PANDAS / PANS defined

Both PANDAS and PANS are most commonly characterized by a sudden onset of obsessive-compulsive symptoms (OCD) within weeks of infection or illness. Additional symptoms can include severe anxiety, eating restrictions, and a range of neurological symptoms.

PANDAS (“Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections”) was first reported by a team at the NIH National Institute of Mental Health in 1998. It was later discovered to be one of a larger category of disorders not necessarily triggered by strep, known as PANS (“Pediatric Acute-onset Neuropsychiatric Syndrome”)

PANS is not limited to children, and does not always have a known trigger, but it is believed to be triggered by one or more pathogens; PANDAS is specifically associated with cases of pediatric strep infection. 

Criteria for Diagnosis

PANDAS has 5 distinct criteria for diagnosis, including abrupt “overnight” OCD or dramatic, disabling tics; a relapsing-remitting, episodic symptom course; young age at onset (average of 6–7 years); presence of neurologic abnormalities; and onset following a strep infection. These are usually accompanied by further symptoms typical of PANS.  Please see list below for possible symptoms.

When strep cannot be linked to the onset of symptoms, the NIMH recommends healthcare providers look into the possibility of PANS.

PANS is similarly characterized by a sudden onset of obsessive-compulsive symptoms (OCD) or eating restrictions. Behavioral deterioration in at least two of eight domains is also required for diagnosis (please see the PPN Diagnostic Guidelines).

PANS and PANDAS are clinically diagnosed syndromes. At this time there are no biomarkers to test for or accurately measure for diagnosis.

PANDAS/PANS symptoms (typically acute onset)

  • OCD (extreme hand washing, checking, etc)

  • Restrictive eating (refusing to eat favorite foods to texture aversion which can be due to fears over choking, contamination, etc)

  • Tics (uncontrolled motor or physical-clearing throat, shoulder shrugs, arm rolling, etc.)

  • Extreme anxiety (separation anxiety, school anxiety, leaving house anxiety, etc.)

  • Emotional lability (not being able to control one’s emotions-uncontrollable laughing or crying)

  • Depression (unusually depressive/sad thoughts, suicidal talk/ideation, etc.)

  • Irritability and Aggression (rage events, triggered easily, walking on egg shells)

  • Behavioral Regression (babytalk)

  • Developmental Regression

  • Deterioration in School Performance and/or Handwriting (math, noticeable margin drifts and legibility of writing, difficulty concentrating, difficulty retaining information)

  • Sensory Sensitivities (touch, sounds and smells-may not be able to wear certain clothes due to texture or aversion to textures)

  • Somatic Signs (This includes sleeping difficulties, enuresis, frequent urination, and bed wetting)

  • Hyperactivity

  • Choreiform movements (child holds hands out straight with eyes closed

  • Dilated pupils (noticeable trait in many PANDAS/PANS kids)

  • Hallucinations (both visual and auditory)