiver burden.
*As per Dr. Frankovich- SANE conference lecture 2019