Tics are involuntary, repetitive movements or sounds that are sudden and quick, often appearing as eye blinking, head jerking, or throat clearing. Strep throat is a common bacterial infection of the throat and tonsils caused by Group A Streptococcus bacteria, which can cause a sore throat, fever, and swollen tonsils.
The Strep-Tic Connection
A specific connection between strep infections and the sudden appearance of tics is observed in Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). PANDAS is an autoimmune disorder where the body’s immune response to a strep infection mistakenly attacks parts of the brain, particularly the basal ganglia, a region involved in movement and behavior. Antibodies produced to fight strep bacteria can cross-react with healthy brain tissue, leading to inflammation and disrupted neuronal function.
This mechanism, known as molecular mimicry, occurs when bacterial antigens resemble proteins found in the brain. This autoimmune reaction can cause a sudden onset or worsening of neuropsychiatric symptoms, including tics. While PANDAS specifically links these symptoms to strep infections, Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is a broader category encompassing similar sudden-onset neuropsychiatric symptoms triggered by other infections or factors. PANDAS is considered a subtype of PANS, emphasizing the unique role of streptococcal infections.
Identifying PANDAS
Identifying PANDAS involves recognizing a sudden and dramatic onset of symptoms, particularly tics or obsessive-compulsive disorder (OCD). This abrupt change can occur within 24 to 48 hours after a strep infection, leading parents to describe their child as “a different person” overnight. Tics can be motor, such as eye blinking, head jerking, or shoulder shrugging, or vocal, including grunting, throat clearing, or repeating sounds.
Beyond tics, children with PANDAS frequently exhibit other neuropsychiatric symptoms. These include severe anxiety, often manifesting as separation anxiety and rapid, intense mood swings. Other associated symptoms may involve sleep disturbances, changes in handwriting, and increased sensory sensitivities. The episodic nature of PANDAS means symptoms can improve for periods and then reappear or worsen, especially after subsequent strep infections.
Approaches to Diagnosis and Care
Diagnosing PANDAS relies on a clinical evaluation, based on the child’s medical history and the characteristic sudden onset of symptoms. There is no single definitive laboratory test for PANDAS, though tests for a recent strep infection, such as throat cultures or antibody tests, may support the diagnosis. A thorough medical assessment helps differentiate PANDAS from other conditions with similar symptoms.
Treatment strategies for PANDAS involve addressing any active strep infection with antibiotics. In some cases, prophylactic antibiotics may be considered to prevent future infections and symptom flares. Managing neuropsychiatric symptoms often includes therapies like cognitive behavioral therapy (CBT), which helps children develop coping strategies for OCD and anxiety. In more severe cases, immune-modulating treatments may be considered to address the underlying autoimmune response. Consulting a healthcare professional is important for proper diagnosis and to develop a personalized treatment plan.