Far too often I evaluate kids with abrupt mood and cognitive changes. As I dig thru their histories and interview parents, many times I find a tick exposure. Lyme disease and other tick-borne illnesses bring a borage of physical symptoms all too familiar. Of course I'm looking for other underlying causes as well and never assume that everyone has Lyme Disease. An undeniable trend is the connection between behavioral changes in children and tick-borne illnesses. Those not privy to the "Lyme world" are unaware of the cognitive and psychological components involved. Children account for about 25% of those diagnosed and are the highest risk groups. As a result of exposure, children suffer more from cognitive and social impairment, executive processing disorders, ADHD, dyslexia, irritability, expressive aphasia, short-term memory issues all which can be misdiagnosed! Within the context of cognitive and behavioral changes, there lies an acute syndrome that can occur as a result of Lyme disease or other tick-borne illness exposures known as PANS.
To give you a little background, the spirochete B. Burgdorferi that causes Lyme Disease has an affinity for the central nervous system. Studies have isolated this spirochete in cerebrospinal fluid as early as 18 days after a tick bite. Other studies show this stealthy little spirochete's ability to punch thru endothelial cells and invade glial cells that surround neurons in roughly 12 hours. This invasion provokes an immune response followed by a sizeable inflammatory cascade event. Mast cells residing in the central nervous system are activating releasing cytokines and other inflammatory markers. The brain does not like inflammation! Once this occurs, symptoms of OCD (obsessive-compulsive disorder), anxiety, tics, short term memory recall difficulties, cognitive decline including fine and gross motor skill occur. No two symptom clusters are the same, however notable changes do occur.
An interesting morsel of information, Out of the CDC reported 300,000 cases documented each year, 1/3 of those affected develop neurological symptoms. Of those neurological cases, many progress to significant psychiatric syndromes. Despite the research and published reporting, few studies connect Lyme as a culprit of the pediatric neuro-inflammatory response known as PANS (pediatric acute-onset neuropsychiatric syndrome).
A common response when I mention the possibility of PANS as an underlying syndrome is " Lyme can cause PANS? I thought that only Strep did that."
Originally the acronym PANDAS was coined by Dr. Susan Swedo as a clinical description of a cluster of cases affecting children after a strep infection that triggered acute onset OCD, tic disorders, anxiety, Sydenham's chorea and other neuropsychiatric symptoms that prior to the strep infection didn't exist. In 2012 Dr. Swedo expanded PANDAS to PANS (pediatric acute-onset neuropsychiatric syndrome) which involved all infectious, environmental and possibly genetic triggers that could create an immune dysregulation as a response to inflammation on a child's brain. The PANDAS network website has a nice overview of both PANDAS and PANS.
When faced with treating a child for Lyme induced PANS, considering all potential underlying contributors is key to healing. Usually a number of insults have occurred that triggered PANS. Genetic SNPS, allergies, gut dysbiosis, viruses and other bacterial infections can all contribute. It's a stacking event with an eventual immune tipping. Antibiotic combinations with herbals/homeopathy to tackle the infection along with supplements and dietary restrictions to decrease the inflammation and support the immune system will provide relief. Reoccurrence does and most likely will happen but is treatable.
As providers, collectively, we don't communicate as effectively as we could with each other to form a strong integrative consensus regarding the neurological/cognitive involvement of Lyme disease in children. The current symptoms described by the CDC and local health departments regarding Lyme Disease is just the beginning. As parents, asking your primary care providers for Lyme and other tick-borne infection testing is a good first step.