Some develop a sudden onset of neurological disorders after a strep infection: obsessive-compulsive disorder (OCD), Tourette’s, tics, odd behaviors, emotional instability, and other psychiatric and neurological disorders. This condition is called PANDAS — Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.
It is believed the strep infection triggers an autoimmune attack against the brain, which explains the rapid onset of neurological and psychiatric symptoms.
Additionally, a similar disorder called PANS, or Pediatric Acute-Onset Neuropsychiatric Syndrome, results from environmental factors or other infections triggering similar symptoms.
Many doctors and researchers don’t believe PANDAS/PANS is a credible condition, in part because it can’t be measured by a lab test and because it doesn’t have much research behind it. However, many parents know it to exist because their once healthy and normal child changed drastically and permanently after an exposure to strep or other pathogenic insult.
Instead, these experts believe the children should be diagnosed with conditions such as OCD and that the connection between an infection or pathogen is not credible.
Now, however, new research sheds additional light on the disorder and why it triggers neurological disorders in some children and not others.
PANDAS/PANS is a result of inflammation in an area of the brain called the basal ganglia. The basal ganglia helps control emotions and motor control.
When autoimmunity is triggered by a strep infection or other insult in susceptible children, the immune system attacks and damages the basal ganglia.
In 2018, researchers isolated cells called cholinergic interneurons in the basal ganglia. These cells were found to be the target of autoimmune attack. Past research has demonstrated these same cells become depleted in Tourette’s syndrome, causing symptoms.
The autoimmune attack causes these cholinergic interneurons to fire less when strep antibodies attach to them, causing symptoms of PANDAS/PANS.
Why does this affect some children and not others? One explanation is a leaky blood-brain barrier.
In a healthy brain environment, strep antibodies are not be able to cross the blood-brain barrier to cause immune attacks in the brain.
However, in vulnerable children, inflammatory TH-17 immune cells from a strep infection can cause the blood-brain barrier to become overly permeable. This is called a leaky blood-brain barrier, and it allows strep antibodies and other compounds that belong in the brain to enter.
Research shows most of these TH-17 cells pool in the olfactory bulb, the “smelling” area of the brain that receives signals from the nasal passages.
This pathway allows antibodies to enter into the brain, especially after 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:
- Emotional swings and/or depression
- Irritability, anger, oppositional behavior
- School performance deteriorates
- Sensory or motor abnormalities
- Sleep disturbances, urinary frequency, bed wetting
Functional medicine for PANDAS/PANS
Functional medicine can help reduce inflammation and autoimmune attacks in PANDAS/PANS and support immune and brain health.
Strategies may include removing inflammatory triggers from the diet and environment; nutritional supplements geared toward lowering inflammation and supporting brain health; stabilizing blood sugar, gut health, and toxicity; supporting neurotransmitters; and repairing mitochondrial function and the blood-brain barrier.
Swift action can improve the outcome from PANDAS/PANS. Although some doctors may not believe it’s a valid condition, parents know their children best. For more information, contact my office.