When to consider evaluation for PANS

If you see an unusually abrupt and acute onset of

  • Obsessive-Compulsive Symptoms and/or Severe Eating Restrictions

And at least two comorbid cognitive, behavioral, or neurological symptoms

  • Anxiety
  • Emotional Lability and/or Depression
  • Irritability, Aggression, and/or Oppositional Behaviors
  • Behavioral/Develolpmenta Regression
  • Sudden Deterioration in School Performance
  • Motor or Sensory Abnormalities
  • Somatic Signs and Symptoms, including Sleep Disturbances, Enuresis, or Urinary Frequency

10 THINGS You Should Know About PANS

  1. Strep throat is NOT the only infectious trigger. Although group A streptococcal (GAS) infections are associated with PANDAS, PANS is a broad-spectrum syndrome that can result from a variety of disease mechanisms and multiple etiologies.
  2. Acute onset can be preceded by milder episodes. Mild cases have been documented, and symptoms might look like behavioral problems, isolated tics, and sensory issues, among other issues that require awareness on the part of the parent and provider. These children should be clinically evaluated for PANS/PANDAS.
  3. Tics are not always present. While tics were part of the original PANDAS diagnostic criteria, they are not required for a PANS diagnosis.
  4. OCD symptoms vary. While the mean age of OCD in children is between the ages of 9 and 10, in children with PANS/PANDAS it can start much earlier. OCD presentation is acute and disruptive to a child’s normal functioning.
  5. Restrictive eating can be a primary symptom. Some children with PANS/PANDAS present with Avoidant Restrictive Food Intake Disorder without OCD or tics. A child with severe food restriction resulting in dramatic weight loss or who refuses fluid intake should be examined for PANS/PANDAS.
  6. Children with PANS/PANDAS may experience recurrence of episodes.  Some children experience remission of symptoms after treatment with no recurrence, while a portion experience subsequent exacerbation (relapse) incited by a variety of triggers.
  1. Prevalence is unknown due to poor diagnosis. PANS/PANDAS affects as many as 1 in 200 children each year according to the PANS/PANDAS consortium.
  2. Scientific studies strongly support PANS/PANDAS diagnosis. Diagnostic guidelines published by the Journal of Child and Adolescent Psychopharmacology (July 2017) and a recent nationwide study in the Netherlands designed to test PANDAS hypothesis demonstrated that individuals with a positive streptococcal test have an increased risk of neuropsychiatric disorders. The study also demonstrated an increased risk with non-streptococcal throat infections.
  3. Early diagnosis and treatment lead to improved outcomes. According to Dr. Sue Swedo, “preliminary data suggest that with appropriate treatment early in the course of illness, and effective use of antibiotic prophylaxis, we may be able to prevent up to 25%-30% of childhood mental illnesses.”
  4. Pediatricians CAN diagnose and treat PANS/PANDAS. The 2017 JCAP Treatment Guidelines issued by the PANS Physician Consortium are designed to provide practical clinical guidelines for the management and treatment of children diagnosed with PANS/PANDAS.