Archive for the ‘PANS’ Category

What’s Behind This Epidemic of Chronic, Inflammatory Conditions?

What’s behind this epidemic of chronic, inflammatory conditions?

by Daniel A. Kinderlehrer MD

I have witnessed many changes in the over 40 years I’ve been a doctor, including epidemic rises in multiple medical conditions.

I’m not talking about the present pandemic, nor am I referring to the opioid crisis, another devastating epidemic that has taken the lives of over 500,000 Americans. I’m talking about chronic conditions that cause a slow burn and sometimes kill.

Lyme disease is but one example.

But think how things have changed since the beginning of the previous century: heart disease was barely on the radar in 1900, but for over 50 years it has been the number one cause of death in the U.S.1

A whopping 69% of Americans are now overweight, with 36.5% obese,2 directly contributing to the skyrocketing incidence of adult-onset diabetes mellitus.3 When I was in training in the 1970s, I never saw a patient with AODM who was under 40 years old. Now, it is being diagnosed in children.

And then there are the dramatic increases in autism spectrum disorder,4 attention deficit hyperactivity disorder (ADHD),5 autoimmune conditions,6 some types of cancer7 and food allergies.8

Food sensitivities, mental health

Twenty-five years ago, when I had a large environmental medicine practice, most of my patients with food sensitivities reacted to one or more of a half dozen foods: milk, corn, eggs, wheat, citrus, or sugar/yeast. It was easy to put patients on an elimination diet: fish, lamb, vegetables, legumes, potatoes and rice. Now people react to avocados, rice, and anything under the sun.

And, of course, there’s the rise in mental health disorders. Even before the Covid pandemic, the World Health Organization predicted that depression would become the leading cause of death globally.9

According to the CDC, in 2019, 19% of Americans suffered from depression and 7% were moderately to severely affected.10 Among adults, suicidal ideation is increasing. Suicide has become the second leading cause of death in children and adolescents ages 13 to 19—and the leading cause of death among 13 year-olds.11 (Among all Americans, it is the tenth leading cause of death.11)

The role of epigenetics

There are a host of factors that determine the how, where and why illness occurs. These include genetic proclivity, lifestyle, trauma, diet, exposures to microbes and toxins. But here is what is further catapulting these seemingly disparate epidemics: a change in the human condition that we now understand as epigenetics.

While it takes millennia of natural selection to change our genes, specific proteins that turn genes on and off can alter gene expression in a single generation. Epigenetics explains how a change in expression of genes can be passed from one generation to the next without actually changing the DNA. There are literally thousands of conditions that can cause epigenetic changes.

Nutrient deficiencies, for example exacerbated by soil depletion, can activate epigenetic changes that result in neurological issues from mood and behavioral disorders to cognitive dysfunction, and these problems are passed on to subsequent generations.12,13 Epigenetics helps explain why the skyrocketing sugar intake in our diets is causing obesity.14,15

Chemical exposures also have epigenetic consequences. Over the past century, we have been exposed to hundreds of thousands of chemicals that are new to human existence. Pesticides, insecticides, herbicides, and other chemicals all have the potential to modify epigenetic activity.16 Countless agents now ubiquitous in daily life, from air pollution to air fresheners and fabric softeners can negatively impact overall health.17,18

Societal changes

But it is not only diet, nutrition, and exposure to toxic chemicals that have changed in the past century. Another factor which has undergone radical transformation is the social milieu. The social sphere, which used to revolve around communities, has devolved to extended families, then to nuclear families, then single-parent families, and now, tragically at times, to homeless families or solitude.

