Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is characterized by the sudden appearance of neuropsychiatric symptoms, often including obsessive-compulsive behaviors or restrictive eating. This abrupt onset differentiates PANS from disorders that develop gradually. While exact causes are still under investigation, PANS is understood to be triggered by infections, metabolic disturbances, or other inflammatory reactions that lead to brain inflammation.
Core Treatment Principles
Treating PANS involves an individualized approach. A key aspect of care is a multidisciplinary team, which may include pediatricians, neurologists, psychiatrists, and various therapists. This collaborative model ensures all aspects of a child’s health are considered. Treatment strategies generally focus on three main areas: addressing the presumed underlying infection or inflammation, managing acute neuropsychiatric symptoms, and providing supportive therapies to improve functioning.
Targeted Medical Interventions
When an active infection is present, antibiotics are used to eradicate the pathogen. Common antibiotics for PANS when a strep infection is suspected include penicillin, amoxicillin, cephalexins, azithromycin, and clindamycin. An initial course might last several weeks, and if significant improvement occurs, it may continue for an additional 2-4 weeks. For Group A Streptococcus (GAS) triggers, prophylactic antibiotics might prevent future infections and flares, sometimes for one to two years after the last flare.
Anti-inflammatory medications reduce brain inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may manage symptom exacerbations or “mini-flares.” Short courses of oral corticosteroids, like prednisone, can be considered for moderate-to-severe symptoms or when NSAIDs are insufficient, as they suppress the immune system and reduce inflammation. These medications mitigate the immune system’s misdirected response that attacks healthy brain cells.
Immunomodulatory therapies are often reserved for more severe or persistent cases. Intravenous Immunoglobulin (IVIG) involves administering purified antibodies from healthy donors to rebalance the immune system, showing efficacy in reducing symptom severity in moderate to severe cases. Plasmapheresis, also known as therapeutic plasma exchange, filters a patient’s blood to remove harmful antibodies and immune complexes. This treatment is often considered for extremely severe symptoms due to its rapid response rate. Specialists like pediatric neurologists or immunologists typically prescribe and monitor these treatments.
Symptom Management and Supportive Therapies
Managing neuropsychiatric symptoms is a central part of PANS treatment. Psychiatric medications often alleviate specific symptoms. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine or sertraline, are frequently prescribed for obsessive-compulsive disorder (OCD) and anxiety. A “start low, go slow” approach is recommended, beginning with very low doses and gradually increasing them to minimize side effects. Benzodiazepines may be used for acute agitation, aggression, anxiety, and insomnia.
Cognitive Behavioral Therapy (CBT), especially Exposure and Response Prevention (ERP), is an effective behavioral intervention for managing OCD and anxiety. ERP helps children gradually confront fears and resist compulsive behaviors, building resilience. Occupational Therapy (OT) addresses sensory sensitivities, motor difficulties, or handwriting challenges, providing practical strategies for daily activities.
Educational accommodations support academic progress. A 504 plan or Individualized Education Program (IEP) can provide adjustments like reduced workload, extended time, or a quieter classroom. These accommodations reduce academic stress and allow effective learning. Family support and counseling offer guidance for coping with PANS challenges.
Long-Term Care and Monitoring
Finding experienced specialists familiar with PANS can be challenging but is important for comprehensive care. Organizations dedicated to PANS and PANDAS can assist families in locating knowledgeable providers.
Monitoring progress involves consistent symptom tracking and assessing functional improvements. This ongoing evaluation allows the care team to adjust treatment plans as needed, optimizing interventions for the child’s evolving condition. Managing flares, which are periods of symptom worsening, is a key aspect of long-term care. Families learn to recognize triggers and have a pre-determined plan for prompt action, which may include medication adjustments or short-term supportive therapies.
The course of PANS can be variable, with some children experiencing full remission and others having a relapsing-remitting pattern. Parental advocacy plays a significant role in securing appropriate medical care and educational support, ensuring the child receives necessary resources for sustained recovery and well-being.