PANDAS: The pediatric disorder that you should know about.
Strep throat is very painful and commonly happens around the holiday season. Most children fully recover from strep throat, but there are a few children who may not fully recover. Strep throat can trigger PANDAS or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections.
Symptoms usually dramatic, happen ‘overnight’ or ‘out of the blue’, and could include vocal and/or vocal tics, compulsions and/obsessions. Other common symptoms are irritability or moodiness, or the child may experience anxiety attacks. This can be very worrying for both the parents and the children. PANDAS is rare, so it can be shocking when it is diagnosed. Here is what you need to know what about PANDAS.
Streptococcal or the strep bacteria are ancient organisms that survive in the human body by hiding from the immune system as long as it can. Most of the time, the bacteria usually hides itself on the cell walls, so it looks like the tissue that is found in the skin, heart, joints, and brain tissue. This hiding is called ‘molecular mimicry’ and it allows the bacteria to avoid detection.
However, the strep bacteria are eventually found and the immune system reacts to the bacteria by starting to produce antibodies. Due to the molecular mimicry, the immune system reacts to not only the strep bacteria, but also the tissue molecules that were mimicked. This allows the antibodies to ‘attack’ the child’s own tissues. This can cause damage to the child’s body, including the brain.
How is PANDAS Diagnosed?
PANDAS is a clinical diagnosis, which means there is no lab test that is able to diagnose PANDAS. However, there is a diagnostic criterion that is used by healthcare providers to make the diagnosis of PANDAS. Right now, the clinical features of PANDAS are the only means of determining if a child may have the illness.
PANDAS criteria are:
-Pediatric onset of symptoms
-Presence of a tic disorder and/or obsessive-compulsive disorder
-Episodic course of symptom severity
-Abrupt onset or worsening of symptoms
-Association with neurological abnormalities
-Association with group A Beta-hemolytic streptococcal infection
If the symptoms are present for more than a week, then blood tests can be done to document if there has been a preceding streptococcal infection.
There are PANDAS symptoms that children often experience. This could be one or more of the following symptoms along with the tic disorder and/or obsessive compulsive disorder.
-Changes in motor skills
PANDAS Symptoms are Episodic
Children with PANDAS often have dramatic ups and downs in their tics and/or OCD. Tics or OCD are almost always present at relatively consistent levels, not as an episodic course. Most children with tics or OCD have good days and bad days. However, PANDAS have a very sudden onset or worsening of symptoms, which are usually followed by a gradual improvement. If a child with PANDAS gets sick with another strep infection, the symptoms will get worse again. Most of the time, the increased symptoms usually last for several weeks, but they can sometimes last months or even longer.
If My Child has had Strep Throat Before and He has OCD, Tics, or Both. Does that mean that they have PANDAS?
No. Many children have tics and/or OCD, and nearly all school-aged children will have strep throat at some point. On average, a grade-school student will have a minimum of two or three strep infections every year.
PANDAS is considered a diagnosis when there is a close relationship between the strep infection and the onset or worsening of the child’s tics and/or OCD. If strep is found in conjunction with two or more episodes of tics, OCD, or both, then it may be diagnosed that the child has PANDAS.
Can Adults Develop PANDAS?
PANDAS is considered a pediatric disorder. Typically, it first appears during childhood with most children ranging from age 3 to puberty. Most times, it is uncommon for PANDAS to appear after the age of 12, but researchers state that it is possible, but rare. This means that it would be very unlikely for a person to develop PANDAS as an adult, since this has been fully studied.
The best treatment for PANDAS acute episodes is to treat the strep infection causing the symptoms with antibiotics, if it is still present.
A throat culture should be done to see if the strep bacteria are present. If the culture comes back positive, a single course of antibiotics is most times enough to treat both the infection and the PANDAS symptoms. If the throat culture is negative, other tests may be done to ensure that the infection is not hiding as another illness. Most of the time, this is rare, but it is problematic since the infection can take longer to treat and other antibiotics may be required to fully fight off the infection.
Behavioral Therapies and Medications
Children who have PANDAS-related obsessive-compulsive symptoms can benefit from behavioral therapies and medications. OCD symptoms are best treated with a combination of selective serotonin reuptake inhibitor (SSRI) medications and cognitive behavioral therapy (CBT). Tics can also respond to medications.
PANDAS can have side-effects with medications, so it is important to start with a low dosage when taking these medications. If the PANDAS symptoms worsen, the medications should be returned to a lower dosage. Most times, stopping medications abruptly can cause difficulties or even make the symptoms worse.
Can Penicillin Be Used to Treat PANDAS or Prevent Future Symptoms?
Penicillin does not specifically treat PANDAS. However, it does treat a sore throat by killing the bacteria in the mouth and throat. Research suggests that the antibodies the body produces in response to the strep infections are the cause of the PANDAS symptoms, not the strep bacteria itself.
There are also ongoing studies at the NIMH to determine if using antibiotics could be a form of prophylaxis or to prevent future problems. However, there is not enough evidence at this time to recommend the long-term use of antibiotics to treat PANDAS.
Replace Toothbrushes After Each Antibiotic Treatment
This is a simple way of reducing the risk of re-infection. When a child starts antibiotics and after they are done, they should have a new or sterilized toothbrush. A new toothbrush is recommended because sterilizing a toothbrush may not kill all the bacteria in it.
Children should also avoid sharing utensils because sharing utensils poses the risk of bacteria being spread. The strep bacteria can live in the human body for months without showing any symptoms, so there is no way of being a 100 percent sure that someone does not have the bacteria. The best option is for everyone to have their own utensils and avoid sharing food.
Strep Throat is very common in school-age children, and most children get sick with these infections each year. Strep throat is rarely dangerous, but there is the risk of a child developing PANDAS. PANDAS is rare, but it can have lifelong effects. The symptoms usually come and go, but they can be treated with therapy and medications. If you are worried that your child may have PANDAS, you should speak with your doctor about your concerns.