Archive for the ‘PANS’ Category

Study Links Eating Disorders to Childhood Infections (Lyme/MSIDS Can Do This)

New data from a Mass General researcher highlights a link between the immune system and the onset of eating disorders.

The question of what causes eating disorders has puzzled the medical community since “wasting disease” was first described in the 17th century. Today, researchers and clinicians agree that, in addition to psychosocial and environmental risk factors, there is a strong biological basis to these disorders. Now, new data from a Massachusetts General Hospital researcher suggests that exposure to common childhood infections, such as strep throat or bronchitis, may significantly raise a person’s risk of developing anorexia nervosa, bulimia nervosa and other eating disorders.

“Infections, by and large, have typical behaviors associated with them, and among those most commonly reported is loss of appetite.”

Results of the population-based study, published in JAMA Psychiatry, found that infections that required hospitalization or treatment with anti-infective medications, such as antibiotics, antifungals or antivirals, increased the risk of developing an eating disorder by as much as 39%. The multi-institutional study, which analyzed the health histories of more than 500,000 adolescent girls in Denmark, also found that recurrent infections and repeated treatment increased the risk.

Infections and Behavior

“Infections and inflammation more broadly have been recognized to play a role in psychiatric diseases like schizophrenia, but this has been less explored in eating disorders,” says Lauren Breithaupt, PhD, a clinical psychologist in the Mass General Eating Disorder Clinical and Research Program, and lead author of the study. “We’re hoping that a better understanding of the relationship between the immune system and disordered eating will help identify a mechanism behind the increased risk and biochemical changes we see happening.”

Lauren Breithaupt, PhD
Lauren Breithaupt, PhD

As an observational study, the findings don’t point to a single cause or effect, but one possible explanation, according to Dr. Breithaupt, is that the infection or treatment of the infection disrupts the gut microbiome, which in turn alters the brain’s neurobiological reward system. Another possibility is the body’s own inflammatory response. Inflammatory proteins have been shown to cause changes in behavior, such as loss of appetite.

“Infections, by and large, have typical behaviors associated with them, and among those most commonly reported is loss of appetite,” Dr. Breithaupt says. “If you’re already at risk for an eating disorder, this period of no appetite could have a priming effect.” Although more research is needed, Dr. Breithaupt is encouraged the findings further enforce the biological nature of the disease.

Eating Disorder Stereotype

Eating disorders have long been seen as social constructs — think of the stereotype of the wealthy white girl who isn’t eating because she wants to look a certain way,” says Dr. Breithaupt. “It’s taken a lot of evidence — more than most other mental illnesses — to blow that stereotype out of the water. We now know that the rates are similar across the world and across cultures. We’re even seeing that there may not be as big a gender discrepancy as we previously thought.”

Despite mounting biological evidence, there is still a great deal of confusion in the medical community about how to diagnose and treat eating disorders. Dr. Breithaupt is hopeful that the team’s findings can lead to increased awareness of the signs and symptoms and that more hospitals and treatment centers adopt a more scientific approach to treating these diseases.

The Role of Philanthropy

“The Eating Disorders Clinical and Research Program at Mass General offers gold standard evidence-based treatment for eating disorders, but we receive so many referrals per year that unfortunately we can’t treat every patient who seeks services,” she says. “That’s why philanthropy is so important to the growth of our program. The work that we do is often funded by individuals and families who have been touched by these diseases.”

The other key to advancing the understanding and treatment of eating disorders, Dr. Breithaupt says, is education.

“In order to identify biological markers, we need larger sample sizes and data sets, which requires individuals with the disorder to come forward and to participate in research,” she says. “By educating the public about the biology underlying eating disorders, we can break down barriers and overcome the stigma.

To learn more about how you can support eating disorder programs and research at Mass General, please contact us.



Great read and a fantastic reminder that eating disorders often have a biological basis.

If a wild animal is sick with an infection it stops eating. This begins to make sense when we understand that nearly 5-15% of our body’s energy goes into digestion:

According to Dr. Bransfield eating disorders are common with Lyme/MSIDS:

In addition, Lyme can trigger a condition known as pediatric acute-onset neuropsychiatric syndrome (PANS) which in turn can also cause eating disorders.  PANS, similarly to Lyme, still has not been accepted by mainstream medicine despite thousands upon thousands suffering from both.

