What Is PANS?
Pediatric acute-onset neuropsychiatric syndrome (PANS)a condition characterized by National Institute of Mental Health (NIMH) researchersexpands on a condition called pediatric autoimmune neuropsychiatric disorder associated with Streptococcus (PANDAS). Children and adolescents with PANS develop severe OCD symptoms, abnormal eating behaviors, and other psychiatric symptoms. PANS symptoms develop suddenly and come and go with no known cause.
PANS may be diagnosed when acute symptoms, for example overwhelming fears, obsessive thoughts, compulsive rituals, develop without a link to Streptococcus, which is a bacteria that causes strep throat, skin infections, pneumonia, meningitis, and other infections. PANS is a newly-recognized disorder and more research is needed to better understand the condition.
Possible Diagnostic Criteria for PANS
For a diagnosis of pediatric acute-onset neuropsychiatric syndrome, kids and teens must meet these 3 criteria:
- Sudden onset of severe OCD symptoms and/or anorexia (eating disorder that results in unhealthy weight loss)
- Sudden, severe onset of at least two additional neuropsychiatric symptoms such as
- Anxiety (child may be terror stricken or develop severe separation anxiety, panic attacks)
- Mood swings and depression (child may go from laughter to tears with no reason)
- Aggressive behavior
- Irritability and oppositional behavior
- Developmental regression ("baby talk," temper tantrums)
- Significant decline in school performance or learning ability
- Sensory/motor abnormalities (worsening of handwriting, loss of fine motor skills)
- Physical signs and symptoms (trouble sleeping, bedwetting)
- Symptoms cannot be attributed to a known neurological, psychological, or medical disorder
Diagnosing PANS can involve:
- Testing for conditions that may cause PANS symptoms, such as Strep infection, Lyme disease, Mycoplasma (type of bacteria that can cause pneumonia), mononucleosis (mono)
- Ruling out other conditions that can cause symptoms similar to PANS like Sydenham chorea (associated with rheumatic fever), systemic lupus erythematosus, and Tourette syndrome
- Checking blood levels of vitamin D, iron, and thyroid hormone
A throat culturerapid strep test, 4 hour agar plate culture, and other diagnostic tests (magnetic resonance imaging [MRI] scan, spinal tap [lumbar puncture], electroencephalogram [EEG]) may be performed.
At this time, more research is needed to find effective treatments for PANS. A combination of medication(s) and type of cognitive behavioral therapy (CBT) called exposure and response prevention (ERP) may be the best option.
Medications to treat pediatric acute-onset neuropsychiatric syndrome can include pain relievers (e.g., nonsteroidal anti-inflammatory drugs [NSAIDs]), antibiotics, and/or corticosteroids. ERP may help the child/teen learn to manage his or her fears and OCD symptoms.
Sources: National Institute of Mental Health (NIMH), International OCD Foundation