What is PANDAS (pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections)

PANDAS is a childhood mental health disorder. Children with the disorder develop one or both of these conditions:

• Obsessive-compulsive disorder (OCD).
• Rapid and repetitive muscle contractions that cause purposeless body movements or noises (tics).

PANDAS very rarely occurs after puberty. It is a rare and new disorder that experts are still learning about.

What are the causes?

This condition may be caused by a reaction to a strep infection. When your child has a strep infection, his or her body makes proteins called antibodies in response to strep bacteria. In children with PANDAS, these antibodies attack brain cells instead of the bacteria.

What increases the risk?

This condition is more likely to develop in children who:

• Are 3–12 years old.
• Have or have had a strep infection, such as strep throat or scarlet fever.
• Have OCD or tics.

What are the signs or symptoms?

Symptoms may start suddenly following a strep infection. They may come and go or fade over time. Symptoms of this condition may include:

• Hyperactivity.
• Mood swings.
• Sleep disturbances.
• Bedwetting.
• Changes in handwriting.
• Inability to pay attention or remember things.
• Panic attacks.
• Obsessive fears.
• Twitches and tics.
• Increased sensitivity to touch, noise, and light.
• Separation anxiety.

Children who already have OCD or tics may have new or worsening symptoms.

How is this diagnosed?

This condition may be diagnosed based on:

• Your child’s symptoms.
• Your child’s medical history.
• A physical exam.
• Tests, such as:
  • Blood tests to check for a current or recent strep infection.
  • A throat culture to test for strep throat.

Your child’s health care provider will look for an association between a strep infection and OCD or tics that has occurred in an overnight or dramatic on-or-off way. Your child’s health care provider may diagnose PANDAS if your child is 3–12 years old and has:

• Sudden OCD or tic symptoms.
• Sudden worsening of OCD or tics.
• OCD symptoms that come and go suddenly.
• An associated strep infection.
• Hyperactivity or uncontrolled movements.

How is this treated?

This condition may be treated with:

• Antibiotic medicine to treat an active strep infection.
• Talk therapy (psychotherapy) for OCD behaviors.
• Antidepressant medicines called SSRIs.
• Immunoglobulins given through an IV and plasma exchange for very severe symptoms. Immunoglobulins are donor antibodies. Plasma exchange is a type of blood transfusion treatment.

Follow these instructions at home:

• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• If your child was given an antibiotic, make sure your child takes it as directed. Do not stop giving your child the antibiotic even if he or she starts to feel better.
• If your child was diagnosed with a strep infection, change his or her toothbrush to avoid re-infection.
• Work with your child’s health care providers and therapists to find the best treatment for your child.
• Allow your child to return to normal activities as told by your child’s health care provider. Ask your child’s health care provider what activities are safe for your child.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

• Your child has a fever.
• Your child has a sore throat.
• Your child has swollen glands.
• Your child’s OCD symptoms suddenly get worse.
• Your child’s OCD symptoms do not improve with medicine.