It is no longer routine for people to go next door to be held by grandma, or move in with aunts and uncles when the going at home gets rough. In essence, safe shelter has disappeared. This lack of safety is compounded for survivors of childhood trauma, who often develop epigenetic abnormalities and thus pass the trauma on to their offspring.19

Intergenerational trauma

That’s right—PTSD can be inherited. A review paper by Rachel Yehuda and Amy Lehrner on intergenerational transmission of trauma and the role of epigenetic mechanisms states:

“There is now converging evidence supporting the idea that offspring are affected by parental trauma exposures occurring before their birth, and possibly even prior to their conception. On the simplest level, the concept of intergenerational trauma acknowledges that exposure to extremely adverse events impacts individuals to such a great extent that their offspring find themselves grappling with their parents’ post‐traumatic state.”20

PTSD is not only a psychological disorder, it triggers increasing dysregulation of an individual’s neurobiology.21

Other social factors also have an enormous impact on health and well-being. Social isolation is a major risk factor for depression.22 The chronic stresses of poverty, racism, homophobia, and misogyny not only make for a bad day, they act on our biochemical pathways impacting immune, hormonal, and neurological function.23

The long-term release of the stress hormone cortisol and of proteins called cytokines (which regulate the body’s immune system response) can cause even more damage. These biochemical messengers, in turn, can result in epigenetic changes that are passed on to future generations.24

We’re not born with a clean slate

Epigenetic transmission means that both physical and emotional traumas are cumulative over generations. Newborns are not born with a clean slate. And these alterations in epigenetics are manifesting in a tsunami that is destabilizing individuals’ core regulatory systems.

Increasingly, people respond as if they have continuous PTSD—their nervous and immune systems going haywire at both real and imagined threats, with all the downstream consequences evident in an increasingly sick population.

Which brings us back to PANS, which I have discussed in the past few articles.

I think we are witnessing an epidemic of autoimmune reactivity to multiple agents in the environment—like foods, viruses, bacteria, and mold. We are clearly seeing it with SARS-CoV-2 (COVID-19). When autoimmune reactivity results in neuroinflammation, it can result in cognitive dysfunction, PANS and a panoply of mental health disorders—for generations to come.

We need to become more cognizant of the cumulative stresses that result in combined mental and physical issues, and address them at their core.

Dr. Daniel Kinderlehrer is an internal medicine physician in Denver, Colorado, with a practice devoted to treating patients with tick-borne illness. He is the author of  Recovery From Lyme Disease: The Integrative Medicine Guide to the Diagnosis and Treatment of Tick-Borne Illness.


  9. Tucci V, Moukaddam N. We are the hollow men: The worldwide epidemic of mental illness, psychiatric and behavioral emergencies, and its impact on patients and providers. J Emerg Trauma Shock. 2017;10(1):4-6. doi:10.4103/0974-2700.199517
  12. Liu J, Zhao SR, Reyes T. Neurological and Epigenetic Implications of Nutritional Deficiencies on Psychopathology: Conceptualization and Review of Evidence. Qi L, ed. Int J Mol Sci. 2015;16(8):18129-18148.
  15. Ling C, Rönn T. Epigenetics in Human Obesity and Type 2 Diabetes. Cell Metab. 2019;29(5):1028-1044.
  16. Collotta M1, Bertazzi PABollati V. Epigenetics and pesticides. Toxicology. 2013 May 10;307:35-41.
  19. Matosin N, Cruceanu C, Binder EB. Preclinical and Clinical Evidence of DNA Methylation Changes in Response to Trauma and Chronic Stress. Chronic stress (Thousand Oaks). 2017;1:10.
  20. Yehuda R, Lehrner A. Intergenerational transmission of trauma effects: putative role of epigenetic mechanisms. World Psychiatry. 2018;17(3):243-257.
  21. McFarlane AC. The long-term costs of traumatic stress: intertwined physical and psychological consequences. World Psychiatry. 2010;9(1):3-10.
  22. Bhatti AB, Haq A ul. The Pathophysiology of Perceived Social Isolation: Effects on Health and Mortality. Muacevic A, Adler JR, eds. Cureus. 2017;9(1):e994.
  23. Song H et. al. Association of Stress-Related Disorders With Subsequent Autoimmune Disease. 2018;319(23):2388-2400.
  24. Notterman DA, Mitchell C. Epigenetics and Understanding the Impact of Social Determinants of Health. Pediatr Clinics North Am. 2015;62(5):1227-1240.



