PANDAS/PANS is a syndrome that has generated a good deal of interest, research and controversy in recent years. Because of our reputation and experience dealing with neurobehavioral disorders in children, we have become deeply involved in the diagnosis and treatment of individuals with this complex condition.
- IMMUNE IMBALANCES
Simply stated, PANDAS/PANS is an immune-mediated medical disorder in children that is characterized by obsessive/compulsive behaviors, tics, and rapid (often dramatic) mood changes, especially separation anxiety. It usually starts rather suddenly and often has a Jekyll and Hyde quality. Affected children are simply unable to control the obsessive thoughts or mood swings. There are also numerous other manifestations, including fine motor problems (handwriting), hyperactivity and /or decreased attention, urinary frequency and bed wetting, and less common ones, such as anorexia nervosa.
CLASSIC ILLUSTRATIVE CASE
- 12 year-old child suddenly awakens one morning "a different child"
- Fears of being contaminated with germs
- Doesn't want to be touched
- Excessive hand washing
- Abrupt onset of twitches and tics, motoric hyperactivity, anxiety, separation anxiety and handwriting deterioration.
Most of the research in PANDAS focuses on the autoimmune response to a streptococcal infection. The proposed mechanism involves the immune system generating an antibody to strep that may cross the blood brain barrier and attack the person’s own nervous system, in particular the basal ganglia. There are many case reports and studies showing a connection between strep exposure and the onset (or recurrence) of PANDAS symptoms as well as laboratory tests documenting strep. But there are also cases where there is no clear strep connection, and it is proposed that other organisms such as Mycoplasma or viruses might trigger the same response (PANS).
PANDAS is likely just the latest in a large number of autoimmune diseases such as rheumatoid arthritis, multiple sclerosis and Crohn’s disease. Autoimmunity is a growing problem in the developed world and medical science is revealing many of the mechanisms that underlie this process. In addition to the autoantibodies that are involved in autoimmunity, it has also been discovered that the cellular immune system, in the form of TH17 lymphocytes, is a significant contributing factor as well. We can use this kind of information to design treatment approaches that reduce the tendency toward autoimmunity and to help better regulate the immune system.
For example, the gastrointestinal tract is the location of the majority of our immune system. If the intestinal flora is unbalanced, it can lead not only to increased inflammation, but also an increase in intestinal permeability. This allows more ‘invaders’ to reach the immune system and generate autoantibodies. This process can also be triggered by gluten, food sensitivities and drugs. It is therefore helpful to restore normal intestinal flora and avoid foods and other agents that affect intestinal permeability. There are also nutritional agents which can help heal the gut lining.
Environmental toxins such as heavy metals or endocrine disrupters can also affect the immune system and lead to autoimmunity. Avoiding these substances and promoting detoxification can therefore be helpful. Vitamin D metabolism and hormones may also have a role and should be measured and adjusted.
At Bock Integrative Medicine, we approach PANS/PANDAS the way we approach all complex medical problems. We begin with a comprehensive assessment of the individual’s physiological function, emphasizing those areas that can contribute to immune imbalance. We of course offer the conventional therapies of antibiotics and IVIG, but just as importantly, we address the deficiencies, toxicities, sensitivities, and other imbalances that drive the auto-immune response and prolong the course of this illness. This effort employs all the tools of integrative medicine including dietary and environmental modifications, nutritional and herbal supplements, detoxification modalities and attention to psychosocial issues. It is this multifaceted approach that seems to offer the best chance for success.
LINKS TO RESEARCH
- Inflammation and gastrointestinal Candida colonization
- Dietary n-3 Polyunsaturated Fatty Acids (PUFA) Decrease Obesity-Associated Th17 Cell-Mediated Inflammation during Colitis
- Is obsessive-compulsive disorder an autoimmune disease?
- Lyme disease and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): an overview
- PANDAS: pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections — an uncommon, but important indication for tonsillectomy
- Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections: Clinical Description of the First 50 Cases
- What every psychiatrist should know about PANDAS: a review
- Prospective Identification and Treatment of Children With Pediatric Autoimmune Neuropsychiatric Disorder Associated With Group A Streptococcal Infection (PANDAS)
- Induction of TGF-beta1 and TGF-beta1 – dependent predominant TH17 differentiation by group A streptococcal infection
- Passive transfer of streptococcus-induced antibodies reproduces behavioral disturbances in a mouse model of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection
- Immunomodulatory and therapeutic activity of curcumin