Strep throat is a common childhood illness. Some kids get it again and again, and a simple round of antibiotics usually clears it up. But for a small number of children, the infection triggers strange behavior changes known as PANDAS syndrome. PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections.
With PANDAS, your child may seem to turn into a different person overnight. They may become moody, anxious, aggressive, show obsessive-compulsive behaviors, and struggle with body movements they can’t control. It can be scary, but once your child is diagnosed with PANDAS and starts treatment, they’ll likely make a full recovery.
What Causes PANDAS Syndrome?
PANDAS is most common in children aged 3 to 12 but can affect older children too. Doctors aren’t sure why some children get PANDAS, but it appears to be an autoimmune disorder. That’s when an infection causes your immune system to attack your body’s healthy cells, in this case, brain cells. The strep bacteria disguise themselves to look like normal cells. When the immune system eventually finds and fights them, it sometimes also fights the cells that the strep is imitating.
Researchers believe that children with a certain genetic makeup may have a higher risk of PANDAS, but they haven't been able to identify a specific gene. It may also be more likely in children who have frequent group A streptococcal infections, including strep throat and scarlet fever.
PANDAS Syndrome Symptoms
Symptoms of PANDAS come on suddenly and last a few days to weeks. They may go away and return later. Common symptoms include:
- Uncontrolled, jerky movements, or tics
- Obsessive-compulsive behavior
- Symptoms of ADHD, such as hyperactivity, fidgeting, and trouble paying attention
- Anxiety attacks or fear of being away from parents or other caregivers
- Depression
- Joint pain
- Moodiness, irritability, and crying or laughing at inappropriate times
- Sensory problems, including being very sensitive to light and possibly seeing or hearing things that aren’t there
- Sleep problems
- Bedwetting, peeing more often during the daytime, or both
PANDAS Syndrome Diagnosis
There is no test to diagnose PANDAS. Your child's doctor will need to assess the signs and symptoms to make a diagnosis. A test for the strep bacteria or a history of the bacteria is necessary to confirm your child has PANDAS, which can mimic other disorders. A blood test can show whether your child had a recent strep infection even if they recovered.
If your child doesn’t or didn't have strep, they don’t have PANDAS. But their symptoms could still be part of an immune system response gone wrong. PANDAS is a type of pediatric acute-onset neuropsychiatric syndrome (PANS), which is a broader group of autoimmune diseases that affect the brain. The symptoms are similar, but they may be triggered by something other than strep. Your child’s doctor may order blood tests or brain scans to see if a different infection or something else entirely is causing the symptoms.
Not all doctors have experience diagnosing PANDAS. Your child may need to see a rheumatologist, an immunologist, or someone who specializes in strep infections. A referral to a psychiatrist or psychologist will probably be part of the treatment plan.
PANDAS Syndrome Treatment
The sooner you can diagnose and treat PANDAS, the better the chances are that the symptoms will go away. Treatment usually involves medication and therapy.
Antibiotics. Your child’s doctor will treat the underlying strep infection with antibiotics. It usually takes a week or two, although some kids improve within days. You may have to try more than one antibiotic to find what works.
Anti-inflammatories. These drugs can calm the immune system. Your child may get a steroid pill for several days. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may also help.
Cognitive behavioral therapy. While medications fight the infection, therapy can help control your child's obsessive-compulsive disorder (OCD). A therapist will give your child strategies to deal with OCD thoughts and fears. It’s important for you to learn what goes on in therapy so you can help your child apply it at home.
Antidepressants. Medications called selective serotonin reuptake inhibitors (SSRIs) can help manage OCD. But they can be dangerous for children, and kids with PANDAS seem to be especially likely to have side effects. If your doctor recommends them, make sure you understand the right dose to give and any problems to watch for.
IVIG/plasmapheresis. If other treatments don’t work, or your child’s symptoms are so severe they can’t function, their doctor might consider a more extreme procedure to reset their immune system. One option is IVIG, which involves an infusion of antibodies from other people, delivered through a vein. In another option, plasmapheresis, doctors remove blood from your child’s body and filter it through a machine that removes the antibodies that are attacking their brain.
Does PANDAS Syndrome Go Away?
Although it may take time, most children who have PANDAS recover completely with treatment. Symptoms tend to slowly get better over several months once the strep infection clears, but there may be ups and downs.
PANDAS is likely to come back if your child gets strep again. Sometimes, all it takes is exposure to the germ. To help your child stay healthy, teach good hygiene habits: wash hands, change toothbrushes often, and stay away from sick people. Your whole family may need to get tested for strep to make sure no one is carrying the bacteria.
Your pediatrician may prescribe antibiotics long-term to try to prevent new strep infections. Some children have their tonsils removed. But scientists haven’t studied either of these strategies enough to know whether they work.
It’s rare for kids older than 12 to have reactions to strep infections. But that doesn’t mean your teenager is out of the woods. Very little research has looked into whether PANDAS can show up in older kids or adults. So, it’s important to know the symptoms and get medical help quickly when they seem to appear.
PANDAS Syndrome Complications
PANDAS syndrome can be very disruptive for you and your child, even if it only lasts a short time. Recurrent episodes are even more likely to cause these complications in the short and long term:
- Trouble at school
- Problems with learning and concentration
- Lasting effects on the brain if the condition is left untreated or occurs frequently
To prevent these effects, work closely with your doctor to get fast and comprehensive treatment for your child. Take care to prevent reinfection and future PANDAS episodes.
Takeaways
PANDAS syndrome is a condition that follows a strep infection. It's characterized by sudden changes in mood and behavior. It can be treated but may return with future strep infections. It's important to visit your child's doctor if you recognize any of the signs of PANDAS. Early treatment can prevent possible long-term complications.
PANDAS Syndrome FAQs
What happens if PANDAS syndrome goes untreated?
Untreated PANDAS syndrome can have long-term effects on your child's brain.
Can an adult develop PANDAS?
It's very rare, but adults can develop PANDAS.
Can you fully recover from PANDAS?
With proper treatment, you can make a full recovery.
How long does PANDAS syndrome last?
PANDAS symptoms can last a few days or weeks. They can go away and come back after a long period if your child is exposed to the bacteria that causes strep.