Strep throat is a normal part of childhood and while it causes discomfort, the symptoms usually clear up after the first few doses of antibiotics. But for a small number of children, the infection triggers unusual behavior changes known as PANDAS syndrome: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. When a child has strep throat, his or her immune system produces antibodies to fight the strep bacteria. But in the case of PANDAS, these antibodies can also attack molecules in the brain.
The condition, which may affect approximately 1 in 200 children or 1 in 500 children, is mostly characterized by OCD (obsessive compulsive disorder), tic disorders or both developing or worsening dramatically, anxiety and aggression after a bout with strep throat, or another type of strep infection, according to the National Institute of Mental Health. And it manifests itself quickly. Typically, OCD develops over years or months, but in PANDAS the symptoms literally begin overnight. It can be scary, but once your child is diagnosed with PANDAS and starts treatment, it’s likely he’ll eventually make a full recovery. It’s also important to note that just because your child acquires a group A strep infection, this does not mean that it will automatically lead to PANDAS.
Here’s what else you need to know about PANDAS syndrome:
- signs of obsessive-compulsive disorder (OCD,) tics, or both
- separation anxiety, fear, and panic attacks
- incessant screaming, irritability, and frequent mood changes
- emotional and developmental regression
- visual or auditory hallucinations
- depression and suicidal thoughts
- sensitivities to light, sound, and touch
- deterioration of small motor skills or poor handwriting
- hyperactivity or an inability to focus
- trouble sleeping
- refusing to eat
- joint pain
- frequent urination and bedwetting
Can anyone develop PANDAS syndrome?
PANDAS is considered a pediatric disorder and typically first appears in childhood from age 3 to puberty. Reactions to strep infections are rare after age 12, but researchers recognize that PANDAS could occur, though rarely, among tweens or teens. It is unlikely that someone would experience these post-strep neuropsychiatric symptoms for the first time as an adult, but it has not been fully studied.
Treatment options for PANDAS
The best treatment for acute episodes of PANDAS is to treat the strep infection causing the symptoms with antibiotics. Your doctor may prescribe penicillin, amoxicillin (Amoxil), azithromycin(Zithromax), or another antibiotic. The treatment for the symptoms — OCD and other forms of severe anxiety — is cognitive behavioral therapy and anti-depressant (also called anti-obsessional) medication, a selective serotonin reuptake inhibitor or SSRI. Tic disorders are often treated with a variety of medications, as well.
Other therapies like plasmapheresis (a procedure that removes antibodies from the blood) and/or intravenous immunoglobulin or IVIG (used to alter the function or production of abnormal antibodies), which are often used to treat autoimmune disorders, may be a treatment option for children with PANDAS as well. But these treatments are often reserved for severely affected children who do not respond to the other therapies.
Although it may take time, most children who have PANDAS recover completely with treatment.Symptoms tend to slowly get better over several months once the strep infection clears, but there may be ups and downs. Plus, PANDAS is likely to come back if your child gets strep again. Sometimes all it takes is exposure to the germ. It is not currently possible to predict which children will be affected or how severely.