New research provides more clues in PANDAS

Children who recently had a strep infection and then go on to suddenly develop symptoms of obsessive-compulsive disorder (OCD), Tourette’s, tics, odd behaviors, emotional instability, and other psychiatric and neurological disorders are believed to have PANDAS.

PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.

In some children, a strep infection appears to trigger an autoimmune attack against the brain, causing a sudden onset of neuropsychiatric symptoms.

PANS, or Pediatric Acute-Onset Neuropsychiatric Syndrome, is similar, except environmental factors or other infections trigger symptoms.

PANDAS/PANS isn’t believed to be fully credible by many experts or doctors, in part because it must be diagnosed by symptoms and because the supporting research hasn’t been very strong. Instead, they diagnose affected children with conditions such as OCD.

However, recent research sheds new light on the disorder and why it affects some children and not others.

PANDAS/PANS causes inflammation in an area of the brain called the basal ganglia, which helps govern emotions and motor control. When the immune system creates antibodies to the strep infection, these antibodies mistakenly attack tissue in the basal ganglia as well.

In 2018, researchers isolated cells in the basal ganglia, called cholinergic interneurons, which are affected by the immune attack. Previous research has shown these cells are depleted in Tourette’s syndrome.

These cholinergic interneurons fire less when strep antibodies attach to them, which is believed to cause the symptoms associated with PANDAS/PANS.

Normally, antibodies would not be able to cross the blood-brain barrier to cause immune attacks in the brain. However, research shows the spike in inflammatory immune cells called TH-17 from a strep infection can cause the blood-brain barrier to open up. This is commonly called leaky blood-brain barrier and can allow strep antibodies and other pathogens to enter into the brain.

It has been found that most of these TH-17 cells pool in the olfactory bulb, an area of the brain that receives signals from the nasal passages.

This creates a path through which antibodies can enter, especially with repeat strep infections.

Genetic susceptibility has also been found to be a link in PANDAS/PANS.

PANDAS diagnosis criteria

• Significant obsessions, compulsions, tics
• Abrupt onset of these symptoms or relapsing and remitting symptom severity
• Onset prior to puberty
• Association with strep infection
• Association with neuropsychiatric symptoms, including PANS symptoms

PANS diagnosis criteria:

Abrupt, dramatic onset of OCD or severely limited food intake and the addition of at least two of the following:

• Anxiety
• Emotional swings and/or depression
• Irritability, anger, oppositional behavior
• Regression
• School performance deteriorates
• Sensory or motor abnormalities
• Sleep disturbances, urinary frequency, bed wetting

Functional medicine for PANDAS/PANS

Functional medicine strategies can help reduce inflammation and autoimmune attacks in PANDAS/PANS and support immune and brain health.

Functional medicine strategies may include removing inflammatory triggers from the diet and the environment; nutritional therapies to lower inflammation and support brain health; addressing blood sugar, gut health, and toxicity; supporting neurotransmitters; and repairing mitochondrial function and the blood-brain barrier.

Quick action can improve outcome. For more information, contact my office.

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