For more on PANS: In short, treat the infection(s), inflammation, and deal with the psychiatric issues.

Hypoglycemia can also be a player. And according to this article, insulin resistance “causes the body to have problems metabolizing carbohydrates into biological energy called ATP. This energy is essential in the production of feel good neurotransmitters such as serotonin. Thus without that energy the person may tend to feel depressed. The unabsorbed carbohydrates are converted to, first, glycogen and then into fat cells. Thus we find that depressed people may be overweight AND depressed. They are not depressed because of obesity, but because of insulin resistance!! (MedicalNewsToday 8 Oct 2009) See also Hemat.”

The article has great advice if you suspect hypoglycemia is your issue:

“If you suspect that an eating disorder is related to insulin resistance (a pre-diabetic condition called hypoglycemia) then have this tested by a doctor. See How to test for hypoglycemia. If found to be positive, encourage your client to adopt the Hypoglycemic Diet.

For most people sticking to a regime of frequent snacks of high proteins (every 2 ½ hours), plus various vitamins and mineral – so as never to feel hungry – should supply sufficient energy from proteins to produce feel good neurotransmitters such as serotonin. This together with regular – but not excessive –  exercises should prevent unabsorbed carbohydrates from being converted to fat cells! But keep in mind possible allergies and food sensitivities that may affect the digestive system.”

I knew a patient who was not over weight at all but due to severe hypoglycemia and hypothyroidism they developed eating disorders. When they adopted the hypoglycemic diet and began supplementing with natural thyroid hormone the eating disorders disappeared.
Please spread the word as many doctors will only continue to look at this as a psychiatric problem when there are often biological causes.

Psychosis and PANS Meet Plasmapheresis – Our Final Slam Dunk

Psychosis and PANS meet Plasmapheresis – Our Final Slam Dunk

PANS and PANDAS often mimic mental illness, presenting as psychosis. The day after Aidan’s worst night in the psychiatric hospital three years ago, he sat in the corner of the hallway picking at his red hospital socks and said to his nurse, Ms. English,

“Nobody knows how I feel.”

Our son, Aidan, was psychotic – there, I said it. Nurse English was the one psyche nurse with whom Aidan connected. She was ultra compassionate and took the time to meet Aidan where he was – in the corner, in the hallway, on the floor. Picking, picking, picking at his one-size-too-big, floppy hospital socks – the ones with the no-slip bottoms. Interestingly enough, he still has those socks tucked away in his top dresser drawer. I think they were the highlight of his stay.

Yes, I saw it with my own eyes. Aidan was psychotic because of PANS. Pyschotic because of a illness that was almost diagnosed during his inpatient stay in 2016.

Unlike many children diagnosed with PANS or PANDAS, Aidan’s onset was not overnight; I believe that he had a misdirected immune system from infancy. However, I can recall what illness in what month of what year and how many weeks after he ‘recovered’ from that illness when we noticed increased rages and aggression, decreased motor skills and an onset of tics. In short, the bottom fell out. We did not know what to do or where to go.

We ended up in a pediatric psyche ward and came out with more diagnoses: a movement disorder for the tics and imbalance, and a second-time mood disorder NOS (not otherwise specified) for the rages, aggression and psychosis. He was also labeled a fall risk (rightfully so) and was emotionally liable upon discharge.

Game Changer #1: Proper Diagnosis

Three weeks after Aidan’s discharge from the hospital, he had an appointment with the developmental pediatrician who diagnosed him with autism. It was a follow-up appointment that was scheduled one year prior.

The exam room had a mat on the floor, and for that I was thankful. All Aidan had done since coming home from the hospital was roll around on the floor, from one side of the family room to the other.

I remember saying to the doctor, “Is this Aidan with autism but on different medications?” I explained life since the bottom fell out until now, looking up from the mat where I was trying to keep Aidan somewhat calm. I wasn’t very successful, nor was I ready for what the doctor had to say:

“This isn’t autism, Mrs. Keatts. This is PANDAS or PANS, and the most successful treatments are not covered by medical insurance.”

By the end of this appointment, my head was spinning. Aidan had been seen by more than 10 doctors during his inpateint stay, and at an appointment that I made one year prior for an unrelated diagnosis, we discover the root cause of Aidan’s symptoms that were holding him hostage in his own body.

