How PANDAS Syndrome Affects Children’s Behavior and Health

Written by Medicover Team and Medically Reviewed by Dr K Sindhura , Pediatricians

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a condition in which children develop sudden-onset neuropsychiatric symptoms following a Group A Streptococcal infection. Symptoms may include obsessive-compulsive behaviors, tics, anxiety, and behavioral changes.

PANDAS is thought to involve an abnormal immune response following a streptococcal infection. Early evaluation can help identify possible triggers and manage the child's symptoms appropriately.

What are the Symptoms of PANDAS Syndrome?

PANDAS symptoms typically develop suddenly and may appear within days or weeks following a Group A Streptococcal infection. The severity and combination of symptoms can vary between children.

Common Symptoms

Sudden onset of obsessive-compulsive behaviors (OCD)
Motor or vocal tics, such as eye blinking, facial twitching, or throat clearing
Anxiety, including separation anxiety
Separation anxiety and difficulty being away from caregivers
Mood changes and emotional instability

Other Symptoms

Aggressive, irritable, or defiant behavior
Sleep disturbances or nightmares
Increased urinary frequency or new urinary symptoms
Changes in eating behavior or food restriction
Difficulty concentrating, memory problems, or decline in school performance

What are the Causes of PANDAS Syndrome?

PANDAS is associated with a Group A Streptococcal infection followed by an abnormal immune response. The immune response may affect brain pathways involved in movement, behavior, and emotional regulation.

Group A Streptococcal infection: Infections such as strep throat or scarlet fever may precede the sudden onset of symptoms.
Abnormal immune response: The immune system may mistakenly affect tissues involved in neurological function following the infection.
Recurrent streptococcal infections: Repeated infections may be associated with recurrent or worsening symptoms in some children.

When to See a Doctor for PANDAS Syndrome?

Consult a pediatrician or pediatric neurologist if a child develops sudden obsessive-compulsive behaviors, tics, or significant behavioral changes, particularly after a recent streptococcal infection. A child psychiatrist or psychologist may also be involved when significant OCD, anxiety, or behavioral symptoms are present.

Sudden onset of OCD symptoms or motor or vocal tics
Significant anxiety, emotional changes, or behavioral problems
Sleep disturbances or changes in eating behavior
Difficulty concentrating or a sudden decline in school performance

Seek urgent medical attention if:

Severe behavioral or neurological symptoms develop suddenly
The child is unable to eat, drink, sleep, or function normally
There are severe symptoms of infection or rapidly worsening symptoms

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How Is PANDAS Syndrome Diagnosed?

There is no single laboratory test that confirms PANDAS. Diagnosis involves a detailed medical history, physical and neurological examination, assessment of the timing of symptoms, and evaluation for a recent or current Group A Streptococcal infection.

Clinical Evaluation

Sudden onset of OCD symptoms or motor or vocal tics
Evidence of a recent or current Group A Streptococcal infection
Neurological or behavioral changes that develop abruptly
Assessment to rule out other medical, neurological, psychiatric, or behavioral conditions

Diagnostic Tests

Throat swab or rapid strep test: Helps identify a current Group A Streptococcal infection.
Anti-streptolysin O (ASO) and Anti-DNase B tests: May provide evidence of a recent streptococcal infection.
Neurological assessment: Helps evaluate tics, involuntary movements, and other neurological symptoms.
Additional investigations: Other tests may be considered when needed to rule out alternative causes of the symptoms.

What are the Treatment Options for PANDAS Syndrome?

Treatment for PANDAS focuses on addressing any confirmed streptococcal infection and managing neuropsychiatric symptoms. Treatment should be individualized according to the child's symptoms, severity, and overall health.

Antibiotics

Antibiotics such as penicillin, amoxicillin, or azithromycin may be prescribed to treat a confirmed Group A Streptococcal infection.

Psychiatric and Behavioral Therapies

Cognitive Behavioral Therapy (CBT)
Exposure and Response Prevention (ERP) for OCD symptoms
Family counseling and psychological support

Immunomodulatory Therapy

Corticosteroids may be considered in selected cases.
Intravenous immunoglobulin (IVIG) may be considered for severe cases under specialist care.
Plasmapheresis is reserved for selected severe and treatment-resistant cases.

Supportive Care

School accommodations and educational support
Occupational or speech therapy when clinically indicated
Regular follow-up with the child's healthcare team

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What are the Risk Factors of PANDAS Syndrome?

PANDAS is associated with certain factors that may increase the likelihood of developing symptoms following a streptococcal infection.

Childhood age, particularly between 3 and 12 years
Recent or recurrent Group A Streptococcal infections
Personal susceptibility to autoimmune or neuropsychiatric conditions
Family history of autoimmune or neuropsychiatric disorders may be relevant in some children

What are the Complications of PANDAS Syndrome?

Persistent or severe symptoms can interfere with a child's daily activities, education, relationships, and emotional well-being. Appropriate evaluation and symptom management can help reduce these effects.

Persistent or worsening OCD symptoms
Chronic or recurrent motor or vocal tics
Anxiety, emotional difficulties, or behavioral problems
Sleep and eating difficulties
Problems with school performance and social functioning

How Can PANDAS Syndrome Be Prevented?

There is no guaranteed way to prevent PANDAS. However, prompt recognition and appropriate treatment of streptococcal infections may help reduce the risk of complications.

Seek medical evaluation for symptoms suggestive of strep throat or other streptococcal infections.
Follow the prescribed antibiotic treatment for confirmed infections.
Maintain good hand hygiene to reduce the spread of infections.
Monitor children with recurrent infections for sudden behavioral or neurological changes.

Frequently Asked Questions

1. Can PANDAS Syndrome go away on its own?

While some symptoms may gradually improve, PANDAS usually requires medical intervention for full and lasting recovery. A multi-specialty hospital like Medicover can help manage both infection and behavioral symptoms.

2. Is PANDAS contagious?

PANDAS itself is not contagious, but the underlying strep infection that can trigger it is. Preventing and promptly treating strep is important to avoid flare-ups.

3. Can a child have PANDAS without a sore throat?

Yes, children can have a strep infection without typical symptoms like a sore throat, yet still develop PANDAS. Silent strep infections can be identified through proper testing.

4. How long do symptoms last?

PANDAS symptoms can last from a few weeks to several months. Some children may experience persistent or recurring issues that benefit from long-term care and monitoring.

5. Will my child need psychiatric medication?

In certain cases, psychiatric medications are used to manage severe OCD, anxiety, or behavioral changes, often alongside antibiotics and therapy for best results.

6. Can PANDAS reoccur after treatment?

Yes, symptoms can return if the child gets another strep infection. Ongoing medical supervision, which hospitals like Medicover provide, can help prevent and manage recurrences.