What Are the Symptoms of PANDAS?

PANDAS is a sudden-onset mental disorder caused in children subsequent to a strep throat infection.

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a pediatric disease with a sudden and dramatic appearance of symptoms of obsessive-compulsive disorder (OCD) and/or tic disorders, or worsening of OCD and/or tics following a strep infection such as strep throat or scarlet fever.

The main symptoms of PANDAS are obsessions, compulsions, and/or repetitive behaviors and motor and/or vocal tics that come on suddenly, “out of the blue.” Symptoms must be associated with a strep infection. 

Additional symptoms of PANDAS may include:

• ADHD symptoms 
  • Hyperactivity
  • Inattention/inability to focus
  • Fidgeting
• Separation anxiety (child has difficulty separating from parents or caregivers)
• Mood changes
  • Irritability
  • Anxiety/panic attacks
  • Sadness
  • Depression
  • Aggression
  • Excessive emotional reactions (affect lability) such as laughing or crying inappropriately or unexpectedly 
• Memory problems
• Sleep problems (insomnia)
• Overnight bed-wetting and/or frequent daytime urination 
• Decline in motor skills 
  • Changes in handwriting
  • Clumsiness
• Joint pains
• Sensitivity to light, touch, and sound
• Loss of appetite

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is triggered by strep bacteria, the same bacteria that cause strep throat and scarlet fever. 

PANDAS affects children from age 3 to about 12 years, and rarely, adolescents. It is believed that younger children are more susceptible to PANDAS because they respond to infections with higher quantities of antibodies and a more vigorous autoimmune/inflammatory response than older adolescents and adults. Older adolescents and adults may have a more muted response and thus not exhibit symptoms.

There are no lab tests used to diagnose PANDAS. It is considered a clinical diagnosis, which means patients must meet certain criteria to be diagnosed with the condition. 

The diagnostic criteria are:

• Presence of obsessive-compulsive disorder (OCD), a tic disorder, or both
• Onset of symptoms occurs in pediatric patients age 3 to puberty
• Very sudden onset or worsening of symptoms
• Episodic course of symptom severity 
  • Symptoms go up and down in severity, usually suddenly
  • Symptoms may then slowly and gradually improve
  • If another strep infection occurs, symptoms may recur
• Symptoms are associated with group A Beta-hemolytic strep infection, such as a positive throat culture for strep or history of scarlet fever
• Association with neurological abnormalities, such as physical hyperactivity or unusual, jerky movements that are out of the child’s control

A blood test called an anti-strep antibody titer may be performed to confirm a prior strep infection.

Treatment for PANDAS involves treating the strep infection with antibiotics.

Other treatments for PANDAS include:

• Neuropsychiatric therapy 
  • Selective serotonin reuptake inhibitor (SSRI) antidepressants
  • Cognitive behavior therapy
  • Medications for motor and vocal tics 
• Immune modulating therapy 
  • Glucocorticoids
  • Plasma exchange
  • Intravenous immune globulin (IVIG)

Complications of PANDAS include:

• Problems at school
  • Inattention
  • Handwriting problems
  • Memory problems
  • Absences
• Recurrences of PANDAS

It may be possible to prevent PANDAS by preventing strep infections.

• Wash hands thoroughly with soap and warm water for 20 seconds
• Use hand sanitizer if soap and water are not available 
• Avoid anyone who is sick with strep throat, scarlet fever, sinusitis, impetigo, or other types of strep infections
• Do not share personal items with someone who is sick, such as dishes and utensils, towels, and toothbrushes
• If you are prescribed antibiotics, take the full course prescribed, even if you feel better before the medicine is finished
• Stay home if you feel sick to prevent spreading infection to others