One of the diseases that we’ve been investigating is pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or PANDAS.  It is a condition that affects children, and symptoms seemingly appear “overnight” following a group A streptococcal infection. Pediatric acute-onset neuropsychiatric syndrome (PANS) is a related disorder where the infectious trigger may be other types of infection or not identified. PANS/PANDAS often presents as obsessions or compulsions or restricted eating, and includes at least two other symptoms, including:

• ADHD symptoms (e.g., hyperactivity, inattention, or fidgeting)
• Separation anxiety
• Mood changes (e.g., irritability, sadness, depression, behavioral regression)
• Trouble sleeping
• Nighttime bed-wetting
• Frequent daytime urination
• Change in motor skills (e.g., handwriting)
• Decline in cognitive and executive function
• Motor, sensory, or vocal abnormalities 
• Joint pain
  
  

Initial treatment of PANS/PANDAS should importantly target any underlying infection using antibiotics, antiviral, or related antigen therapeutic. Further symptoms may be managed using a combination of medication, behavioral therapy, and cognitive behavioral therapy. In severe PANDAS, immunotherapy may be considered—research suggests plasma exchange or immunoglobulin (IVIG) can often improve neuropsychiatric symptoms associated with PANDAS.

Diagnosing and treating PANS/PANDAS can be tough and complex, since these conditions are still emerging and not yet fully understood. However, with the outbreak of the COVID-19 pandemic and widespread investigation of psychological reactions to coronavirus infection, there is an increase in research into why pathogens can affect the brain of some people but not others. Hopefully in the near future this will aid in making PANS or PANDAS easier to diagnose.