What Is PANDAS Syndrome? How Infections Can Trigger OCD & Anxiety

Imagine your child suddenly developing severe obsessive-compulsive behaviors, anxiety, or even personality changes—seemingly overnight. This is the reality for families dealing with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).

PANDAS is a rare but serious condition where a strep throat infection triggers an autoimmune reaction, causing brain inflammation and leading to OCD-like symptoms, anxiety, tics, and mood swings. This controversial condition has sparked debates in the medical community, but research continues to support its existence.

What Is PANDAS Syndrome?

PANDAS is a disorder where a child's immune system mistakenly attacks the brain after a streptococcal (strep) infection. This misdirected immune response affects the basal ganglia, a brain region involved in motor control, emotions, and cognitive functions.

Key Features of PANDAS:

✔ Sudden onset of symptoms (not gradual)
✔ Obsessive-compulsive behaviors (OCD)
✔ Severe anxiety or panic attacks
✔ Motor or vocal tics (similar to Tourette’s)
✔ Mood swings, aggression, or irritability
✔ Bedwetting or frequent urination
✔ Handwriting deterioration (dysgraphia)

These symptoms appear abruptly, often after a strep infection (such as strep throat or scarlet fever), and can worsen quickly.

How Does a Strep Infection Trigger PANDAS?

1. Strep bacteria mimic human cells
   • Group A Streptococcus bacteria have proteins that resemble human tissue, particularly in the brain.
2. The immune system mistakenly attacks the brain
   • In trying to eliminate the bacteria, the immune system produces antibodies that cross-react with the basal ganglia.
3. Brain inflammation leads to neurological symptoms
   • This attack disrupts normal brain function, leading to sudden behavioral changes, OCD, and anxiety.

PANDAS vs. PANS: What’s the Difference?

• PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections) is specifically triggered by a strep infection.
• PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a broader condition that can be caused by other infections (like Lyme disease, flu, or mycoplasma pneumonia) or even environmental triggers.

Both conditions share similar symptoms and are treated in similar ways.

Diagnosing PANDAS: Why It’s Challenging

There is no single test for PANDAS, making diagnosis difficult. Doctors rely on:
🧪 Throat cultures to check for strep infections
🩸 Blood tests for strep antibodies (Anti-DNase B, ASO titers)
🧠 Neurological & psychiatric evaluations

Because symptoms can mimic OCD, Tourette’s, or general anxiety disorders, many children are misdiagnosed before reaching a proper PANDAS diagnosis.

Treatment Options for PANDAS Syndrome

1. Antibiotics (First-Line Treatment)

Since PANDAS is linked to strep infections, antibiotics like penicillin or azithromycin are often prescribed to eliminate the bacteria and reduce symptoms. Some children improve dramatically within days of starting antibiotics.

2. Anti-Inflammatory Treatments

Reducing brain inflammation can help with symptom relief.
✔ Ibuprofen (Advil) or corticosteroids can decrease inflammation.
✔ Omega-3 supplements may help with neurological healing.

3. Immunotherapy for Severe Cases

If symptoms are severe, doctors may recommend:
✔ IVIG (Intravenous Immunoglobulin Therapy) – Boosts the immune system and reduces autoimmune reactions.
✔ Plasmapheresis (Plasma Exchange) – Removes harmful antibodies from the blood.

4. Cognitive Behavioral Therapy (CBT) & Medications

✔ CBT & Exposure Therapy – Helps manage OCD symptoms.
✔ SSRIs (Selective Serotonin Reuptake Inhibitors) – Used cautiously, as PANDAS patients can be more sensitive to psychiatric medications.

Scientific Research & Controversy

While many doctors recognize PANDAS as a real disorder, some skeptics argue that its exact cause is not fully understood. However, growing research supports the link between infections and sudden psychiatric symptoms in children.

Scientific Studies & Sources

1. Swedo, S. E., et al. (1998). "Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)." American Journal of Psychiatry.

   • The landmark study that first defined PANDAS and its link to strep infections.

2. Cunningham, M. W. (2012). "Molecular mimicry, autoantibodies, and PANDAS: The role of autoimmunity in mental illness." Biological Psychiatry.

   • Explains how the immune system mistakenly attacks the brain.

3. Frankovich, J., et al. (2015). "Clinical management of pediatric acute-onset neuropsychiatric syndrome (PANS): An expert consensus guideline." Journal of Child and Adolescent Psychopharmacology.

   • Provides treatment guidelines for PANDAS/PANS.

4. Murphy, T. K., et al. (2014). "Antibiotic prophylaxis in PANDAS: A double-blind, placebo-controlled trial." Journal of the American Academy of Child & Adolescent Psychiatry.

   • Found that long-term antibiotics may help prevent relapses in PANDAS.

Can Adults Develop PANDAS?

PANDAS is primarily seen in children between ages 3-12, but some teens and adults report similar symptoms linked to infections. However, adult cases are less understood and are usually classified under PANS rather than PANDAS.

Final Thoughts: Is PANDAS Real?

Despite ongoing debates, PANDAS is recognized by leading medical experts as a serious autoimmune-related disorder. If your child develops sudden and severe OCD, anxiety, or behavioral changes after an infection, seek medical attention and ask about PANDAS testing and treatment.

Early intervention can lead to faster recovery and symptom relief.