top of page

PANS and PANDAS: A Mysterious Intersection of Infection and Mental Health

By Nikki Elmi



Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) represent a fascinating yet troubling medical phenomenon where an infection triggers sudden and severe neuropsychiatric symptoms in children. These disorders primarily affect children between the ages of 3 and puberty, though cases in adolescents and even adults have been occasionally reported. PANDAS is specifically linked to Group A Streptococcus infections, such as strep throat, while PANS can arise from a broader range of infectious or environmental triggers. The hallmark of both conditions is the abrupt onset of obsessive-compulsive behaviors, tics, and severe mood disturbances, often occurring seemingly overnight in an otherwise healthy child. Families often describe the experience as “losing” their child overnight, witnessing a sudden transformation in behavior, cognition, and emotional regulation. Despite increasing recognition, these disorders remain controversial in the medical community due to their complex presentation and diagnostic challenges.



The underlying cause of PANDAS is believed to be an autoimmune reaction following a streptococcal infection. When a child’s immune system responds to strep bacteria, the antibodies produced may mistakenly attack the basal ganglia — a region of the brain involved in regulating emotions, behaviors, and motor control — due to molecular mimicry. This misdirected immune response leads to inflammation and dysfunction in these critical brain areas, triggering the sudden neuropsychiatric symptoms observed. PANS is broader in etiology and is thought to result from a variety of infectious agents (such as influenza, mycoplasma, or Lyme disease) or even environmental triggers like metabolic disturbances. In both disorders, the common physiological thread is neuroinflammation and immune system dysregulation. Unlike traditional psychiatric illnesses, where symptoms develop gradually over time, PANS and PANDAS involve an acute, immune-mediated attack on the brain that rapidly derails normal neurological functioning.



Children with PANS or PANDAS typically present with an abrupt onset of obsessive-compulsive disorder (OCD) symptoms or eating restrictions that are so severe they interfere dramatically with daily life. Alongside OCD, children often develop motor tics, sensory sensitivities, severe separation anxiety, mood swings, irritability, regression in skills (such as handwriting or toileting), sleep disturbances, and even hallucinations. Some may experience urinary frequency or new fears that were never present before. Parents often note that their child, previously calm and independent, suddenly becomes clingy, fearful, or aggressive. Importantly, these symptoms are not mild — they represent a profound and distressing shift from the child’s baseline personality. The suddenness and severity distinguish PANS and PANDAS from more conventional psychiatric disorders, which typically emerge more slowly and predictably over time.



Effective treatment for PANS and PANDAS hinges on addressing both the infection and the resulting immune response. Antibiotic therapy is central for PANDAS, targeting the underlying streptococcal infection with medications like penicillin or azithromycin. In some cases, long-term prophylactic antibiotics are recommended to prevent recurrence. For children suffering from ongoing neuroinflammation, immunomodulatory therapies such as corticosteroids, intravenous immunoglobulin (IVIG), or plasmapheresis may be used to calm the immune system. Symptomatic treatments — including cognitive-behavioral therapy (CBT) for OCD, psychiatric medications, and occupational therapy — are also critical for managing daily functioning. Prevention largely centers on early recognition and aggressive treatment of strep infections in children, along with monitoring for sudden behavioral changes after any infection. However, because PANS can be triggered by non-streptococcal infections, complete prevention remains challenging. Still, increased awareness among parents, pediatricians, and mental health professionals can facilitate quicker diagnoses and improved outcomes.



PANS and PANDAS highlight the intricate and sometimes devastating relationship between the immune system and the brain. Although rare, these conditions demonstrate how physical illnesses can profoundly alter mental health, blurring the lines between neurology, immunology, and psychiatry. Early recognition is essential, as timely treatment can often reverse or significantly reduce symptoms, helping children return to their normal developmental trajectory. Continued research into the pathophysiology of these disorders promises not only better treatments but also a deeper understanding of the brain’s vulnerabilities to immune system dysfunction. As medicine advances, interdisciplinary collaboration will be key to demystifying PANS and PANDAS, providing better support for affected children and their families.




By Nikki Elmi


References:



Assessed and Endorsed by the MedReport Medical Review Board

©2025 by The MedReport Foundation, a Washington state non-profit organization operating under the UBI 605-019-306

 

​​The information provided by the MedReport Foundation is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. The MedReport Foundation's resources are solely for informational, educational, and entertainment purposes. Always seek professional care from a licensed provider for any emergency or medical condition. 
 

Privacy Policy

Editorial Policy

Terms & Conditions

bottom of page