PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. It is a controversial and hypothetical diagnosis for a subset of children with rapid onset of obsessive-compulsive disorder (OCD) or tic disorders. PANDAS is hypothesized to be an autoimmune disorder that results in a variable combination of tics, obsessions, compulsions, and other symptoms with sudden or abrupt onset that may be severe enough to qualify for diagnoses such as chronic tic disorder, OCD, and Tourette syndrome.
The cause of PANDAS is not fully understood, but it is believed that tics and OCD are produced in a similar manner. One part of the brain that may be affected in PANDAS is the basal ganglia, which is believed to be responsible for movement and behavior. It is thought that similar to Sydenhams, the antibodies cross-react with neuronal brain tissue in the basal ganglia to cause the tics and OCD that characterize PANDAS.
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 adolescents. The symptoms are usually dramatic, happen “overnight and out of the blue,” and can include motor or vocal tics or both and obsessions, compulsions, or both.
There is no specific test to diagnose PANDAS, but healthcare providers will perform a physical exam and evaluate the childs symptoms. The diagnosis is based on clinical diagnostic criteria, which include the sudden, dramatic onset of OCD or extremely restricted food intake, and the simultaneous appearance of additional neuropsychiatric symptoms with acute, severe onset from at least two of the following seven categories: irritability, aggression, or oppositional behaviors; motor or sensory abnormalities; emotional lability or depression; behavioral (developmental) regression; sleep disturbances; anxiety; and/or severely restricted food intake.
Treatment for PANDAS may include standard medications, behavioral therapies such as cognitive-behavioral therapy (CBT), or both. OCD symptoms are treated best with a combination of CBT and a medication called a selective serotonin reuptake inhibitor (SSRI) . Focusing on cognitive-behavioral therapy for behavioral problems and habit reversal training for tics helps decrease the frequency of symptoms and provides children with the best chance for a full recovery.
