PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections)

  • Medical Author:
    David Perlstein, MD, MBA, FAAP

    Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

  • Medical Editor: Roxanne Dryden-Edwards, MD
    Roxanne Dryden-Edwards, MD

    Roxanne Dryden-Edwards, MD

    Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

Just a Sore Throat or Strep Slideshow

What causes PANDAS?

PANDAS is in part caused by an autoimmune response to a strep infection. Streptococcus is known to be associated with a number of immune-related disorders, including rheumatic fever, scarlet fever, and acute glomerulonephritis (a kidney disorder). The strep molecules are known to hide from the host immune system by mimicking host cells. Ultimately, the immune system recognizes the foreign cells, and the antibodies produced attack the bacterium, and unfortunately, some of the host's own cells due to cross-reactivity. In some situations, these antibodies attack brain cells, causing OCD, tics, and other symptoms frequently observed in PANDAS patients.

What are symptoms and signs of PANDAS?

PANDAS symptoms are similar to those of obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), and motor or verbal tics. Symptoms tend to appear suddenly, and the recovery period is variable. Often the symptoms may worsen during streptococcal infections and improve in between.

How is PANDAS diagnosed?

PANDAS is diagnosed clinically. That means that it depends more on history and physical examination rather than other specific studies. The following summarizes the five criteria used to diagnose PANDAS:

  1. Presence of obsessive-compulsive disorder (OCD) and/or a tic disorder, ADHD symptoms, or oppositional behaviors
  2. Abrupt onset and or symptoms vary in intensity
  3. Association with neurological abnormalities, including motor hyperactivity, or abnormal movements, such as choreiform movements (involuntary jerky movements), other combinations of neuropsychiatric symptoms, such as anxiety, emotional lability, bedwetting, or other regressive behaviors (temper tantrums), personality changes and deterioration in math skills and handwriting
  4. Onset of symptoms from age 3 years to puberty
  5. Association with group A beta-hemolytic streptococcal infection (the bacteria that causes strep throat) either by culture or other evidence of infection, such as scarlet fever or by laboratory test evidence

As mentioned above, there are five criteria used to diagnose the disorder and must include the sudden onset of OCD, tics, ADHD, or a rapid worsening of existing symptoms. To make the diagnosis, one also needs evidence of a recent or active strep infection either by throat culture or by other laboratory confirmative study of that infection (for example, antistreptolysin O or antideoxyribonuclease B antibodies). Along with the clinical diagnosis, it is important to be sure that there is not some other reason for the symptoms, and additional testing might be performed for that reason. In fact, distinguishing PANDAS from Tourette's syndrome (a common tic disorder), OCD, or Sydenham chorea (a movement disorder associated with rheumatic fever also caused by Streptococcus) is not always a simple task.

Medically Reviewed by a Doctor on 2/19/2015

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