I’ve got news for you: vaccines are also stressors.  They can reactivate latent infections including but not limited to Lyme/MSIDS.  They can also be contaminated with retroviruses, viruses, cancer, parasites, metals, graphene oxide, polyethylene glycol (PEG) and ethylene alcohol, and other harmful nanoparticles.  And all gene-based vaccines such as the COVID jabs can be expected to cause blood clotting and bleeding disorders based on their molecular mechanisms of action. Further, the spike protein is a dangerous toxin causing untold damage.

Vaccines have been and are a source of destruction that is being put directly into bodies of millions worldwide. It is the “golden calf” no one wants to talk about, or is censored and bullied if they do, but is THE elephant in the room.

It’s a “Gene-Environment-Immune Complex”…How Mycotoxins Impact Lyme, Autism, and PANS

It’s a “Gene-Environment-Immune Complex”….How Mycotoxins impact Lyme, Autism and PANS

Mycotoxins from mold can invade the body thru exposure to contaminated food and water, respiratory inhalation of spores and through contact with mucous and cutaneous membranes.

Decades of data link mycotoxins as a neurotoxic and immunotoxic inducing agent. In fact, several studies that examined the neurocognitive impact of mycotoxin exposure in children show a higher incidence of neurotoxic mold in children with autism spectrum disorder (ASD).

Additionally, children exposed to mold for more than two years show a statistically significant drop of 10 IQ points when compared with their mold free counterparts. Extensive exposure in both children and adult show increased pain syndromes, movement disorders like Chorea and Parkinson’s disease as well as neurocognitive disorders akin to dementia and delirium.

Knowing the neurological and immunological effects of mycotoxins from mold exposure, how does it affect those with behavioral, neurological disorders like ASD, autoimmune encephalopathy and pediatric acute-onset neuropsychiatric syndrome (PANS)?

Multiple studies link pathobiology of mold/mycotoxins specifically to Autism and other symptoms that mimic Autism like PANS and autoimmune encephalopathy. Mycotoxins play a gene-environment interaction that is thought to contribute to dysfunctional progression of neurodevelopment.

The mycotoxins once in the body elucidates a strong immune reaction leading to significantly elevated cytokines. These cytokines permeate throughout the body and often cross over the blood brain barrier. Those exposed can experience increased GI permeability or “leaky gut”, elevated oxidative stress responses and inflammation. This appears to stem in the gut where the mycotoxins provoke a reactive oxygen species release in the epithelial cells which line the inner gut wall. The mycotoxins will colonize in the GI system, disrupting the healthy normal flora. As a result of this disruption, a chronic inflammatory response occurs.

Many studies show the link between chronic gut inflammation and neurological and psychological ailments like depression, anxiety, OCD all common symptoms of ASD, neuro-Lyme and PANS/Autoimmune Encephalopathy.

Other studies link mycotoxins to increased autoimmune disorders and development of autoantibodies in the brain. When this occurs, the nervous system is inflamed leading to significant cognitive struggles, brain fog, mood disorders and involuntary tics and movement disorders. This is the typical progression of Autoimmune Encephalopathy, PANS and some components of ASD.

So how does this connect with Lyme?

Applying the inflammatory, immune and GI effects of mycotoxin illness to Lyme simply adds another layer of symptom severity. Lyme and other tick-borne illnesses are known to provoke an inflammatory cytokine response. Borrelia Burgdorferi specifically provokes anti-neuronal antibodies which can travel peripherally causing brain inflammation. The inflammatory response of tick-borne illnesses like Lyme can further trigger leaky gut and blood brain barrier permeability. More circulating cytokines begets increased inflammation and the vicious cycle continues.

