PANDAS / PANS / PITANDS
- PANDAS is an abbreviation for PEDIATRIC AUTOIMMUNE NEUROPSYCHIATRIC DISORDERS ASSOCIATED WITH STREPTOCOCCAL INFECTIONS
- PANS is a broader classification termed PEDIATRIC ACUTE-ONSET NEUROPSYCHIATRIC SYNDROME that includes all cases of abrupt onset of symptoms, not linked to streptococcal infection
- PITANDS are infectious triggers of PANS including viruses, lyme, chicken pox and mycoplasma
Dr. Susan Swedo has been investigating PANDAS since the 1990’s and has identified a group of symptoms that are related to a “strong stimulant” to the immune system such as viral or bacterial infection or exposure to environmental toxicants such as aluminum or pesticides.
- Abrupt onset
- Dramatic symptoms that appear suddenly
- OCD including obsessive thoughts and compulsive behaviours
- Motor and vocal tics
- Separation anxiety
- Anxiety attacks
- Irritability, aggression, rage
- Extreme mood swings
- Temper tantrus
- Night wetting
The strep bacteria is an “ancient organism”, according to the NIMH, which survives via molecular mimicry. It hides from your child’s immune system by mimicking molecules making them nearly identical to human cells found in the heart, joints, skin and brain. The closeness in appearance is confusing to immune system resulting in the autoimmune (attack of self) response. In the case of PANDAS, the body creates “anti-brain” antibodies that trigger symptoms.
There are tens of thousands of microbes in our microbiome that could trigger immune responses in at risk children. We are also surrounded by a hundred thousand environmental toxins that have the capability of confusing the immune system, termed immunotoxins.
While “full blown”, rapid onset PANDAS/PANS/PITANDS is gaining acceptance, there are still many researcher and doctors who aren’t aware of these disorders or do not believe they are disorders at all.
In clinical practice, while we do see increasing cases of diagnosable PANS/PANDAS/PITANDS, the majority of patients are suffering from a less intense version of these disorders that we term “micro-PANDAS”. Micro-PANDAS can still have a massive impact on development, quality of life and stress on caregivers. Children with PANDAS can have significant behavioural concerns that are often diagnosed as something else like ADHD, autism, oppositional defiant disorder, anxiety, OCD, sensory processing disorder, Tourette syndrome or tic disorder. Often, children will come into the clinic with a number of these diagnoses. We call this group the “alphabet” kids. They have often been assessed multiple times and not all the assessments have come to the same consensus.
While it is probably that many children could and will be diagnosed with PANS/PANDAS/PITANDS, it is unlikely that this is at the root of their concerns. A microbial or toxin that triggers an autoimmune attack against the brain means that there is another variable. Pre-disposition to autoimmunity due to low glutathione is how we approach these disorders in a clinical setting. It isn’t just the trigger, it is why the trigger was able to have such a profound impact. The answers likely lie in the complex interplay between genetic predisposition, environmental toxins and microbial imbalance. Much of what is described in the landmark cell danger response and immunoexcitotoxicity landmark papers explains the symptomology of PANDAS/ PANS/PITANDS.