Sudden Shift: Understanding PANDAS and PANS, the Rapid-Onset neuropsychiatric Syndromes Affecting Children
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A growing awareness is emerging around rare, yet devastating, pediatric neuropsychiatric syndromes – PANDAS and PANS – that can dramatically alter a child’s behavior and development within days, or even overnight.These conditions, characterized by a sudden onset of symptoms, are often misdiagnosed, leading to years of inappropriate treatment and prolonged suffering.
The Eruptive Nature of PANDAS and PANS
Unlike typical childhood mental health conditions that develop gradually,PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) and PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) present as an abrupt and alarming change in a child’s functioning. A previously well-adjusted child can quickly become overwhelmed by fears, compulsive behaviors, debilitating anxiety, or experience a significant regression in skills.
“The ability of the parent to say ‘on day X the child was fine, and since than he has fully changed’ is one of the strongest alarm signals for an acute neuropsychiatric onset,” explains a leading pediatrician. This rapid transformation is what sets these syndromes apart and underscores the urgency of accurate diagnosis.
Distinguishing PANDAS and PANS from traditional Disorders
The core difference between PANDAS/PANS and classic mental disorders isn’t the type of symptoms, but how they appear. While anxiety or obsessive-compulsive disorder (OCD) typically unfold over time, these syndromes are marked by a sudden and easily identifiable starting point.
The term PANDAS emerged in the late 1990s, following observations that some children developed severe OCD symptoms shortly after a streptococcal infection. Researchers, led by American physician Sue Swedo, noted a rapid decline in previously acquired skills alongside these behavioral changes. Later,it became clear that similar explosive onsets could occur after other infections or inflammatory events,leading to the broader definition of PANS.
Clinicians rely on a careful evaluation of the onset, progression, and associated symptoms – a “pattern” of presentation, as Dr. Bidiga describes it.
Evaluation typically begins with a detailed medical history and clinical examination. Depending on the individual case, additional tests – including inflammatory markers, cultures, neurological assessments like MRI or EEG, and psychological evaluations – may be used to rule out other conditions and gather supporting evidence. These investigations should be guided by the specific symptoms,not conducted indiscriminately.
The Need for Multidisciplinary Care
In cases of acute and severe neuropsychiatric onset, functional regression, neurological symptoms, significant disruption to daily life, or a lack of response to standard treatments, a multidisciplinary evaluation is crucial. This team should include a pediatrician,neurologist,and psychiatrist,with an immunologist potentially joining in more severe or treatment-resistant cases.
However, experts caution against overdiagnosis. “PANDAS and PANS are not routine diagnoses for tics, obsessive-compulsive disorder, or anxiety. Invoking them automatically risks oversimplifying complex clinical pictures and detracting from proper assessment,” warns a pediatrician. Conversely, these syndromes can be easily missed if the sudden onset is misinterpreted as an emotional crisis.
Essential Questions for Suspicion
Suspecting PANDAS or PANS requires careful consideration of several key factors:
- How sudden was the onset of symptoms?
- Is there evidence of functional regression?
- Are the symptoms fluctuating in severity?
- Was the child considerably different before the onset?
- Is there a temporal connection to a recent illness?
The absence of even one of these elements significantly reduces the likelihood of PANDAS or PANS. “PANS can be overdiagnosed just as easily as it can be missed,” emphasizes a doctor, highlighting the need for careful and nuanced clinical judgment.