Game Changer #2: Proper Intervention

If and when our children are properly diagnosed and a proper treatment plan is implemented, parents and doctors try to counter PANS and PANDAS with antibiotics, anti-inflamatories, steroids, supplements, IVIG and antibody therapy. Sometimes, one of these interventions or a combination thereof provides long-term relief. For us, however, they did not.

Our last resort was plasmapheresis, which in its simplest terms is a way to cleanse the blood system of the antibodies that are attacking our children’s brains. This is how I can best explain how plasmapheresis works:

  1. Blood has three parts: plasma, red cells and white cells. Antibodies are found in the plasma part of the blood.
  2. Plasmapheresis takes blood from the strongest source, the heart, and separates the plasma from the red and white blood cells.
  3. The red and white bloods cells are stored together and kept safe during the treatment, while the old plasma is collected separately and disposed of later.
  4. Then the red and white blood cells are put back into the blood stream with the new donor plasma.
  5. Plasmapheresis therapy takes place over the course of two weeks – three days each week, with at least one day in between each session.

Some kids, like Aidan, respond immediately to plasmapheresis – also called PEX. Others, progress slowly over weeks, even months. And still others require additional treatment modalities ranging from IVIG to cognitive behavioral therapy and intensive exposure therapy to further recover from the damage done by a misdirected immune system.

Regardless of the pace at which the child progresses following PEX, for many children this ‘blood cleaning’ process opens the pathway to healing and recovery.

On the Rebound

We are coming up on the two-year anniversary of Aidan’s plasmapheresis treatments, and since then I have spoken to several moms before their child began PEX. While their children’s onset stories and symptoms vary, one constant prevails — each mom is understandably apprehensive about plasmapheresis. It is invasive – a surgery is required to place a port into the aorta, and there is risk of infection.

Every time I share our experience with plasmapheresis, I speak from my heart. PEX opened a door to Aidan’s healing that I truly thought we would never find. In complete transparency, Aidan’s illness tested my faith far beyond any other struggle in my life.

Nearly two years later, I realize that there are four intentions that I subcouncioulsy set, yet mindfully observed during Aidan’s PEX. When I fully saw how the Divine’s healing hand was there all along, I gained clarity that is unique to Aidan’s journey. And so, I share with you my insights with a heart not only of gratidude for Aidan’s healing, but a fierce hope that your child will too find healing.

  • Be brave. Your child and family have gone through hell and back because of PANS or PANDAS. You are all warriors in your own right. You have been courageous and resilient from the beginning – even if you have fallen apart and cried yourself to sleep more times than you can count. You made it to this point, and that’s what matters.
  • Be bold. Let your spirit lead you. Let your worries drift away. Believe that your child will heal, and that healing begins this day. Sacrifice and intention preempt healing. Your child and your family have sacrificed much and suffered terribly. Now, set your intention. A mindset of clarity and healing is the next step. Each day leading up to the procedure claim your intention – to heal your child.
  • Be open. Your child will be just as anxious and afraid as you are, yet neither of you will tell the other. You have both learned how to be stoic throughout this journey. I welcome you to share Aidan’s story with your child and explain that other kids with PANS / PANDAS have begun to heal after the ‘bad guys’ were removed from their bodies.
  • Be watchful. Sometimes healing begins almost immediately. Other times it progresses slowly. Every child is different, and every story of healing is unique. The smallest signs of healing are blessings and are meant to encourage hope. Although Aidan’s signs of healings began just one day after his first plasmapheresis treatment, his full path to remission lasted more than a year. Healing occurs in stages as the body is able to respond and process various interventions. Be patient, and remain watchful.

After years of flagrant fouls and air balls in our journey to heal Aidan, PEX allowed us to score the winning shot in a game that ran into overtime for years. Reflecting on my fears, frustrations, desperation, and even my loss of faith, I now see twists and turns in Aidan’s illness through a new lens – a courtside view of Nurse English rebounding the ball for Aidan during open play in the hospital gymnasium, and a box seat view of the Divine palming the ball, guiding my next pivot and lifting us up for the final slam dunk.

MJ Keatts is a mom of three – one of whom inspired her to start this blog. A journalist by trade, minimalist at heart, and a stunt girl in her dreams, MJ proudly admits that she’s learned more from her kids and husband than she could ever teach them herself. She loves to laugh – especially at herself – and one day hopes to amaze her husband and be ready on time.



Click on the author’s name at beginning of article for other articles she’s written.

