PANDAS – Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections

What is PANDAS disease?

Most children will have strep throat at least once during their childhood. Parents take the child to their healthcare provider, an antibiotic is ordered and in 24-48 hours, the child feels better. And life goes on … for most.

In rare cases, the strep infection takes a very different turn: parents report their child’s temperament suddenly changes – like someone “flipped a switch.” The child repeats acts over and over again, similar to an obsessive-compulsive disorder (OCD), in an attempt to better control his or her environment. The child may also become more defiant or fearful, laugh or cry at inappropriate times, wet the bed frequently and have trouble sleeping at night.

Doctors call it pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or PANDAS. Its autoimmune nature is what connects it to the world of allergy. The body reacts to the strep infection by attacking not only the strep bacteria but also some of the child’s own cells – including brain cells, bringing on the sudden behavior change.

How is PANDAS disease diagnosed?

Doctors will look for five signs to diagnose PANDAS:

• A recent strep (Streptococcal aureus) infection or another related infection, like scarlet fever
• Child is age 3 to puberty.
• Presence of OCD behavior, symptoms of attention deficit hyperactivity disorder (ADHD), defiant or “clingy” behavior.
• Abnormal movements (jerky movements that the child cannot control), anxiety, personality changes, or not being able to do math skills or write as well anymore.
• Sudden onset of symptoms or increasingly severe symptoms.

What is the treatment for PANDAS disease?

• Treat the strep infection with antibiotics. Usually a throat culture is done to confirm the child has had a strep infection and, if the diagnosis is positive for strep, a course of antibiotics is prescribed.Treatment may also include anti-inflammatory medications (such as ibuprofen) and immune-modulating therapies (such as steroids or intravenous immunoglobulin – IVIG) for acutely or severely affected children.
• Manage PANDAS-related behavior. Cognitive behavioral therapy (CBT) can help address the behavior changes. 

How is PANDAS prevented? 

• Sterilize or replace toothbrushes during and following antibiotics treatment, to make sure the child is not re-infected with strep. 
• Ask a healthcare provider to perform throat cultures on every family member and caregiver to make sure none are “strep carriers” who could serve as sources of the strep bacteria.
• If you’re concerned about sudden changes in your child’s behavior following an illness such as strep throat, see your doctor right away. If it’s PANDAS, you’ll want to be sure there is no delay in treatment.

Patient Resources

PANDAS Network: pandasnetwork.org