PANDAS: What was that again?


The acronym PANDAS stands for:

pediatric autoimmune neuropsychiatric disorders associated with Streptococcus infections.

That is a whole mouthful, you’ll agree.

We’re talking about a unique sub-set of psychiatric patients: there are children in whom an acute manifestation of OCD and/or tic disorders occurs. This is special, because with OCD the symptoms usually develop over time.

The disorders were initially thought to be caused by infection with Group-A beta-hemolytic Streptococcus (GABHS).

Susan Swedo and her group published an important research report on  this in 1998.

Two decades later, there have been changes in the concept of PANDAS; actually, it is now named: PANS (pediatric acute-onset neuropsychiatric syndrome). It hasn’t been accepted as a distinct disorder (or group of disorders) yet – but that doesn’t mean there haven’t been additional findings.

  • several agents other than Streptococcus may be involved in its inception
  • there is a male predominance in the patient population: 65% of it is male
  • 54% of those affected show a specific association with Streptococcus
  • gender and pubertal status have a strong effect on symptom course and chronicity of the illness
  • the rate of co-occurring medical illness is high – a general immune dysfunction is suggested by experts
  • PANS has a considerable impact on the daily life of the children
  • antibiotic treatment is advised to resolve the symptoms of infection early on
  • it may be that the resident immune cells of the brain, the microglia, aren’t functioning well in PANS

Now, we are lucky: some fine articles on these matters are available at the open source of the National Institute for Mental Health, in Bethesda, Maryland, via the Pubmed site:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3783973/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5174185/

…and here’s a figure (sans comment) to whet your appetite, from the first article:

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