For more:

FYI: Lyme/MSIDS can often be a part of the PANS/PANDAS picture.

One Family’s Story of Strep, Lyme Disease, and PANS/PANDAS

One family’s story of strep, Lyme disease, and PANS/PANDAS

Abstract: Bartonella in Boy with PANS

Bartonella henselae Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome

First Published March 18, 2019 Case Report

In March 2017, Bartonella spp. serology (indirect fluorescent antibody assays) and polymerase chain reaction (PCR) amplification, DNA sequencing, and Bartonella enrichment blood culture were used on a research basis to assess Bartonella spp. exposure and bloodstream infection, respectively. PCR assays targeting other vector-borne infections were performed to assess potential co-infections.

For 18 months, the boy remained psychotic despite 4 hospitalizations, therapeutic trials involving multiple psychiatric medication combinations, and immunosuppressive treatment for autoimmune encephalitis. Neurobartonellosis was diagnosed after cutaneous lesions developed. Subsequently, despite nearly 2 consecutive months of doxycycline administration, Bartonella henselae DNA was PCR amplified and sequenced from the patient’s blood, and from Bartonella alphaproteobacteria growth medium enrichment blood cultures. B henselae serology was negative. During treatment with combination antimicrobial chemotherapy, he experienced a gradual progressive decrease in neuropsychiatric symptoms, cessation of psychiatric drugs, resolution of Bartonella-associated cutaneous lesions, and a return to all pre-illness activities.


Please note that this boy would be in a psych ward if not treated with antimicrobials for Bartonella.




Why Your Kid’s Strep Throat Keeps Coming Back

Why your kid’s strep throat keeps coming back

Why your kid's strep throat keeps coming backEach year, some 600 million people around the world come down with strep throat. But for some children (and their parents) it’s more than an occasional misery. It’s a recurring nightmare. Yet, it was unclear why some kids are prone to repeated bouts of strep throat while others appear to be more or less immune. The latest study by researchers provides the first clues why some children are more susceptible than others to contracting recurrent group A strep tonsillitis, better known as strep throat.

Their findings, published in the issue of Science Translational Medicine, suggest that recurrent tonsillitis is a multifactorial disease where immunological factors combined with an underlying genetic susceptibility allow group A strep to invade the throats of certain individuals time and again. Gaining a better understanding of why some children fail to develop protective immunity also opens the door to developing a vaccine to protect against strep throat, the researchers predict.

“Repeated strep throat is the second most common indication for the removal of tonsils in children. Like every surgery it carries certain risks but there is recent data suggesting that tonsillectomy may increase the risk of upper respiratory tract diseases in the long term,” says senior co-author Matthew. “My hope is that as we learn more about the causes behind recurrent strep infections we’ll be able to intervene before they happen.”

Strep throat is one of a diverse array of conditions caused by the bacterium Streptococcus pyogenes, better known as group A Streptococcus (GAS). It can cause pneumonia, scarlet fever, impetigo, which results in highly infectious skin sores, and necrotizing fasciitis, the feared flesh-eating disease. Unlike necrotizing fasciitis, strep throat is easily treated with antibiotics. But if left undiagnosed, it, too, can lead to serious complications.

Trying to understand the longstanding mystery why some children are predisposed to frequent bouts of GAS tonsillitis and what their immune response looks like, the researchers turned to the tonsils themselves. Tonsils are lymph-node like structures located on each side of the back of the throat. Small pockets, or crypts, on their surface collect and sample microbes and can become the breeding ground for GAS.

The authors collected tonsil tissues from a cohort of children aged 5 – 18 who had their tonsils removed either because they suffered from repeated bouts of strep throat or underwent tonsillectomies for unrelated reasons such as sleep apnea. They were particularly interested in germinal centers, the central hubs where B cells have to team up with so-called follicular helper T cells (Tfh cells) to start producing antibodies.

In addition to a significant decrease in the frequency of both B and follicular helper T cells, tonsils from children with recurrent tonsillitis had consistently smaller germinal centers areas overall. “These kids have a poor germinal center response,” says the author. “Interestingly it is associated with a particularly poor antibody response to SpeA, which is an important aspect of protective immunity.”

