Introduction
PANDAS, or pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, are frequently accompanied by other behavioral symptoms. Pediatric infection-triggered autoimmune neuropsychiatric diseases (PITANDs), children's acute neuropsychiatric symptoms (CANS), and pediatric acute-onset neuropsychiatric syndrome (PANS) have all been identified as PANDAS-related illnesses. PANDAS has been a contentious diagnosis since it was first identified in 1998.
What Are Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS)?
The controversial theory known as PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) contends that streptococcal infections are responsible for children's abrupt development or exacerbation of neuropsychiatric symptoms. This theory postulates that some strains of Streptococcus bacteria might cause an autoimmune reaction that results in antibodies being produced that attack the brain, namely the basal ganglia.
Children who experience an autoimmune response may experience symptoms including obsessive-compulsive disorder (OCD), tics, anxiety, and behavioral changes. Examining symptoms, taking into account previous streptococcal infections, and using antibiotics or immunomodulatory medications are all part of the diagnosis and treatment process. To further understand the disorder, more study is required because the existence and exact nature of PANDAS is still up for discussion in the medical profession.
Why Is Pandas Controversial?
PANDAS has not been approved as a disease categorization for a number of reasons. There have been no systematic investigations into the potential connections between GAS and other neurologic symptoms, and it is suggested age of start and clinical characteristics were specific to a patient population selected for research studies. Whether its choreiform movement symptom was different from the related motions of SC was a matter of debate. Whether the abrupt onset pattern was unique to PANDAS was unknown. Lastly, there was disagreement on the existence of a temporal correlation between GAS infections and PANDAS symptoms.
Why Does PANDAS Syndrome Occur?
Some people think that the production of antibodies by the child's immune system to combat the strep bacteria causes PANDAS. But because the cells mirror those of the strep infection, the antibodies may potentially inadvertently target healthy cells in other regions. Some people think that antibodies harm the child's brain tissues, causing the occasionally described neurological and psychiatric disorders.
What Are the Symptoms of PANDAS?
Common PANDAS signs and symptoms include:
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Children with obsessive-compulsive disorder (OCD) may have intrusive thoughts, severe phobias, or compulsions. These compulsions and obsessions are frequently strong and impair day-to-day activities.
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Both motor tics and verbal tics, or abrupt, repeated motions, can happen. The child's activities may be interfered with by these tics.
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Children with PANDAS may show elevated anxiety levels, such as separation anxiety, generalized anxiety disorder, or enhanced emotional sensitivity.
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Children may exhibit abrupt behavioral changes such as impatience, emotional lability (mood swings), violence, or oppositional behaviors. Additionally, individuals could go through a behavioral regression in which they act younger than their actual age.
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Some PANDAS youngsters may struggle with cognitive processing, attention, focus, memory, and other skills. Their academic performance may be impacted by these issues.
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PANDAS Symptoms of Adults: After the age of twelve, strep infections rarely cause reactions, although researchers are aware that PANDAS, though uncommon, can happen in teenagers. Although the possibility of experiencing these post-strep neuropsychiatric symptoms for the first time in adulthood is low, this possibility has not been well investigated.
What Is the Diagnosis of PANDAS?
There are no particular laboratory tests or clear diagnostic criteria for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS), making a diagnosis difficult. Clinical observations, medical history, and the elimination of other potential reasons for the symptoms are often used to make a diagnosis. The diagnosis of PANDAS is often made by healthcare professionals using a set of standards. These standards consist of:
Presence of Neuropsychiatric Symptoms: Neuropsychiatric symptoms must be present, including a rapid development or exacerbation of OCD and/or tic disorder symptoms in the kid.
Preceding Group A Streptococcal (GAS) Infection: Evidence of a recent streptococcal infection should exist, which is often verified by a throat culture or blood test. The precise interval between the infection and the onset of symptoms is still unclear.
Association With Other PANDAS Features: The symptoms should be linked to other PANDAS characteristics, such as sudden symptom onset and episodic course (fluctuations in symptom intensity).
Exclusion of Further Causes: Further infections, neurological diseases, and psychological illnesses should all be thoroughly explored and ruled out through the proper diagnosis.
Are PANDAS Syndrome and PANS Syndrome Synonymous?
The acronym PANS stands for "pediatric acute-onset neuropsychiatric syndrome." Some suppliers believe PANDAS to be a subset of PANS. Those people believe that both produce comparable symptoms that appear unexpectedly. But although PANS is known to originate from other diseases like Lyme disease or influenza, PANDAS is thought to be connected to a strep infection.
How Can PANDAS Syndrome Be Prevented?
The best strategy to avoid any sickness that is assumed to be brought on by an infection is to stop the infection before it starts. Promote proper hygiene in the children by:
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Using a tissue or their elbow to cover their mouth and nose when they sneeze or cough.
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Not distributing food, beverages, or private things like toothbrushes.
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Often washing hands and, if feasible, using hand sanitizer.
What Is the Treatment for PANDAS?
Depending on the child's particular needs and the severity of the symptoms, the specific treatment approach may change. Here are a few typical treatment methods:
Antibiotic Treatment: Antibiotics like Penicillin or Amoxicillin may be recommended to treat an active streptococcal infection if it is identified or believed to exist. The goal is to eliminate the germs and stop additional immune activation that can make symptoms worse. The child's unique situation and medical background will determine how long and which antibiotics are prescribed.
Immunomodulatory Therapy: Immunomodulatory therapy may be taken into consideration when symptoms are severe, chronic, or severely affecting a child's ability to function on a daily basis. These remedies are designed to alter the immune response and lessen brain inflammation. Several immunomodulatory treatments for PANDAS include:
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Prednisone and Other Corticosteroids: They can be used in short-term regimens to suppress the immune system and lessen inflammation. However, due to potential adverse effects, prolonged use of corticosteroids is typically discouraged.
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Intravenous Immunoglobulin (IVIG): IVIG is a treatment that includes injecting a large dosage of antibodies from donors who are in good health. Modulation of the immune response and short-term symptom alleviation are the goals of this therapy. IVIG is often only used in severe or resistant PANDAS patients.
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Plasma Exchange (Plasmapheresis): It is a procedure that includes withdrawing a child's blood, separating the plasma (which carries antibodies) from the blood cells, and then replacing it with donated plasma or a plasma replacement.
Treatment for Symptoms: It may be advised depending on the particular symptoms and how they affect the child. In addition to supportive therapies like cognitive-behavioral therapy (CBT) or other types of psychotherapy to address anxiety and behavioral disorders, this can include the use of selective serotonin reuptake inhibitors (SSRIs) to manage obsessive-compulsive symptoms or tics.
Conclusion
In summary, there is still debate and study around the hypothesis of Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, or PANDAS. While some researchers and physicians agree that some streptococcal infections might cause autoimmune responses in children that result in neuropsychiatric symptoms, others express doubts over study procedures, diagnostic standards, and the need for stronger proof. PANDAS is a contentious illness that requires an individualized treatment plan in close consultation with medical experts that takes into account the child's particular requirements and symptoms. For better results in diagnosis and therapy, further study is required to clarify the nature of PANDAS.
