By Vicki Hill Reidel, The Balanced Mind Foundation Parent-to-Parent Volunteer

Did your child’s neuropsychiatric symptoms come on suddenly following an infection? Do you notice that your child’s symptoms suddenly worsen during or just following an infection? Does your child have obsessive-compulsive symptoms or tics? If so, you may be looking at a case of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus).

The theory for  PANDAS came out of research during the 1980’s at the National Institute of Mental Health (NIMH). Doctors noticed that some children with movement disorders following Rheumatic Fever also had Obsessive-Compulsive Disorder (OCD) symptoms. Rheumatic Fever is caused by Group A Beta hemolytic streptococcal bacteria, commonly known as strep throat.

During a strep infection, the human body naturally produces antibodies to fight off the infection. If those antibodies ‘get confused’ an autoimmune reaction may develop in which the antibodies attack a portion of the body itself, in this case the basal ganglia area deep within the brain. As research has traced OCD to problems in the basal ganglia, the result of this autoimmune attack can by obsessive-compulsive symptoms.

Tic disorders, including Tourette’s Syndrome, are thought to be genetically-related to OCD. Thus, problems in the basal ganglia, brought on by the autoimmune response of PANDAS, can also trigger tics.

Further research has suggested a biological marker in certain blood cells for children with PANDAS. However, this test is currently only used in research laboratories and is not used for diagnostic purposes.

      
 While various ideas are being researched, at present there is no specific treatment for PANDAS. In general, the most important thing is to aggressively treat strep infections with antibiotics, making sure to complete all courses of antibiotic treatment.

Note that the quick throat swab test is not always accurate enough to detect a strep infection. It the quick test comes back negative, ask your doctor to also run the older 48-hour test which has greater accuracy.

While the antibiotics should kill the strep bacteria within a few days, the antibody level may be elevated for several weeks. This means that the child may feel better in a few days, but it may take several weeks to see the OCD and/or tic symptoms go away. Because of the lengthy period of elevated antibody levels, two other tests, the anti-streptolysin O titer and anti-streptococcal DNase B titer, can be used to determine whether there has been a recent (possibly overlooked) strep infection.

As the parent of a child diagnosed with PANDAS, I would add one bit of advice. If you see sudden increases in the neuropsychiatric symptoms, don’t immediately presume it is time for a psychiatric medication adjustment. Instead, start with a visit to the pediatrician to check for signs of physical illness. On numerous occasions, my son has appeared well, but on a doctor’s examination, he clearly showed signs of strep throat or ear infections. If the pediatrician sees no physical illness, then you can talk with the psychiatrist, letting him know that physical illness has already been ruled out as a possible cause for the sudden increase in symptoms.