Strep throat is a common bacterial infection causing a sore throat, fever, and swollen tonsils. Seizures are neurological events characterized by abnormal electrical activity in the brain. While a direct link between strep infection and typical epileptic seizures is uncommon, an indirect, rare connection exists through specific autoimmune conditions. This article explores how strep can lead to neurological symptoms.
The Indirect Connection: PANDAS and PANS
The link between strep and neurological symptoms involves an immune system response that can misfire following an infection. This connection is primarily seen in Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). These conditions occur when an infection, specifically strep for PANDAS or various infections for PANS, triggers an immune response.
Instead of solely targeting the infection, the immune system mistakenly creates antibodies that attack parts of the brain, particularly the basal ganglia. While PANDAS and PANS are most recognized for causing a sudden onset of obsessive-compulsive disorder (OCD) and tics, the resulting brain inflammation and neurological dysregulation can lead to a broader range of neurological symptoms. The neurological impact of these conditions can sometimes manifest as seizure-like activity, motor abnormalities resembling seizures, or, in rare instances, a lowered seizure threshold due to neuroinflammation.
Recognizing Neurological and Behavioral Changes
A hallmark of PANDAS and PANS is the sudden onset of symptoms. Individuals may experience an abrupt appearance of obsessive-compulsive disorder symptoms, such as intrusive thoughts or repetitive behaviors. Motor and vocal tics, involuntary movements or sounds, are also common. Behavioral regression, where a child might exhibit temper tantrums or begin using “baby talk” not age-appropriate, can occur.
Other signs include increased anxiety, often presenting as separation anxiety, and increased sensory sensitivities to light, sound, or touch. Sleep disturbances, such as insomnia or night terrors, along with new-onset urinary frequency or bedwetting, can also occur. Fine motor skills may deteriorate, evident in a sudden decline in handwriting ability. Motor abnormalities or transient neurological events in PANDAS/PANS might be mistaken for seizures due to the conditions’ neurological impact.
Diagnosis and Management Approaches
Diagnosing PANDAS and PANS can be complex, as there is no single definitive laboratory test. Diagnosis relies on clinical criteria, including a thorough medical history and physical examination to assess symptom onset and rule out other conditions. Due to their specialized nature, diagnosis is often made by a multidisciplinary team, including neurologists, psychiatrists, or immunologists.
Management strategies begin with treating any active underlying infection, such as strep, with appropriate antibiotics. Symptomatic therapies, like cognitive behavioral therapy (CBT) for OCD or tics, help manage behavioral and neurological manifestations. In severe, acute episodes, immune-modulating treatments may be considered. These can include intravenous immunoglobulin (IVIG) or plasmapheresis, which aim to reduce the autoimmune response affecting the brain.
When to Seek Medical Attention
Seek medical attention promptly if there is a sudden onset of behavioral or neurological symptoms. This includes concerns about seizure-like activity or observed seizures, especially if these changes follow a strep or other infection. Early diagnosis and intervention are crucial for managing these conditions and improving outcomes. Consulting a healthcare professional can help determine the underlying cause and guide appropriate treatment.