PANDAS Not of the Zoological Variety

"Whether PANDAS [Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections] is a unique clinical entity continues to be questioned. As a result of the high incidence of GABHS [strep] infections in the pediatric population, the relationship between PANDAS and GABHS infections might be purely coincidental."
The Canadian Family Physician, journal of the College of Family Physicians of Canada

"There is still a lot to be learned about PANDAS in terms of how it works inside the body. Each case could be different."
"Literally, it gets into an immune cell and hides."
"I think the reason there's no consensus comes down to the case. Until we can identify and diagnose the mechanism, there will be disagreement. Only when you have that, can you develop a medical course of action. Regulated health professionals have to be absolutely sure of what they're looking for."
Dr. Jason Tetro, microbiologist, visiting scientist, University of Guelph

"I think most of what is written about PANDAS on the Internet and in the press is helpful to these parents [of children with symptoms identifying PANDAS]. How else would they learn about this? Unless your physician knows about this disorder [and many do not], then often a child with changes like these ends up diagnosed with mental health issues that he or she truly doesn't have. Of course, there are people on the Internet who should not be calling themselves experts and reporting on this condition."
"But if you look for reputable sources [like the PANDAS Network in the United States at pandasnetwork.org] you will find information from physicians and researchers who study and publish about this and are really at the forefront."
Dr. Wendy Edwards, pediatrician specializing in treating children with Autism, Chatham, Ontario

PANDAS, with its long, complicated descriptive identity as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections is a relatively rare condition (and frightening condition) and as such is rarely diagnosed. Its origins are also mysterious, though it has been identified as being somehow related to the onset of that common childhood affliction, strep throat, for which antibiotics are normally prescribed.

According to the U.S. National Institute of Mental Health, it tends to affect children between the ages of three and puberty. The theory is that the strep bacteria hide through a process called 'molecular mimicry' on entry to the body. The host's natural response is for the immune system, recognizing the foreign bacteria posing as belonging, mustering itself to produce attack antibodies to combat the invading bacteria. And as sometimes occurs, the body's immune system may inadvertently attack the tissues belonging to the body, occasionally targeting the brain.

The symptoms of PANDAS appear suddenly in the wake of a strep infection, with symptoms that include obsessive compulsive disorder or a tic disorder. Symptoms may include hyperactivity, mood changes and sleeping difficulties, with symptoms that are 'episodic' and which can worsen before a gradual improvement occurs. Yet if a successive strep infection occurs, the symptoms return and become even more serious.

• ADHD symptoms (hyperactivity, inattention, fidgety)
• Separation anxiety (child is "clingy" and has difficulty separating from his/her caregivers; for example, the child may not want to be in a different room in the house from his or her parents)
• Mood changes, such as irritability, sadness, emotional lability (tendency to laugh or cry unexpectedly at what might seem the wrong moment)
• Trouble sleeping, night-time bed-wetting, day-time frequent urination or both
• Changes in motor skills (e.g. changes in handwriting)
• Joint pains 

When this occurs, it is a frightening development in the life of a young child, shocking to the parents who fear for their child's mental and physical stability, looking to their family doctor for an explanation. And that family doctor may have no real idea what has occurred, much less what the cause is, or the treatment; it is a little-recognized, little-studied condition. While recognized by many researchers and medical professionals, it does not have a listing in the International Classification of Diseases the standard diagnostic tool used by the World Health Organization.

The U.S.-based PANDAS Network assays a 'conservative' estimate to be one in 200 children that might be afflicted with this mysterious condition. Moreover, it is the belief of the Network that a link exists between PANDAS and a minority of pediatric OCDs (obsessive compulsive disorders), and tic disorders like Tourette Syndrome. PANDAS, according to microbiologist Jason Tetro, author of The Germ Code and the Germ Files, is a psychiatric condition whose cause may be microbiological in origin.

The Journal of the Canadian Academy of Child and Adolescent Psychiatry in 2007 documented an eight-year-old boy with PANDAS - related OCD with an eating disorder after an obsession with reading labels, and avoiding specific foods. He ritualized eating with a series of bizarre movements. A single course of antibiotics generally clears up a strep infection and the symptoms, but strep infections have the capacity to shelter in the sinuses and other body parts so they become difficult to detect and completely eradicate.

Some PANDAS parents feel the long-term use of antibiotics, though controversial, works best for their affected children, rather than the recommended cognitive behavioural therapy and selective serotonin reuptake inhibitor medication. The Canadian Family Physician journal in its 2012 article failed to recommend long-term antibiotic use as a solution for children suffering from PANDAS. PANDAS may results from the same infection that continues to resurface, or it may represent autoimmunity.

The average elementary school student can experience contact with the bacterium causing strep throat several times annually, which explains why it is that long-term antibiotic treatment appears effective, eradicating each bout of infection as it recurs, according to Dr. Tetro. This is yet another anomalous childhood disease that strikes without the cause, let alone the treatment being fully understood, and as with all such instances, more research is required to identify cause and remedy.

When a sudden, inexplicable illness affects a child’s health, getting an accurate diagnosis, proper treatment and support can make all the difference. This has proven to be especially true in the case of two complex, related syndromes known as Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS).