Pediatric Autoimmune Neuropsychiatric Disorders (PANDAS)

By Naomie Natasha

What is PANDAS?

PANDAS is a serious syndrome associated with streptococcus. Following an infection involving streptococcal-A infection, there is an onset of obsessive compulsive disorder (OCD) or tics. This is a rare condition and the children affected by Pediatric Autoimmune Neuropsychiatric Disorders have dramatic symptoms.

They include dramatic movements or vocal tics, compulsion and sometimes moodiness. PANDAS disorder still defies explanation by researchers which have left many parents with children suffering from this syndrome feeling devastated (1).

The cause of PANDAS is believed to be an autoimmune response to strep infections such as strep throat or scarlet fever.

Causes of PANDAS

Pediatric Autoimmune Neuropsychiatric Disorders is a condition associated with streptococcal infections. It is an autoimmune response following these infections; scarlet fever, sinusitis, strep throat and cellulitis.

It was not discovered long ago and it is diagnosed when children develop extreme physical and behavioral symptoms. It is a rare condition and affects mainly children.

In 1990s, researchers (2) identified that some children developed sudden obsessive compulsive disorder symptoms. All children had sudden changes in behavior, vocal and motor tics and identified that the bacteria that causes sore throat to be responsible.

Other infections have contributed to trigger this condition such as influenza, Lyme disease and varicella.

Streptococcus bacteria are known to trigger other immune related disorders such as rheumatic fever and kidney disorders. Streptococcus bacteria are known to mimic host cells and when identified in the immune system, antibodies are produced to attack them. In the process, some of the children’s body cells are attacked like the brain cells causing OCD and other symptoms seen in PANDAS patients.

Risk factors for Pediatric Autoimmune Neuropsychiatric Disorders

A family with history of getting rheumatic fever and other autoimmune diseases can increase the chances of their children getting this disorder. Streptococcal infections also are associated with causing this disorder.

Symptoms and Signs of Pediatric Autoimmune Neuropsychiatric Disorders

When my child max was 3, he was a gifted, happy little guy. He never had any problem eating, temper tantrum and looked healthy until he woke up one day and stopped eating. He often said that he was not hungry and he went from being happy to having meltdowns where he would behave wildly and hit, spit and punch other children.

It became worse where he would take his clothes off and threaten to kill us and himself. It did not take long for tics to develop. We would see him shrugging his shoulders, eye blinking, clear his throat hard, sniffing his fingers and shaking his head violently.

It is then I became worried and knew something was very wrong with my boy. I took him to 4 different pediatricians who diagnosed him with feed disorder, autism and even some depression but there was no improvement after those diagnoses so I kept searching.

He soon tested positive for a strep infection and I almost fainted because he had no strep symptoms. With the help of a specialist, I came to realize that my son was suffering from Pediatric Autoimmune Neuropsychiatric Disorders.

PANDAS is a dangerous condition that pediatricians may fail to recognize its symptoms and signs. It is an autoimmune response to strep infections in which the antibodies attacks the healthy cells including brain cells which causes changes in movement and behavior.

Diagnosis of Pediatric Autoimmune Neuropsychiatric Disorders

One of the difficulties of this disorder is that one cannot diagnose it with a blood test. The best way to identify it is a performing a clinical diagnosis by taking the medical history of the child and his parents.

Physical examination is also important to determine if the child has the symptoms of compulsions, being irritated, obsessions and tics.

Unfortunately, children with this condition are often misdiagnosed. If a pediatrician is not familiar with Pediatric Autoimmune Neuropsychiatric Disorders, they may diagnose children suffering from it as having poor parenting or being in rebellious developmental stages.

Sometimes, it can be misdiagnosed as mental illness and the wrong medications are prescribed. It is important for pediatricians to note that this disorder is triggered by other infections such as chickenpox, Lyme disease and flu.

PANDAS is not contagious and cannot be transferred by just touching or by sitting with other children. However, the bacteria infection that triggers this disorder can be passed from child to the other (2).

Treatment of Pediatric Autoimmune Neuropsychiatric Disorders (PANDAS)

Effective treatment of Pediatric Autoimmune Neuropsychiatric Disorders (PANDAS) must begin with the present infection in order to address the immune system problem. The strep infection must be treated where antibiotics are prescribed.

A single course of antibiotics is used to treat strep infections such as

  • Penicillin
  • Cephalosporin
  • Amoxicillin and Azithromycin.

To prevent re infection, some measures need to be undertaken because it is possible for the bacteria to reinfect again. Replace your child’s toothbrush with a new one after finishing his or her full course of antibiotics.

OCD can be treated by use of serotonin reuptake inhibitors. These are antidepressants and they include the following;

  • Paroxetine
  • Fluoxetine
  • Sertraline and fluvoxamine

A pediatrician will prescribe these medications in small doses as a start then increase depending on the severity of the symptoms. In some cases, corticosteroids may be prescribed to improve the symptoms of Pediatric Autoimmune Neuropsychiatric Disorders.

It is important to note that steroids can make tics worse and if prescribed, they are supposed only to be taken for a short period. In rare cases, this disorder might not respond to medications. Blood plasma exchange or intravenous immunoglobulin therapy is done instead.

A donor is extracted blood plasma products in order to boost the immune system of a child suffering from Pediatric Autoimmune Neuropsychiatric Disorders (PANDAS).  There has been a report that these types of treatments are effective (3).

If not treated, this disorder can leave your child unable to function in home and at school. The symptoms may worsen and can result in cognitive damage. The sooner the disease is diagnosed; the easier it is to treat its symptoms (3).


  1. Information about PANS/PANDAS. (n.d.). Retrieved from,
  2. International OCD foundation. (n.d.). Retrieved from,
  3. IVIG. (n.d.). Retrieved from,