PANDAS is a now recognized neuropsychiatric syndrome which can be triggered by a previous infection with group A beta-hemolytic streptococci in children and adolescents. The symptoms are similar to those of OCD or Tourette’s syndrome. Good results in preventing the disease from becoming chronic have already been achieved through antibiotic treatment.
What is PANDAS?
PANDAS is the abbreviation for the English term for the syndrome P ediatric A utoimmune N europsychiatric Disorders Associated with S treptococcal Infections”. This name stands for a neuropsychiatric syndrome which is triggered by infection with group A beta-hemolytic streptococci in childhood and adolescence can be.
The most important type of bacteria in this group is Streptococcus pyogenes. Streptococcus pyogenes triggers, among other things, scarlet fever or purulent tonsillitis. It has been noted that in a few cases, the PANDAS neuropsychiatric syndrome occurs suddenly following these infectious diseases. See AbbreviationFinder for abbreviations related to PANDAS.
If left untreated, this disease can become chronic. The PANDAS syndrome shows symptoms similar to obsessive -compulsive disorders or tics (Tourette ‘s syndrome). It is an autoimmune disorder thought to result from the cross-reaction of antibodies that attack the surface of the bacteria with special structures in the brain called the basal ganglia.
Group A beta-hemolytic streptococci generally have the property of being able to trigger rheumatic fever and other rheumatic diseases after an infection. The mechanism of development of these secondary diseases of infection is similar in all diseases of the rheumatic circle.
The antibodies often also attack endogenous structures, especially collagen IV. The resulting diseases include rheumatic heart inflammation, inflammation of the joints (arthritis), skin inflammation (erythema), muscle inflammation or chorea minor.
Causes
As already mentioned, the cause for the occurrence of PANDAS is to be found in a cross-reaction of the antibody against the bacterial surface with endogenous structures in the brain. These are structures of the basal ganglia. The basal ganglia are responsible for coordinating movement.
If they are damaged, there are disturbances in the motor function that correspond to the clinical picture of chorea minor. In contrast to chorea minor, psychiatric symptoms dominate in PANDAS. Studies using imaging methods have found that there are changes in parts of the brain, in the striatum.
PANDAS is an autoimmune disease in which the body’s own immune system attacks the basal ganglia. According to the current state of knowledge, this disease is caused by group A beta-hemolytic streptococci. However, PANDAS belongs to a group of syndromes that are summarized under PANS and show similar symptoms.
All diseases in this group are thought to be caused by basal ganglia antibodies, although other infections and non-infectious processes may also play a role in PANS. Only in the subgroup of PANS, of PANDA, is the specific causative agent of the disease antibody to group A beta-hemolytic streptococci.
Symptoms, Ailments & Signs
The PANDAS syndrome is characterized by motor disorders that can occur suddenly after an infection such as scarlet fever, purulent tonsillitis or an acute middle ear infection. The disease begins abruptly with behavioral and thought disorders or tics. Food intake is often refused.
Other symptoms are anxiety, aggression, irritability, depression, retardation in behavioral development in children and adolescents, concentration disorders, deterioration in school performance, deterioration in handwriting, sleep disorders, bedwetting, memory disorders and other psychiatric abnormalities.
A unique feature of PANDAS is that the combination of all symptoms can not be better explained by other diseases such as chorea minor, Tourette’s syndrome or lupus erythematosus. In particular, the symptoms must occur following infection with group A beta-hemolytic streptococci.
Diagnosis & course of disease
The diagnosis of PANDAS is based on the nature of the symptoms associated with the causative infection. In terms of differential diagnosis, the symptoms of PANDAS can be compared with the symptoms of obsessive-compulsive disorder without an infectious background (OCD).
Symptoms such as frequent urination, separation anxiety, impulsiveness, hyperactivity, poor handwriting and a deterioration in school performance come to the fore in PANDAS. These characteristics are closely related to the functioning of the basal ganglia. Finally, imaging procedures provide information about the damaged areas in the brain (striatum).
Complications
In PANDAS, those affected primarily suffer from various mental disorders. The symptoms can vary in severity. In most cases, however, there are various motor disorders and also inflammation in the ears. Those affected suffer from various behavioral disorders and thought disorders and thus also from delayed development.
If PANDAS is not treated at a young age, this can lead to considerable complications and difficulties in the adulthood of the patient. Those affected continue to suffer from bedwetting and concentration disorders. Sleep disorders and permanent aggression or irritability can also occur and thus also lead to social problems. In many cases with PANDAS, the children’s parents also suffer from severe psychological problems and depression.
School performance may deteriorate due to illness. In many cases, the patients are also dependent on the help of their fellow human beings in everyday life. The treatment of PANDAS can be carried out with the help of medication. However, psychological treatments are also necessary to completely limit the symptoms. The life expectancy of the patients is not affected by the disease in most cases.
When should you go to the doctor?