Short for streptococcal pyrogenic exotoxin, SpeA is not an essential component of the GAS genome. However, a particularly potent version of the toxin arose in the bacteria in the 1980s and these strains quickly swept the globe to become the most prevalent cause of strep throat. Children in the control group had high anti-SpeA antibody titers, which indicated that they had been exposed to the bacteria but did not get sick.

Among children with recurrent GAS tonsillitis the disease was likely to run in the family, suggesting a genetic component. Genetic testing revealed two specific genetic variants in the HLA region, which determines how pathogens interact with the immune system, that were associated with increased susceptibility to recurrent tonsillitis and one that protected against the disease.

“Since the immunological connection as well as the genetic connection are all tied to an insufficient antibody response against SpeA it suggests that recognizing this factor is actually a key problem for these kids,” says the author. “Having a vaccine that trains the immune system in advance might be able stimulate a protective immune response that can prevent recurring bouts of tonsillitis.”



This is important as strep can lead to PANDAS:

A highly respected LLMD here in Wisconsin has found that 80% of his PANDAS/PANS kids also have Lyme/MSIDS (borrelia and other coinfections).  There’s much that is still unknown about this life-changing illness but tick borne illness (TBI’s) can definitely cause or exacerbate PANDAS/PANS.




Brain Under Attack – PANS, PANDAS, & Related Developmental Disorders

Episode #88: Brain Under Attack with Maria Rickert Hong, CHHC, AADP

In this episode, you will learn about PANS, PANDAS, and related developmental disorders.

About My Guest

My guest for this episode is Maria Rickert Hong. Maria Rickert Hong, CHHC, AADP is a former Wall Street sell-side equity research analyst who is now a Certified Holistic Health Counselor. She is the author of the bestselling book, “Almost Autism: Recovering Children from Sensory Processing Disorder, A Reference for Parents and Practitioners” and the co-author of “Brain Under Attack: A Resource for Parents and Caregivers of Children with PANS, PANDAS, and Autoimmune Encephalitis”. As a health coach, she helps parents make diet and lifestyle changes to recover their children from symptoms of Sensory Processing Disorder, autism, PDD-NOS and ADHD. She has recovered her two boys from SPD, asthma, and acid reflux. Maria is a board member, Media Director, and blogger for Epidemic Answers, a 501(c)3 non-profit that lets parents know that recovery is possible and is the sponsoring non-profit of “The Documenting Hope Project”. Maria is also a board member of Parents as Partners.

Key Takeaways

  • What is the difference between PANDAS and PANS?
  • When does PANS generally present?
  • What are the symptoms of PANS?
  • What is the role of inflammation in PANS?
  • Do PANS and autism overlap?
  • What leads to a blood-brain barrier breach in PANS?
  • What is the role of EMFs in PANS?
  • What role do glutamate, phenolics, and salicylates play in PANS?
  • What are some of the triggers for PANS?
  • Does mold exposure play a role in PANS?
  • What tests are done to explore the potential for PANS?
  • What is the Epidemic Answers Four Step Healing plan?
  • Why is detoxification and drainage key in PANS recovery?

Connect With My Guest

Related Resources

Epidemic Answers

Brain Under Attack

My Kid Is Not Crazy

Disclaimer:  The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today’s discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.


For more:

Mother’s Appeal After Boy Diagnosed With Autism When He Just Needed Antibiotics

Mother’s appeal after boy diagnosed with autism when he just needed antibiotics

25 January 2019

‘Overnight, something went very wrong’  (News Video in Link)

A mother is calling for greater awareness of a little-known condition she believes changed her easy-going son overnight.

Alison Maclaine fears some children are being misdiagnosed with autism and mental health issues when they are really suffering an infection which can be treated simply with antibiotics.

Her eight-year-old son Jack suffered distressing personality changes and “lost a year of his life”.

And she said she was left “in despair” that she and her family had “no quality of life”.

Now Alison believes he was suffering from Paediatric Acute-onset Neuropsychiatric Syndrome (PANDAS), triggered by a streptococcal infection – a condition that can be treated with simple antibiotics and anti-inflammatories.

Something wrong

Jack went to bed one Friday in January last year, looking forward to a football tournament he was playing in the next day.

But on arrival at the venue on Saturday morning he became overwhelmed with anxiety. After several attempts, he was unable to enter the building.

At home in Dumfries, Alison realised something was very wrong.

She told the BBC: “He started to repeatedly apologise. He said he didn’t deserve to have fun, didn’t deserve to have friends, didn’t deserve to have nice things, didn’t deserve to play football.

