PANDAS syndrome is an entity found in children, which may manifest itself, among others, in tics, obsessions, hyperactivity and mood swings. The exact cause of the disease remains unknown to this day, but the link between PANDAS and streptococcal infections is clearly visible. How would bacteria lead to neuropsychiatric symptoms in children and what is the treatment of PANDAS?

PANDAS syndrome(short for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection) has been mentioned in the medical literature relatively recently - the first cases of this unit have been described for just over 20 years ago, in 1998.

Child autoimmune neuropsychiatric disorders related to streptococcal infections until recently in Poland were a rather little known entity, but nowadays - incl. due to the interest of the parents of young patients - it is becoming a problem that is mentioned more and more in our country.

PANDAS is a rare disorder - it is estimated to affect 1 in 2,000 children . It most often develops in patients aged 3 to 12.

PANDAS team: reasons

Until now, it has not really been possible to clearly establish the causes of PANDAS. However, the name of the problem did not come out of nowhere - according to many researchers, the human immune system may be involved in the development of an individual.

It has been known for a long time that certain diseases are associated with a malfunctioning of the immune system. We are talking here about such units as multiple sclerosis or systemic lupus erythematosus.

In the case of PANDAS syndrome, the symptoms of the immune system in children would be caused by the reaction of the immune system to the intrusion into the organism of foreign microorganisms - bacteria of the genus streptococcus.

Streptococcus can cause various infections, one of the best known is streptococcal angina.

Microorganisms of this type have developed a number of different mechanisms thanks to which they are able to stay in the human body for a long time without causing an immune response.

One of them is the phenomenon antigen mimicry , thanks to which bacteria can avoid being eliminated by the human immune system. Their antigens may be very similar to antigens present in normal human cells.

Ultimately, yes, they may be similar, but not identical, resulting in the production of antibodies against them. These types of immunoglobulins can, in turn, attack not only bacterial cells, but also cells of the sick body.

Some scientists postulate that the symptoms of PANDAS may appear when the antibodies produced in the patient's body begin to attach to certain areas of the central nervous system (such as the basal ganglia). However, the currently available hypotheses are described above - certain data on the causes of PANDAS are simply not available at the moment.

It is worth adding here that not only streptococcal infections can lead to the appearance of various neuropsychiatric symptoms in patients.

In a situation where atypical ailments occur in connection with an infection caused by some other type of microorganism, the problem is called PANS (pediatric acute-onset neuropsychiatric syndrome).

PANDAS syndrome: symptoms

Characteristic of PANDAS is that its symptoms appear suddenly and become very intense within a very short period of time. Additionally, they typically develop within four to six weeks of a streptococcal infection. The most common ailments are obsessive-compulsive thoughts and tics.

PANDAS can have many different problems. Other possible symptoms of this unit include:

  • separation anxiety,
  • irritability,
  • mood swings,
  • hypersensitivity to external stimuli (e.g. sensitivity to light or sounds),
  • hyperactivity,
  • difficulty concentrating,
  • sleep disturbance,
  • memory impairment,
  • loss of appetite,
  • joint pain,
  • increasing the frequency of urination,
  • bedwetting.

PANDAS team: diagnostics

PANDAS is diagnosed on the basis of its characteristic symptoms and the association of their occurrence with streptococcal infection. It is worth adding here that not always parents are able to associate an infection with the appearance of unusual ailments.

As in some patients the symptoms of the syndromePANDAS occurs after severe streptococcal angina, so in other ailments it can occur as a result of oligo- or even asymptomatic streptococcal infection.

There is no one specific test that can make a diagnosis of PANDAS. However, some studies can be ordered. A swab from the throat plays a key role here, which makes it possible to identify a possible streptococcal infection or carrier of a streptococcus.

Another important test is the antistreptolysin test (ASO). This parameter is used in the diagnosis of infections caused by Streptococcus pyogenes.

Imaging examinations of the head, such as computed tomography or magnetic resonance imaging, are also sometimes performed. However, they are used primarily when there are any doubts as to the cause of disturbing symptoms in the patient.

PANDAS team: treatment

Usually, the treatment of PANDAS is quite complex and requires the care of the patient by several specialists. If a child has symptoms of PANDAS and is diagnosed with streptococcal infection, antibiotic therapy is used. Various antibiotics are effective, used in the treatment of an individual, among others:

  • penicillin,
  • azithromycin
  • and cephalosporins.

Effective antibiotic therapy may lead to a reduction in the severity of PANDAS symptoms, but often they do not completely disappear.

For this reason, psychotherapy is sometimes recommended, especially cognitive-behavioral therapy, thanks to which it is possible, among others, to reducing the severity of compulsions.

In situations where the child's obsessions and compulsions are becoming very severe, drug therapy may be prescribed. In this case, antidepressants from the group of serotonin reuptake inhibitors are used, such as :

  • sertraline,
  • fluvoxamine
  • or fluoxetine.

Above are the basic treatments for PANDAS. Sometimes, however, other possibilities are also used. Interventions focusing on the functioning of the immune system are used, including:

  • administering intravenous immunoglobulin infusions to patients,
  • use of plasmapheresis
  • or advising patients to take glucocorticosteroids and anti-inflammatory drugs.

The effectiveness of such interactions has not been clearly established so far, and therefore they are not routinely used in children with PANDAS.

PANDAS team: prognosis

The PANDAS team, as mentioned at the very beginning, was established relatively recently, so it is difficult to say what its long-term consequences may actually be.

The course of an individual in different patients can be very different. In some children, the use of antibiotics results in complete relief of symptoms, while in others the symptoms recur many times when the patient develops a streptococcal infection.

PANDAS team: prevention

If you want to reduce the risk of PANDAS syndrome, you should first of all focus on trying to reduce the risk of streptococcal infections. In children who have experienced post-infectious psychiatric symptoms, reinfection with streptococci may lead to re-infection or exacerbation of pre-existing symptoms. There are various potential ways to help prevent PANDAS.

The prophylactic use of antibiotics is mentioned, but on the other hand, it carries various risks, such as the possibility of diarrhea or the development of drug-resistant bacteria in the patient's digestive tract.

As part of PANDAS prevention, some specialists propose almond removal surgery, but other researchers say that it has not been proven that undergoing such a procedure actually reduces an individual's risk.

Ultimately, in order to reduce the risk of PANDAS, basic methods of reducing the risk of infection may be recommended. It is important to wash your hands frequently, but also to avoid being in crowded places (especially in periods of increased incidence of various infections).

It is also worth taking care of the child's immunity. When his immune system is functioning properly, there is an increased chance that he will defeat the microbes that have invaded the little patient's body before they can lead to the development of a full-blown infection.

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Category:

Psychology