Any significant trigger of chronic inflammation in the body can trigger neuroinflammation and leaky gut. Most individuals can weather the storm with intact immune systems. Those unfortunate to house genes linked to ASD, methylation dysfunction and/or those afflicted with Lyme, Mold or both struggles to clear the inflammation, compounding the symptomatic response.

A study by DeSantis and others studied 52 Autistic children compared to 58 neurotypical children. Results showed the ASD children had a significantly higher mycotoxin load, specifically Ochratoxin A. 

Many integrative providers believe in the Gut-Brain and inflammation connection. This study like many others support this theory and what we as providers see in clinical practice.

We welcome you to contact our office 212-288-8832 for more information and to schedule your one-on-one evaluation and treatment option appointment with one of our clinicians.


Written by Somer DelSignore NP


For more:

Managing Mental Health & Neuropsychiatric Symptoms of Lyme Disease

Managing mental health and neuropsychiatric symptoms of Lyme disease

PANS, A Misdirected Immune Response, Can Hijack a Child’s Life

PANS, a misdirected immune response, can hijack a child’s life

Pandas & Lyme in a 7-Year Old



Hello, and welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. In this podcast, I will be discussing the case of a 7-year-old child who was initially diagnosed with PANDAS and later, Lyme disease.

The article by Cross et al. entitled “Case Report: PANDAS and Persistent Lyme disease with Neuropsychiatric Symptoms: Treatment, Resolution and Recovery” was published in Frontiers in Psychiatry. [1]

The 7-year-old girl developed multiple physical and neuropsychiatric symptoms six months after travelling to a tick endemic region of the U.S. During this period, she was treated for 3 separate strep infections and was subsequently diagnosed with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS). PANDAS was considered based on classic symptoms and a history of strep, a positive ASO titer and a slightly elevated DNase B titer.

However, despite treatment, the patient’s symptoms continued to worsen. Additional testing revealed that she was also positive by CDC’s criteria for Lyme disease. The Lyme EIA and western blot IgM were positive (with 2 of 3 bands). The western blot IgG was positive for 3 of 10 bands at the IGeneX lab. Her B. henselae IgG was positive at Quest labs. Her IgG Mycoplasma and IgG Babesia duncani antibodies were positive at IGeneX.

Dr. Charles Ray Jones, co-author and treating physician, describes the patient’s broad range of symptoms.

Neuropsychiatric symptoms

On her first visit, “the patient presented with crying, anxiety, headache, joint pain, decreased cognitive functioning, fatigue, nighttime awakening and an extreme fear of sleeping alone.”

The patient’s symptoms were extensive, Jones explains, and included:

• Obsessions, compulsions
• ADHD-like behavior
• Decline in school work
• Separation anxiety
• Panic attacks
• Muscle and joint pain
• Mood lability
• Aggressive behavior
• Fatigue
• Headaches
• Difficulty sleeping
• Word selection problems
• Cognitive decline
• Irrational fears (would not sleep alone)

Functional decline 

The young girl was considered a gifted child and excelled in academics. But cognitive symptoms emerged. She reportedly told her mother, “Mom, something happened to my brain.”

“The patient regressed from being a year ahead of her class in math, to being unable to add beyond the number 10. She began having trouble comprehending more difficult reading,” the authors explain.

“During a ride home with her mother, the patient asked, ‘Who are you? What’s your name again?’ And ‘I know you are mommy but what’s your name?’”

Lyme disease, PANDAS and PANS

PANDAS may be diagnosed when a strep infection triggers multiple neurologic and psychiatric symptoms. PANS or Pediatric Acute-Onset Neuropsychiatric Syndrome, on the other hand, may be triggered by other bacterial, viral or fungal infections. Researchers believe that Borrelia burgdorferi, the bacteria that causes Lyme disease can trigger PANS in some patients.

Lyme disease, PANS and PANDAS can present with similar symptoms. Dr. Bransfield, a psychiatrist who specializes in tick-borne diseases, describes a broad range of neuropsychiatric symptoms that he has seen in his Lyme disease patients. [2]

These include: behaviors associated with developmental disorders or autism spectrum disorder, schizoaffective disorders, bipolar disorder, depression, anxiety disorders (panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, intrusive symptoms), eating disorder, decreased libido, sleep disorder, addiction, opioid addiction, cognitive impairments, dementia, seizure disorders, suicide, violence, anhedonia, depersonalization, dissociative episodes, derealization and other impairments.”


According to the authors, the child was treated with multiple courses of oral and IV antibiotics including: intravenous ceftriaxone, Omnicef 300 mg BID, Zithromax 250 mg BID, 500 mg BID and Tindamax 250 mg QD (Saturdays and Sundays only), Bactrim and Mepron. Despite this, her symptoms continued and the Cunningham Panel™ of tests was ordered.

Cunningham Panel™ and IVIG

“The Cunningham Panel was ordered to assess the presence of antineuronal antibodies against specific neuronal receptors,” the authors write. “If the Cunningham Panel is positive or strongly positive, that would be an indication that one has an autoimmune problem that needs to be treated with IVIG, as well as antibiotics,” explains Jones.

READ MORE: Highlights from the case report

Panel results indicated the patient had elevated levels for 3 out of 4 autoantibodies: Dopamine D1 Receptor (DRD1), Dopamine D2L Receptor (DRD2L), and Tubulin (TUB).

“Based upon the patient’s Cunningham Panel tests results, the decision was made to prescribe IVIG,” the authors write.

“Over a span of 31 consecutive months of treatment with various antimicrobials and 3 courses of IVIG she experienced complete remission and remains symptom free at the time of this publication.”


“Currently this patient appears to be fully recovered and has been discharged from the care of the pediatric Lyme disease specialist. She is asymptomatic and performing academically at the “top” of her class according to her mother,” the authors write.

According to Jones, “multiple concomitant infections may be involved and require treatment to effectively resolve symptoms. Improvement in neuropsychiatric symptoms does not typically occur unless all co-infections are addressed and resolved.”

This podcast addresses the following questions:

  1. What is Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS)?
  2. What are the typical symptoms of PANDAS?
  3. What are the similarities between Lyme disease, PANS and PANDAS?
  4. Why was Lyme disease and other tick-borne illnesses considered?
  5. Why was the name Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) introduced?
  6. What is the Cunningham Panel™ of tests and why was it ordered?
  7. What tests did the girl have that supported the diagnosis of a tick-borne illness?
  8. Can you discuss the range of symptoms this patient experienced?
  9. Can you discuss the girl’s treatment for PANS?
  10. Can you discuss the girl’s treatment for Lyme disease, Bartonella, and Babesia duncani?
    Thanks for listening to another Inside Lyme Podcast. You can read more about these cases in my show notes and on my website As always, it is your likes, comments, reviews, and shares that help spread the word about Lyme disease. Until next time on Inside Lyme.

Please remember that the advice given is general and not intended as specific advice as to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.

Inside Lyme Podcast Series

This Inside Lyme case series will be discussed on my Facebook and made available on podcast and YouTube.  As always, it is your likes, comments, and shares that help spread the word about this series and our work. If you can, please leave a review on iTunes or wherever else you get your podcasts.

  1. Case Report: PANDAS and Persistent Lyme Disease With Neuropsychiatric Symptoms: Treatment, Resolution, and Recovery. Cross A., Bouboulis D., Shimasaki C., Jones C.R. Front. Psychiatry, 02 February 2021
  2. Bransfield RC. Suicide and Lyme and associated diseases. Neuropsychiatr Dis Treat. 2017;13:1575-1587. Published 2017 Jun 16. doi:10.2147/NDT.S136137.


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