Some children develop PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) after a recent strep infection which suddenly develops into symptoms that can include obsessive-compulsive disorder (OCD), Tourette’s, tics, odd behaviors, emotional instability, and other psychiatric and neurological disorders.
It seems that a strep infection can trigger an autoimmune attack against the brain in some children, causing this hidden onset of neuropsychiatric symptoms.
In the case of PANS, or Pediatric Acute-Onset Neuropsychiatric Syndrome, environmental factors or other infections can trigger these symptoms.
Many experts and doctors don’t believe that PANDAS/PANS is fully credible. In part, this is because the condition must be diagnosed by symptoms and because there isn’t strong supporting research. Instead, children are often diagnosed with conditions such as OCD.
However, new research is shedding 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 help the strep infection, these antibodies mistakenly attack tissue in the basal ganglia as well.
In 2018, researchers isolated cells in the basal ganglia which are affected by the immune attack. Other research had shown that these cells, called cholinergic interneurons, are depleted in patients who have 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.
Antibodies should not be able to cross the blood-brain barrier and cause immune attacks in the brain. However, research shows that a strep infection can spike inflammatory immune cells called TH-17 which 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 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 is what creates the 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:
- 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 strategies can help reduce inflammation and autoimmune attacks in PANDAS/PANS.
These strategies can 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.
Contact my office to learn more about how functional medicine can help support immune and brain health.