PANS/PANDAS
PANDAS is a pediatric autoimmune disorder characterized by the dramatic onset of neuropsychiatric symptoms such as obsessions, compulsions, motor or vocal tics [Swedo1997]. PANDAS is thought to be similar to Sydenham Chorea where there is dramatic symptom exacerbation following a strep infection[Kirvan2006].
Signs and Symptoms:
Children with PANDAS must be initially diagnosed with Obsessive Compulsive disorder or a tic disorder [Swedo2004]. These children may have some of the following symptoms that accompany the OCD or tic disorder [Swedo1998][Moretti2006]:
PANDAS/OCD is a clinical diagnosis, often marked by the sudden onset and extreme symptom exacerbations (such as an increase of +18 points on the OCD CY-BOCS score during an exacerbation [Murphy2004]). The abrupt onset and remission after eradication of streptococcal infection separates the child from non-PANDAS OCD[Swedo2004]. Many parents can pinpoint a day or a week when behaviors changed [Çengel-Kültür2009].
When a child has primarily vocal and motor tics, the symptoms may appear to overlap with symptoms of Tourettes Syndrome; however, the children can be differentiated by observing symptom exacerbations over time [Pavone2006]. In PANDAS children, a streptococcal infection precedes symptom exacerbation and once treated, initial exacerbations generally remit. The rapid onset with significant remission is characteristic of PANDAS.
Researchers have described chronic PANDAS [Pavone2006] where the tics and/or obsessive-compulsive disorder have a much more gradual course. These cases are difficult to separate from non-PANDAS tics or OCD. Some researchers have found other immunologic markers (anti-neuronal and anti-basal-ganglia antibodies) that help separate PANDAS and non-PANDAS children[Kirvan2006].
For children affected by PANDAS, a GABHS [strep] infection is considered to be the triggering event that causes an initial episode. However, as is the case with Sydenham's Chorea, subsequent PANDAS exacerbations may be triggered by recurrent GABHS, or by other bacterial or viral infections (ear infections, sinusitis, pneumonia, meningitis, impetigo) further complicating diagnosis [Swedo1998].
Signs and Symptoms:
Children with PANDAS must be initially diagnosed with Obsessive Compulsive disorder or a tic disorder [Swedo2004]. These children may have some of the following symptoms that accompany the OCD or tic disorder [Swedo1998][Moretti2006]:
- Obsessions (e.g., preoccupation with a fixed idea or an unwanted feeling, often accompanied by symptoms of anxiety)
- Compulsions (e.g., an irresistible impulse to act, regardless of the rationality of the motivation)
- Choreiform movements (e.g., milk-maid grip, fine finger playing movements in stressed stance)
- Emotional lability (e.g.,irritability, sudden unexplainable rages, fight or flight behaviors) (66%)
- Personality changes (54%)
- Age inappropriate behaviors particularly regressive bedtime fears/rituals (50%)
- Separation anxiety (46%)
- Oppositional defiant disorder (40%)
- Tactile/sensory defensiveness (40%)
- Hyperactivity, impulsivity, fidgetiness, or inability to focus (40%)
- Major Depression (36%)
- Marked deterioration in handwriting or math skills. (26%)
- Daytime urinary frequency/enuresis (12%)
- Anorexia (particularly fear of choking, being poisoned, contamination fears, fear of throwing up)
PANDAS/OCD is a clinical diagnosis, often marked by the sudden onset and extreme symptom exacerbations (such as an increase of +18 points on the OCD CY-BOCS score during an exacerbation [Murphy2004]). The abrupt onset and remission after eradication of streptococcal infection separates the child from non-PANDAS OCD[Swedo2004]. Many parents can pinpoint a day or a week when behaviors changed [Çengel-Kültür2009].
When a child has primarily vocal and motor tics, the symptoms may appear to overlap with symptoms of Tourettes Syndrome; however, the children can be differentiated by observing symptom exacerbations over time [Pavone2006]. In PANDAS children, a streptococcal infection precedes symptom exacerbation and once treated, initial exacerbations generally remit. The rapid onset with significant remission is characteristic of PANDAS.
Researchers have described chronic PANDAS [Pavone2006] where the tics and/or obsessive-compulsive disorder have a much more gradual course. These cases are difficult to separate from non-PANDAS tics or OCD. Some researchers have found other immunologic markers (anti-neuronal and anti-basal-ganglia antibodies) that help separate PANDAS and non-PANDAS children[Kirvan2006].
For children affected by PANDAS, a GABHS [strep] infection is considered to be the triggering event that causes an initial episode. However, as is the case with Sydenham's Chorea, subsequent PANDAS exacerbations may be triggered by recurrent GABHS, or by other bacterial or viral infections (ear infections, sinusitis, pneumonia, meningitis, impetigo) further complicating diagnosis [Swedo1998].
Caution is recommended for using SSRI's with PANDAS/OCD as there are reports of higher activation rates in such cases [Murphy2006]. In addition, there is a lack of controlled studies showing safety and efficacy of anti-tic or anti-OCD medications (e.g., SSRI and anti-psychotics) for children in the PANDAS subgroup.
Symptoms such as stuttering and feelings of not being ‘one’s self’ are also mentioned in the film (LeRoy epidemic). Both are quite common in PANDAS patients.
Tooth decay is made of streptococcus mutans so it is likely that was the source of your childs flare
Tooth decay is made of streptococcus mutans so it is likely that was the source of your childs flare
I would recommend skin testing for allergies, not just the blood panel. Your child may be highly reactive to airborne pollens, thus activating their whole immune system. Skin testing and allergy shots (very tiny needle) are still the gold standard of inhalant allergies. Also, I would wholeheartedly agree about testing for mycoplasma, lyme, bartonella, and other co-infections. I would investigate allergies and food allergies. Dairy for us was a huge one that had to be eliminated for healing.....esp in the short term. DD can handle dairy now, but during exacerbation, she could not.