PANDAS and PANS

What is PANDAS and PANS

PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a broad category for a sudden onset of neuropsychiatric symptoms, while PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) is a specific type of PANS triggered by a strep infection. All PANDAS cases are PANS, but not all PANS cases are PANDAS; PANS can be triggered by a wider variety of infections and other factors, whereas PANDAS is exclusively linked to Streptococcus pyogenes.

What is the difference?

PANDAS/PANS Population Analysis Based on 700 family self-reports

AGE OF ONSET

1 to 3 years 11%
4 to 9 years 69%
10 to 13 years 19%
14+ years 1%

PRIMARY SYMPTOMS

OCD 37%
TICS 14%
BOTH 49%

INFECTIONS REPORTED

Strep 81%
Other 19%

(Mycoplasma, Lyme, etc.)

PANS

Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) is a rare condition that affects children, causing a sudden and significant onset of neuropsychiatric symptoms.

An abrupt, acute, dramatic onset of obsessive-compulsive disorder or severely restricted food intake
Concurrent presence of additional neuropsychiatric symptoms with similarly severe and acute onset from at least 2 of the following categories:
- Anxiety
- Emotional Lability and/or Depression
- Irritability, Aggression, and/or Severe Oppositional Behaviors
- Behavioral (Developmental) Regression
- Sudden Deterioration in School Performance
- Motor or Sensory Abnormalities
- Somatic Signs and Symptoms, including Sleep Disturbances, Enuresis, or Urinary Frequency
Symptoms are not better explained by a known neurologic or medical disorder
Age requirement – None

The onset of PANS may start with infectious agents other than strep. It also includes onset from environmental triggers or immune dysfunction.

PANDAS

PANDAS is a condition where a child develops sudden or significant changes in neuropsychiatric symptoms following a streptococcal (strep) infection.

Clinical diagnosis of PANDAS includes 5 criteria:

Presence of significant obsession, compulsions and/or tics
Abrupt onset of symptoms or a relapsing-remitting course of symptom severity
Prepubescent onset
Association with streptococcal infection
Association with other neuropsychiatric symptom (includes any of the PANS "accompanying" symptoms

Testing and Treatment

Treatment for mild to MODERATE

PANS/PANDAS can include:

Antibiotics
Corticosteroids
Anti-Inflammatories
Therapy
SSRI’s (very low dose)

Treatment for moderate to SEVERE

PANS/PANDAS can include:

Antibiotics
Corticosteroids
Anti-Inflammatories
Therapy
SSRI’s (very low dose)
IVIG
Plasmapheresis

Treatment for severe to EXTREME PANS/PANDAS can include:

Long, tapered corticosteroid courses or repeated high dose IV corticosteroids
IVIG
Plasmapheresis
Rituximab
Antibiotics and the above
DMARDs