Imagine your child suddenly acting like a different person overnight. They may have developed a tic, intense mood swings, new fears, or a sudden change in their appetite. It might sound like an “off day” to many, but for some kids, it can be a real condition called PANDAS: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections.
Discovered in 1998, PANDAS usually occurs when a child acquires a strep infection such as strep throat, scarlet fever, strep impetigo, etc. The only difference between a regular strep infection and PANDAS is that kids with PANDAS often experience a sudden onset of OCD, tics, and behavioural issues. Most healthcare providers need to rule out a variety of other conditions like Tourette’s, OCD, anorexia, autoimmune encephalitis, and a whole load of other disorders before arriving at a diagnosis.
DOES MY CHILD HAVE PANDAS?
Here are some of the things doctors look for when making a PANDAS diagnosis:
- The child must be diagnosed with OCD and/or a tic disorder
- Symptoms must first appear between 3 years old and the beginning of puberty
- Symptoms must be episodic
- There should be some association with a group A beta-hemolytic strep infection
- There should be some association with neurologic abnormalities
WHY PANDAS OCCURS
PANDAS is an autoimmune response to a strep infection. When a child is infected, their antibodies start to rise in response to the infection (i.e., to defend the body and fight off the pathogen). This is a completely normal process. In children with PANDAS, these antibodies cross-react with proteins in their brains. This means the infection fools the body into attacking itself. This causes the immune cells in the brain to go haywire and results in behavioural symptoms as well as neuroinflammation.
You may be wondering, why don’t all kids get PANDAS? The simple answer is that science hasn’t given us the answer yet. PANDAS is a very controversial diagnosis and there is a lot we still don’t know. Some scientists suggest there is a genetic predisposition, and others think that it’s strictly related to our immune system.
TESTING FOR PANDAS
To accurately diagnose PANDAS, a variety of tests need to be completed to establish an infection and to rule out other disorders. Some of the tests that may be suggested for your child include:
- A strep antibody test: This is a blood test to detect whether your child is currently infected with strep bacteria or has been infected with strep bacteria in the past
- The Cunningham Panel: This is a specialised blood test that assesses the presence of antibodies associated with a variety of different neuro-autoimmune infections
- Lyme disease testing: Some symptoms of PANDAS overlap with those of Lyme disease and testing can help rule it out
- Strep swabs: Collecting throat, nasal, and rectal swabs can help determine whether there is a strep infection currently active
- Viral testing: This checks for viruses like cytomegalovirus and Epstein-Barr virus, which can mimic the symptoms of PANDAS
- Neurotransmitter testing/Organic Acids Test: This urine sample can help determine if certain toxins, nutritional deficiencies, or metabolic issues are producing the symptoms we see
TREATMENT OF PANDAS
Although treatment plans do exist, there is no single gold standard protocol on how to approach kids with PANDAS. Some kids present with attention deficit, others with personality changes, some regress behaviourally, and others experience psychosis—hence, a need for a multidisciplinary approach. Most doctors suggest treatment with antidepressants (SSRI medication), cognitive behavioural therapy, and some sort of antibiotic. Other practitioners will prescribe attention deficit disorder medications like methylphenidate, and some like to use holistic treatments alongside these medications.
Naturopathy
Naturopathic doctors (NDs) approach PANDAS on a case-by-case basis and always in conjunction with the advice of your medical doctor. For example, if children are placed on prophylactic antibiotics and start to experience digestive upset, then NDs can offer digestive support in the form of probiotics, teas, and acupuncture. For those who experience appetite changes, naturopaths can work with parents to help devise meal plans and ensure that their kids are getting the nutrients they need. If inflammation seems to be high, herbs like turmeric can help reduce the inflammatory response and potentially improve symptoms. Some herbs can help support the immune system in the case of recurrent infections, fatigue, allergies, and new skin or digestive issues.
THE GOOD NEWS
Children with PANDAS don’t appear to be at a greater risk of developing other autoimmune diseases. In addition, symptoms of PANDAS may spontaneously resolve after just a few months of treatment. If children are reinfected with strep then they may be prone to symptom exacerbation, or a return of their symptoms, but it’s also possible that their symptoms will be gone for good if treated properly. In the meantime, naturopaths can help soothe your child’s sore throat while the antibiotics work to eliminate the strep bacteria.
Helpful Hacks for Soothing Strep
- Gargle with salt water or water infused with an antimicrobial herb like goldenseal to directly kill bacteria in the throat.
- Complete an at-home lymphatic massage on your child, particularly where the lymph nodes run down the sides of the neck. Castor oil can be used to reduce inflammation and support lymphatic drainage.
- Honey! Add a spoonful of honey to a warm beverage of choice to help coat the throat—or, you can swallow the spoonful directly (a win-win for those of us with a sweet tooth).
- Get a compounded throat spray or syrup from a naturopathic doctor that contains anti-inflammatory, antimicrobial, and soothing properties. For example, adding clove oil to a formulation can help relieve pain and discomfort associated with a sore throat.
Unfortunately, PANDAS can sometimes mimic a variety of other disorders, ranging from OCD and Tourette’s to anorexia and ADHD. This suggests that the prevalence rate of kids with PANDAS may be grossly underrepresented. Kids may be misdiagnosed and given the wrong treatments, which can delay improvements and lead to other issues down the line. The best advice for parents is to seek medical attention as soon as symptoms arise. If your child was previously well and within 48 hours starts to show repetitive behaviours, thoughts, or tics, then go to the doctor.
Although some cases of PANDAS can be successfully treated, there are long-term consequences that may occur. For instance, symptoms of OCD, tics, and mood disorders may continue long-term, even after the resolution of the infection. This may have a psychological impact on the family unit as ongoing cognitive or behavioural issues can lead to academic and social challenges at school. Kids may feel socially isolated, struggle to focus in class, or they may suffer from low self-esteem. This is why it’s more important now than ever that PANDAS be addressed as soon as possible.
If you believe your child may have PANDAS or is currently undergoing treatment for PANDAS, then consider seeking the help of a naturopathic doctor. We are equipped with some of the testing and treatments that may be required to narrow down a diagnosis and get your kiddos feeling better, sooner.
