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Pediatric Autoimmune Neuropsychiatric Syndrome (PANS/PANDAS): Diagnosis and Treatment

Recognition and treatment of acute-onset obsessive-compulsive symptoms and tics following infections in children with autoimmune-mediated neuropsychiatric syndromes

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Psikiyatri department. Book Appointment →

What is Pediatric Autoimmune Neuropsychiatric Syndrome (PANS/PANDAS): Diagnosis and Treatment?

PANS describes acute-onset obsessive-compulsive symptoms and additional neuropsychiatric features following infections or immune triggers in children.

PANDAS specifically associates with group A streptococcal infections as triggering event.

Pathophysiology involves molecular mimicry with antibodies cross-reacting with basal ganglia.

Diagnosis is clinical based on acute onset, neuropsychiatric symptoms, infection association and exclusion of other causes.

Distinction from primary obsessive-compulsive disorder requires careful history of acute symptom onset.

Symptoms

Sudden dramatic onset of obsessive-compulsive symptoms within days represents hallmark presentation.
Tics including motor and vocal tics often coexist with obsessive-compulsive symptoms.
Severe anxiety, separation anxiety, mood lability, irritability, regression are common.
Sleep disturbances, eating restriction, urinary frequency, sensory sensitivities accompany core symptoms.
Cognitive symptoms including handwriting deterioration, attention problems, school difficulties manifest acutely.

Risk Factors

Children typically aged 3-12 years with peak incidence around 6-8 years.
Recent group A streptococcal infection within preceding weeks supports PANDAS diagnosis.
Family history of autoimmune disorders or rheumatic fever suggests genetic predisposition.
Personal or family history of obsessive-compulsive disorder or tic disorders increases susceptibility.
Recurrent streptococcal infections without adequate treatment increase risk for PANDAS development.

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Sudden acute onset of obsessive-compulsive symptoms or tics in children warrants pediatric and psychiatric evaluation.
  • Recent streptococcal infection or other infection preceding neuropsychiatric symptoms supports PANS/PANDAS workup.
  • Severe symptoms with significant functional impairment warrant urgent multidisciplinary evaluation.
  • Exacerbations following infections may indicate active immune-mediated process requiring treatment.
  • Multidisciplinary care with pediatrics, psychiatry, neurology, immunology, infectious disease optimizes management.

Treatment Methods

01
Antibiotic treatment of acute streptococcal infection with penicillin or amoxicillin essential for PANDAS.
02
Anti-inflammatory therapy with NSAIDs or short-course corticosteroids reduces neuroinflammation.
03
Immunomodulatory therapy with IVIG or plasmapheresis for severe or refractory cases.
04
Psychiatric treatment with selective serotonin reuptake inhibitors and cognitive behavioral therapy for OCD.
05
Comprehensive multidisciplinary care with pediatrics, psychiatry, neurology, immunology coordination, antibiotic prophylaxis for recurrent streptococcal infections, family education and support, school accommodations during exacerbations, behavioral therapy for OCD and tics, monitoring for relapses with infections, long-term follow-up addressing trajectory of symptoms, and management of comorbidities including ADHD and anxiety provides optimal outcomes for children with PANS/PANDAS syndromes.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.