“Pandaa” is a frequent misspelling for PANDAS, a recognized pediatric condition. PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. This disorder involves a sudden and dramatic onset of neuropsychiatric symptoms in children, believed to be triggered by a preceding streptococcal infection, such as strep throat. This highlights a complex interplay between the immune system and brain, leading to abrupt changes in behavior and cognitive function.
Identifying the Symptoms of PANDAS
Children with PANDAS frequently experience an abrupt onset of symptoms. A prominent symptom is the sudden appearance or severe worsening of obsessive-compulsive disorder (OCD), characterized by intrusive thoughts and repetitive behaviors. Motor and/or vocal tics can also manifest suddenly, presenting as involuntary movements or sounds. These tics may involve eye blinking, head jerking, throat clearing, or uttering specific words.
Accompanying these changes, children may develop intense separation anxiety, showing extreme distress. Emotional lability is another common feature, leading to sudden and pronounced mood swings, irritability, or crying spells. A noticeable decline in academic performance, particularly difficulty with handwriting, is also frequently observed. Other reported symptoms can include sleep disturbances, new-onset bedwetting or frequent urination, and changes in eating patterns.
The Link Between Strep and Neurological Changes
PANDAS theory centers on molecular mimicry. The body’s immune system produces antibodies to combat Group A streptococcus bacteria, which cause infections like strep throat. In PANDAS, it is believed that these antibodies, designed to target the strep bacteria, mistakenly recognize and attack healthy brain tissue. This misdirected attack specifically impacts the basal ganglia, a brain region involved in regulating movement, emotions, and behavior.
The antibodies may cross-react with specific molecules in the basal ganglia. This mistaken immune response inflames the basal ganglia, disrupting neuronal functioning. The resulting inflammation and neuronal disruption are thought to be directly responsible for the sudden emergence of the neuropsychiatric symptoms observed in children with PANDAS.
Diagnostic and Treatment Pathways
Diagnosing PANDAS is a clinical process, as no single laboratory test definitively confirms the condition. Diagnosis relies on established criteria, including acute onset of OCD or tics. There must be a documented association with a recent streptococcal infection, confirmed by a positive strep test. The symptoms typically manifest between the ages of 3 and puberty and follow an episodic course.
Treatment pathways for PANDAS involve multiple approaches. Antibiotics are used to eliminate any active streptococcal infection triggering symptoms. To address the neuropsychiatric symptoms, behavioral therapies such as Cognitive Behavioral Therapy (CBT) are often recommended. Selective serotonin reuptake inhibitors (SSRIs) may be prescribed to manage OCD symptoms. In severe cases, immunomodulatory treatments like intravenous immunoglobulin (IVIG) or plasma exchange may be considered.
Distinguishing PANDAS from PANS
PANDAS is a specific subtype of a broader diagnostic category known as PANS, or Pediatric Acute-onset Neuropsychiatric Syndrome. Both conditions involve sudden onset of neuropsychiatric symptoms, but their triggers differ. PANDAS specifically requires a preceding streptococcal infection as the trigger.
PANS, conversely, encompasses cases where similar acute-onset symptoms, such as obsessive-compulsive disorder or restrictive eating, are present but may be triggered by other factors. Alternative triggers for PANS include other infectious agents, metabolic disturbances, or inflammatory reactions. Therefore, while all PANDAS cases are considered a form of PANS, not all PANS cases are PANDAS.