Epidemiologic studies point toward an autoimmune link between PANS/PANDAS and other immune system dysfunctions. The disabling pediatric condition we know as PANS / PANDAS (Pediatric Autoimmune Neuropsychiatric Syndrome/ Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep), has been debated for years, even as thousands of children suffer under it. Many pediatricians still denies its reality, while the kids’ patients look for answers to the sudden onset of a variety of neuropsychiatric symptoms. This study by Stanford researchers will hopefully convince some of those holdouts to catch up to the science and take this problem seriously.
We don’t have exact statistics on the prevalence of PANS and PANDAS due to the debate and lack of reporting, but probably thousands of children each year come to their primary care providers with the rapid onset of unusual neurologic or psychiatric symptoms. Most commonly, they develop OCD (Obsessive Compulsive Disorder) over a short time period- from practically overnight to over a few days to mere weeks. These onsets are typically linked to a definite infectious illness or at least a suspected illness, perhaps from being around a sick family member. The neurological symptoms, which can often be life altering, may wax and wane with other infectious episodes or remain persistent even without such infections.
For the child’s parents, they often feel like their children flipped into another personality. Parents may initially remain unconcerned if a health care provider falsely reassures them that the symptoms will pass in a week. However, once the symptoms persist for weeks or months, eventually alarm rises to the point of seeking for help that isn’t just a reassurance. Various forms of counseling and evaluations are performed. Hopefully, someone eventually mentions the possibility of PANS/PANDAS and starts looking for reversible causes.
For those of us who recognize the existence of this condition, we work on identifying reversible causes like strep colonization, chronic viral infections, mycoplasma occult infections, and toxicities. We also look for other signs of inflammation that needs our attention if the child is going to get better. While old-fashioned immune inflammation is our primary target, we also keep an eye on allergic inflammation which can also worsen a patient’s symptoms.
Leading into the Stanford study, researchers took this condition seriously based on prior studies supporting the condition’s existence. This support included studies linking PANS/PANDAS with changes in either the adaptive or innate immune system. Much of the research points towards inflammation in a part of the brain called the basal ganglia. Besides studies showing objective inflammation and immune changes in that area, various antibodies to nerve tissue has been identified in many PANS/PANDAS patients. Besides these antibodies, changes in the number and activity of inflammatory Th17 immune cells have been found. Even changes in the spinal fluid for these children support an inflammatory component.
The Stanford researchers built on this understanding and looked for links between PANS/PANDAS inflammation and other autoimmune conditions. The main findings form 193 children diagnosed with PANS/PANDAS in their system included:
- 54% demonstrated nonspecific markers of autoimmunity.
- 12% demonstrated “nonspecific signs of immune dysregulation or inflammation”
- 35% demonstrated signs of vasculopathy (changes in blood vessels or blood flow)
- 5% had another autoimmune condition.
- 55% of a subgroup of these 193 had “joint capsule thickening” indicating joint inflammation by ultrasound
- Other joint inflammation symptoms and signs
While these numbers are superficially suggestive of a link, when we consider that the incidences of these findings are several times greater than would be expected in the general population, they become strong evidence of a wider autoimmune and inflammatory component to PANS/PANDAS than just brain effects.
This supports our contention that the whole child must be considered in caring for PANS and PANDAS patients. Just throwing a psychiatric medication or two at a child suffering from such a systemic autoimmune condition will not solve the problem. Helping children and their families restore a healthier more abundant life requires a whole person approach. Addressing the inflammation and the trigger for such inflammation will lead to deeper and longer lasting recovery than just psych meds. Hopefully, more pediatric providers will come to realize this as we read more about this condition in journals like this one from JAMA (Journal of the American Medical Association).
Original Article
Ma M, Masterson EE, Gao J, et al. Development of Autoimmune Diseases Among Children With Pediatric Acute-Onset Neuropsychiatric Syndrome. JAMA Netw Open. 2024;7(7):e2421688. doi:10.1001/jamanetworkopen.2024.21688
Medical Disclaimer:
This article is intended for educational purposes only. I have attempted to confirm the accuracy of these statements but with time, some currently true statements may be proven incorrect. Before making any medical decisions, you should consult your medical provider. I am not a lawyer nor am I a remediator and cannot provide definitive answers in either category. Discuss legal and remediation decisions with appropriate professionals. Sanctuary is not responsible for decisions you make based on this short video.
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.