PANDAS, first described in 1998, is an acronym for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.
Kids with PANDAS can have tics and/or OCD that come on suddenly or get worse after they get a strep infection. Specifically, a group A streptococcal infection, like strep throat.
These kids might also be moody and irritable, develop problems at school, have trouble sleeping, and have anxiety, including separation anxiety.
What Causes PANDAS?
Like other post-strep complications, PANDAS is thought to be an auto-immune disorder that occurs when a child’s immune system targets the strep bacteria, but also cross-reacts with molecules that strep uses to hide in our body.
“However, the molecules on the strep bacteria are eventually recognized as foreign to the body and the child’s immune system reacts to them by producing antibodies. Because of the molecular mimicry by the bacteria, the immune system reacts not only to the strep molecules, but also to the human host molecules that were mimicked; antibodies system “attack” the mimicked molecules in the child’s own tissues.”
PANDAS—Questions and Answers
If antibodies to mimicked molecules target a child’s brain tissue, then you can get the neuropsychiatric symptoms of PANDAS, including tics and OCD.
Does it sound a little unbelievable?
Do you know what causes rheumatic fever, besides an untreated group A streptococcal infection? It is an auto-immune disorder that occurs when the antibodies that are produced after a strep infection attack your joints and heart, including the valves of your heart.
Similarly, if the antibodies attack your kidney, you can develop post-streptococcal glomerulonephritis.
Do Vaccines Cause PANDAS?
PANDAS is caused by a strep infection.
Vaccines do not cause strep infections and vaccines do not cause PANDAS.
Responding to a petition to add PANDAS and similar conditions as a vaccine table injury, the Advisory Commission on Childhood Vaccines voted 5 to 1 against, stating that:
- No published study that examines anti‐neuronal antibodies including anti‐dopamine receptor 1 (DR1), anti‐dopamine receptor 2 (DR2), anti‐tubulin, anti‐lysoganglioside – GM1 or antibody‐mediated activation of calcium calmodulin dependent protein kinase II (CaMKII) in children suspected of PANS and/or PITAND following pertussis infection or following pertussis immunization was found.
- No published case report of conjugate pneumococcal vaccines or pneumococcal infections and Hib vaccines or Hib infections causing or enabling the development of acute neuropsychiatric symptoms via a mechanism of blood‐brain barrier disruption with GAS antibody‐mediated CNS cross‐reaction in a susceptible child were found.
- No published case report of PANS, PITAND and/or PANDAS following pertussis vaccination or during or following pertussis infection were found.
- No published case report of PANS, PITAND and/or PANDAS following either pneumococcal conjugate or Haemophilus influenzae type b (Hib) vaccination or pneumococcal or Haemophilus influenzae type b infection were found.
There is no evidence that vaccines cause PANDAS.
“Children with PANS and PANDAS should receive standard childhood vaccines, following recommendations from the Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the American Academy of Family Physicians (Centers for Disease Control and Prevention 2016a). The patient and all family members should receive annual influenza immunization as described under Influenza (described earlier).”
Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part III—Treatment and Prevention of Infections
What about PANS and PITANDS?
These are similar, although much more controversial than PANDAS.
What’s the difference?
With PANDAS, the trigger is a strep infection. What about if you have symptoms of PANDAS, but no evidence of a strep infection?
Then some folks stick with the diagnosis and simply label you as having PANS or PITANDS, blaming some other infection, even though there is little evidence that these are a real thing.
More on PANDAS
- PANDAS—Questions and Answers
- Q & A with Dr. Susan Swedo regarding PANDAS
- PANS and PANDAS: An Interview With Dr. Susan Swedo
- Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part I—Psychiatric and Behavioral Interventions
- Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part II—Use of Immunomodulatory Therapies
- Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part III—Treatment and Prevention of Infections
- Pediatric autoimmune neuropsychiatric disorders associated with streptococcus: comparison of diagnosis and treatment in the community and at a specialty clinic.
- Clinical Presentation of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections in Research and Community Settings
- Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases.
- PANDAS: horse or zebra?
- CDC – Group A Streptococcal (GAS) Disease
- PANS and PANDAS: Sudden Onset of OCD Symptoms
- A PANDAS Story
- LeRoy neurological disorders – PANDAS, vaccines, and whatever?