Alison Maclaine
Alison Maclaine knew her son’s diagnosis was not right and did her own research into his symptoms

“That eventually led to ‘I don’t deserve to live, when I get home I am just going to sit outside until I freeze to death’.”

When it came to bedtime, Jack refused to have covers and pillows and started to repeat that he needed to die, until he fell asleep.

The following day saw his behaviour sink further.

Alison said: “One of the worst things in the world must be listening to your child telling you he wanted to die and asking you to help him.”


According to the charity PANS PANDAS UK, PANS (Paediatric Acute-onset Neuropsychiatric Syndrome) is a neuropsychiatric condition which is triggered by a misdirected immune response which results in an inflammation of a child’s brain.

PANDAS is a subset of PANS, triggered by a misdirected immune response to a streptococcal infection which results in an inflammation of a child’s brain.

Happening very quickly, this can cause a child to exhibit symptoms including anxiety, aggressive behaviour, depression, clumsiness, insomnia and the onset of obsessive-compulsive disorder.

It was first recognised in the United States in 1998 where PANS PANDAS charities estimate as many as one in 200 children could be affected.

In 2018, the World Health Organisation recognised the condition, but in the UK it is not widely known.

There is no clear test for the condition so doctors often have to rule out psychiatric conditions. The immediate response to antibiotic or anti-inflammatory treatment is often what confirms the condition.

The charity PANS PANDAS UK said a failure to understand the condition in the UK means that children are regularly wrongly referred to Child and Adolescent Mental Health Services (CAMHS).

‘Absolute despair’

Jack then became aggressive and withdrew from his beloved younger sister Cara. He would become irritable and angry and started to regress, playing with baby toys.

Over the next several months he was repeatedly diagnosed as having autism and severe anxiety.

But Alison, herself a psychiatrist, disagreed.

She said: “It got to the point where I really felt absolute despair.

“I felt that he had no quality of life, we had no quality of life. There were times when I contemplated things.”

Jack Maclaine
His family feels that Jack is “back”

That despair led to Alison doing her own research and the discovery of PANS and PANDAS.

Alison said reading the symptoms was like reading a description of her son and his behavioural changes.

Jack was finally diagnosed privately by a consultant paediatrician in England and treated with simple antibiotics.

They worked overnight and Alison had her son back.

She said: “Jack responded dramatically to the treatment. He hadn’t left the street in five months except for school. After two days on antibiotics he wanted to come to Morrisons with me and Cara. It felt like Jack was back.”

Dr Tim Ubhi

Dr. Tim Ubhi finally diagnosed PANDAS in Jack


Alison is frustrated now, believing if Jack had been given got antibiotics when he first presented to the GP in January, the outcome would have been different.

She said: “It is so frustrating knowing the treatment was so simple. Now I hate to think there are other children in the situation that they have this disorder that has not been picked up on and have been sent down a mental health/psychological route which can’t fix the problem.”

Dr Tim Ubhi, who diagnosed Jack’s condition, said: “The problem here is if we do not recognise this condition and we ignore it, potentially there are children out there who are suffering who could actually get treated and actually improve their symptoms.

“So we have a responsibility as physicians to think about this as a condition and do the work to actually create an awareness of what the condition is doing in the UK.”

A Scottish government spokeswoman said: “We appreciate that watching any loved one suffer is heartbreaking, even more so when it is a child.

“We are working together with partners to improve the outcomes and support for adults and children with rare conditions, and ensure that everyone receives the appropriate treatment.

“Ministers are unable to make or influence clinical decisions or definitions, and it would not be appropriate for them to do so.”

If you, or someone you know, have been affected by mental health issues, these organisations may be able to help.



These stories are repeated over and over worldwide.  Time for doctors to get on board and learn about it so they can recognize and treat this.

Please take note of the plethora of symptoms and the tandem workings of PANDAS/PANS with Lyme/MSIDS. A highly respected LLMD here in Wisconsin has found that 80% of his PANS kids also have Lyme/MSIDS (borrelia and other coinfections).  

For more:

Vaccines can also be triggers:  He has also successfully treated a number of young women who fell ill after their HPV vaccination, which seems to have stimulated a latent Lyme infection to reactivate.  Asymptomatic girls after receiving Gardasil activated dormant Bartonella which was confirmed by testing.