PANS is an acronym for Pediatric Acute-Onset Neuropsychiatric Syndrome. PANS is a clinical diagnosis based on a child’s medical history and physical examination. Symptoms cannot be better explained by another diagnosis. There is no age restriction for a PANS diagnosis.
PANS diagnostic criteria are based on the abrupt onset of OCD and/or eating restrictions, with concurrent symptoms in at least 2 of 7 neuropsychiatric categories:
- Emotional Lability and/or Depression
- Irritability, Aggression, and/or Severe Oppositional Behaviors
- Behavioral (Developmental) Regression
- Sudden Deterioration in School Performance
- Motor or Sensory Abnormalities
- Somatic Signs and Symptoms, including Sleep Disturbances, Enuresis, or Urinary Frequency
PANS can be triggered by infections, metabolic disturbances, and other inflammatory reactions. Infectious triggers include upper respiratory infections, influenza, recalcitrant sinus infections, mycoplasma pneumonia, and lyme borreliosis, among others.
In laypersons terms, it is easiest to understand PANS as an umbrella term for many triggers that create inflammation in the brain, leading to behavioral changes. PANS is a medical disorder with both physical and psychiatric presentations.
PANDAS, a subset of PANS, stands for Pediatric Autoimmune Neuropsychiatric Syndrome Associated with Streptococcus, specifically Group A Strep (GAS) infections, which can occur in many parts of the body – not just the throat. The onset of symptoms can occur within days of contracting strep, or within several months of the inciting infection.
In technical terms, PANS/PANDAS are misdirected immune responses, often with an encephalitic origin, that result in acute onset of OCD, tics and/or restricted food intake, along with other neuropsychiatric and somatic symptoms. After the initial onset, PANS/PANDAS symptoms follow a relapsing/remitting course. Initial triggers may differ from secondary triggers. During each recurrence, symptoms can worsen, and new symptoms may manifest.
Symptoms can range from mild to severe. In mild cases, children might function well enough to continue to attend school. In severe cases, symptoms can become life-threatening due to extreme food restriction and/or suicidality. Many children with PANS/PANDAS are diagnosed with a psychiatric illness and prescribed psychotropic medications rather than being evaluated and treated for an underlying infection.
According to a consortium of experts convened by the National Institute of Mental Health, appropriate treatment for these disorders is a triad that incorporates psychological support (CBT, ERP and/or psychotropic medication), antimicrobial treatment, and immunomodulation.