What Is PANDAS Syndrome?

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Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) syndrome is a childhood disorder in which the immune system overreacts after an illness, causing an inflammatory response in the brain. In PANDAS syndrome, antibodies produced to fight the infection then misguidedly attack healthy brain tissue.

The onset of PANDAS syndrome symptoms comes on quickly, and can include motor and vocal tics, compulsion, obsessions, or a combination.

This article provides an overview of PANDAS syndrome, including its symptoms, causes, treatments, and prognosis.

Child with sore throat

Paul Bradbury / Getty Images

Symptoms

PANDAS syndrome symptoms can vary from person to person and can include:

  • Sudden obsessive-compulsive traits
  • Motor and verbal tics or other unusual movements
  • Loss of motor skills
  • Light sensitivity
  • Difficulty sleeping
  • Fatigue
  • Visual or auditory hallucinations
  • Unusual moodiness or irritability
  • Aggressive behavior
  • Personality changes
  • Nighttime bedwetting
  • Restricted eating
  • Separation anxiety
  • Joint pain

People with PANDAS may also have a combination of symptoms.

Further, if a child already has neurological symptoms before being diagnosed with PANDAS syndrome, the symptoms usually worsen.

If you are concerned about new or usual symptoms in your child, contact your healthcare provider or pediatrician.

Causes

PANDAS syndrome most commonly occurs after a strep infection. However, research shows that other viral, bacterial, or other illnesses can also cause PANDAS syndrome symptoms to appear.

Usually, our immune systems produce antibodies to fight an infection when we get sick. However, with PANDAS syndrome, the antibodies overreact and misguidedly attack healthy tissues in the brain.

The attack on healthy brain cells leads to an autoimmune condition that directly affects central nervous system (CNS) function. The effect can be seen almost immediately in the child, presenting a drastic change in personality, or cause OCD, anxiety, and other neurological issues.

Diagnosis

There are no blood tests or labs to make or confirm a PANDAS syndrome diagnosis.

However, if PANDAS syndrome symptoms have been present for at least one week, a blood test can determine if the child had a recent strep infection.

A healthcare provider will make a clinical diagnosis based on specific diagnostic information, which includes that the child:

  • Is between 3 years old and puberty age
  • Has the presence of obsessive-compulsive disorder (OCD), a tic disorder, or both
  • Has a positive throat culture for group A strep throat or a past medical history of scarlet fever
  • Presents with neurological issues that the child did not previously have and cannot control, including physical hyperactivity or unusual and jerking movements
  • Had a quick onset and worsening of neurological symptoms

Treatment and Recovery

The first step requires antibiotics to treat the strep infection.

A throat culture can determine if the child has strep in the throat. If the culture is positive, a single course of antibiotics will usually cure a strep infection. As the strep resolves, PANDAS syndrome symptoms should as well.

In some cases, a strep culture may come back negative. If that happens and a child is having PANDAS syndrome symptoms, a healthcare provider will usually ensure the child doesn't have a different infection, such as:

  • A sinus infection
  • A strep infection of the vagina, the urethral opening of the penis, or anus

Strep may be harder to resolve in areas other than the throat and may require a longer course of antibiotics.

Strep is a bacterial—not a viral—infection. Antibiotics are necessary to cure strep throat. The condition will linger without antibiotics, and PANDAS syndrome symptoms can worsen.

Prognosis

After starting antibiotic treatment, children with PANDAS syndrome usually see a slow and gradual improvement in symptoms.

Children who later get another strep infection can have a reemergence of symptoms. But with antibiotic medications, PANDAS syndrome symptoms can resolve again.

Symptom duration often depends on how severe the symptoms are. Once antibiotics are started, symptoms usually last from several weeks to months.

Every case of PANDAS is different, so it's essential to discuss prognosis expectations with your healthcare provider.

Summary

PANDAS stands for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. It is a childhood disorder in which the immune system overreacts after an illness, causing an inflammatory response in the brain. As a result, antibodies attack healthy brain tissue.

This condition presents with a fast onset of neurological symptoms, such as obsessive-compulsive traits, tics, loss of motor skills, personality changes, and more.

Treatment begins with antibiotics to address the strep infection. Upon starting antibiotics, children usually have a slow and gradual improvement in symptoms over several weeks to months.

A Word From Verywell

Having a child with a PANDAS diagnosis can be frightening and overwhelming for loved ones. Fortunately, PANDAS syndrome is treatable, and symptoms can resolve over time. Remember that strep throat is a very common infection for children. Most kids get it at some point. The presence of strep throat does not mean your child will get PANDAS syndrome. But if you notice a sudden onset of neurological symptoms, contact your healthcare provider right away.

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3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Institute on Mental Health. PANDAS - questions and answers.

  2. Dop D, Marcu IR, Padureanu R, Niculescu CE, Padureanu V. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (review)Exp Ther Med. 2020;21(1):94. doi:10.3892/etm.2020.9526

  3. PANDAS Network. What is PANDAS?.