When children or adolescents exhibit motor disorders during their developmental process, there is cause for concern. The symptoms appear suddenly after an infectious disease has healed and put a heavy strain on the child’s health. A doctor should be consulted in the event of ear pain, noise in the ear, fever, general malaise and lack of interest. If there are behavioral problems, personality quirks or mental disorders, the observations should be discussed with a doctor.
If the mental performance level drops, if it starts wetting at night or if tics develop, the child needs medical help. Compulsive actions, an aggressive demeanor, easily excitable and inner restlessness are signs of a health impairment. If the general condition deteriorates, the child forgets skills that have already been acquired or if it seems very stressed, a doctor should be consulted. Deterioration of the child’s handwriting is characteristic of the disease.
If this is noticed, a doctor should be consulted immediately. Loss of appetite, withdrawal, or refusal to engage in play activities are considered unusual. If this development continues, it is advisable to consult a doctor. An anxious appearance, reduced self-confidence and sleep disorders should also be presented to a doctor. If the child forgets an independence that has already been achieved, this should be understood as an alarming signal. A doctor’s visit is recommended as soon as possible.
Treatment & Therapy
PANDAS is a syndrome that is currently still in the research stage. Therefore, there are still no strategies for causal treatment. Treatment is currently mainly symptomatic. Behavioral therapies are offered to treat behavioral structures.
At the same time, drug therapies with psychotropic drugs are also used. However, it is questionable whether these therapies can prevent the disease from becoming chronic. Hopeful approaches for a curative therapy are emerging within the framework of studies in which an extensive improvement and suppression of the symptoms was achieved with the help of antibiotic treatment.
With these therapies, it is assumed that by combating group A beta-hemolytic streptococci, the antibody effect against endogenous structures is also reversed. As long as there are no irreversible changes in the brain, the disease can then heal completely.
Outlook & Forecast
The acronym “PANDAS” stands for “Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections”. The prognosis for this is currently poor. Neuropsychiatric symptoms often occur after streptococcal infection. The complaints set in suddenly. If these remain untreated and the streptococcal infection is not recognized as a type A infection, PANDAS will become chronic.
Experts assume that this type of streptococci causes changes in the brain of those affected. Doctors are now striving to treat every streptococcal disease as early and comprehensively as possible in order to avoid such complications. PANDAS is characterized by sudden and drastic behavioral changes, obsessive -compulsive disorders and motor disorders.
It is believed that adults exhibiting such behaviors may be suffering from the lifelong consequences of undetected and untreated PANDAS syndrome. In most cases, the dramatic consequences of the streptococcal infection remain for life. The problem is that, apart from preventive treatment of the disease, there have been too few treatment options for the PANDAS syndrome that has already developed. This is still under investigation.
In the past, the connection with a recovered streptococcal infection was not recognized. Therefore, there was no preventive or symptomatic treatment approach that was effective. Possibly the prognosis of PANDAS sufferers can be improved in the future. Research into a causative, intravenous immunoglobulin therapy is nearing completion.
Prevention
The best prevention of PANDAS is to prevent infection with beta-hemolytic streptococci. These infections are contagious. The most important transmission route of these diseases is droplet infection via contact with the mouth and throat or via the air.
In this way, the transmission of germs can be limited in times of increased risk of infection by avoiding larger crowds. When the disease breaks out, immediate antibiotic treatment is necessary. The usual hygiene measures must be strictly observed.
Aftercare
In most cases, those affected with PANDAS have only a few or only limited measures and options for direct aftercare. In the first place, the person affected by this disease should see a doctor very early on, so that complications or other symptoms do not arise in the further course, so that a doctor should be contacted as soon as the first signs and symptoms of the disease appear.
Self-healing is also not possible. The treatment of PANDAS is usually carried out with the help of various drugs. The person concerned should always ensure that the dosage is correct and that it is taken regularly in order to relieve the symptoms properly and permanently. When taking antibiotics, it should also be noted that they should not be taken together with alcohol in order not to weaken their effect.
If you have any questions or if you have any side effects, you should consult a doctor first. In general, the person affected by PANDAS should avoid contact with other people so that people around him do not become infected. The further course depends heavily on the time of diagnosis, so that no general prediction can be made.
You can do that yourself
People suffering from PANDAS should take it easy and otherwise follow the doctor’s instructions regarding wound care, personal hygiene and taking medication. The disease usually subsides relatively quickly, provided that it is well cured and the patient is not subjected to any further physical exertion.
Patients should contact the doctor if, despite everything, complications occur or unusual symptoms appear that were not noticed before. In addition, general measures apply, such as drinking a lot and eating light food. Fever and chills indicate that the infection is spreading further and should therefore be clarified by a doctor. Parents of affected children should also ensure that the child has no contact with other children, since there is a relatively high risk of infection with PANDAS. In addition, PANDAS require close medical supervision.
If the child is already severely debilitated, emergency medical services should be contacted if the physical or mental condition continues to deteriorate. If in doubt, the child must be taken to the hospital for treatment. The doctor can give further tips for effective self-help measures with PANDAS.
