The Neuroscience Center

PANS and PANDAS in Pediatric Diagnostics

PANS is a relatively new term used to describe acute-onset OCD cases. PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome and includes all cases of abrupt onset OCD, not just those associated with streptococcal infections. PANDAS, is an abbreviation for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.

PANS & PANDAS is used to describe the group of children and adolescents who have sudden onset of Obsessive Compulsive Disorder (OCD) and/or tic disorders, and in whom symptoms worsen following conditions such as streptococcal infection (Strep throat & Scarlet Fever), influenza, chickenpox, Lyme disease, and mycoplasma (which causes so-called walking pneumonia). The illness can become a psychiatric emergency within 48 hours, and should be treated by a Pediatrician (or other primary care physician) along with a Psychiatrist.

Currently, the illness is conceptualized as an example of mis-directed immune attack, and might occur because of a kind of similarity between antigens on the viral or bacterial agent and childs own cells – so the body begins to attack itself.

Both PANS and PANDAS are clinical diagnoses. They are made by a physician after clinical evaluation. The history must reveal an abrupt onset of OCD and/or tics (or sudden, dramatic worsening if the child had pre-existing OCD or tics). Laboratory testing will not confirm or negate the diagnosis. Testing can suggest different routes of acute and/or long-term treatment – relevant tests include anti-streptococcal antibody titers, anti-nuclear antibody titers, and a test of immune reactivity, such as an erythrocyte sedimentation rate (ESR) or C-reactive protein.

The primary care physician will likely prescribe antibiotics, nutritional support, and perhaps steroids. Sometimes, IVIG (immunoglobulins administered by IV) or plasmapheresis (a way of purifying blood and then replacing it into the patient). Hyperbaric Oxygen Therapy is occasionally useful to restore physiologic resilience and aid in stabilizing immune dysfunction. Psychiatric care will likely include traditional anti-OCD interventions such as medication.


Great, concise information.  A warning; however, about steroids if pathogens are involved as certain steroids (catabolic) can suppress the immune system, allowing infection to proliferate and worsen.  This has happened to many a Lyme/MSIDS patient when they were misdiagnosed initially with things like fibromyalgia, MS, and other autoimmune conditions and given catabolic steroids such as prednisone or cortisone.

Not all steroids do this and it’s important not to take a broad brush stroke condemning all when some actually build the body up (anabolic) as well as the fact patients may even require small doses of catabolic steroids such as cortisol if they aren’t making enough.  Blood tests are often used along with a clinical diagnosis to determine these imbalances.

So type of steroid is important as well as dose.

Nothing’s ever simple, is it?

And to confuse things even more

                  HLN, Published 2012, Approx. 8 min.

What if an apparently normal, intelligent and productive person suddenly became psychotic, violent and unstable? Susannah Cahalan, tells her frightening story in the book Brain on Fire: My Month of Madness.

In this case, Cahalan was finally diagnosed after the doctor had her draw a clock, a common test for Alzheimer’s patients.  When she drew it, all the numbers were on the right side, demonstrating that the right side of her brain was not functioning as well as the fact her problem was neurological not psychiatric.  She was found to have autoimmune encephalitis and the treatment is very high doses of steroids which suppress the immune system as well as IVIG, a blood product prepared from the serum of between 1,000 and 15,000 donors, and plasmapherisis, a plasma exchange to rid the body of abnormal antibodies

  Her doctor, then Staten Island surgeon, Dr. Najjar, speaks here about the professional isolation he felt due to the lack of collaboration between the disciplines of psychiatry and neurology.

This problem also exists for Lyme/MSIDS and must change.

 Boy’s Lyme Disease Morphs into Autoimmune encephalopathy.  It took 10 years and 20 doctors to find out 12-year-old Patrik had Lyme disease. Just 4 months later the doctors discovered he also has a condition where his immune system attacks his brain.  Dr. Souhel Najjar, Cahalan’s doctor, heroically saves the day again.

  (Trailer  here)  Zero Media  Published 2017.

These stories are critical to share and with today’s technology we can do this easily.  Please pass this on to every parent you know as it may save another life.

For more on psychiatric Lyme/MSIDS:


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