While pots and pans come in handy for cooking, their namesakes’ causing of significant morbidity in children disrupts many childhoods, as well as the sleep of many parents. POTS stands for Postural Orthostatic Tachycardia Syndrome while PANS stands for Pediatric Autoimmune Neuropsychiatric Syndrome. This latter condition crosses over with PANDAS, Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep. Those of us caring for children with these unusual symptom presentations already saw a connection, but this study demonstrates a correlation and suggests a causative mechanism.
Clinicians at Stanford began by considering a case vignette in which a 14-year-old male patient with severe PANDAS was also found to have POTS by tilt testing. Besides the POTS and PANDAS diagnoses, he also had lab evidence of multiple autoimmune conditions. Given the child’s severe psychiatric illness and relapses despite multiple other therapies, they treated the patient with rituximab to suppress his immune system. Not only did the psychiatric symptoms greatly improve, but the POTS symptoms also improved. With this as a baseline, they further explored if other patients with PANDAS/PANS in their clinic had POTS also.
In the 204 patients they evaluated, 19 met criteria for POTS with 5 of those 19 having symptoms for over 6 months. With further statistical evaluation, POTS symptoms were found to flare in these patients when their PANS/PANDAS symptoms also flared. While I could not find the exact statistical comparison, they stated that this rate of POTS was higher in these PANS/PANDAS patients than in the general population. The children who had a POTS diagnosis also had higher rates of hypermobility and central sleep apnea (caused by brain dysfunction rather than actual airway dysfunction).
We can glean a few other interesting points from this paper.
- They mention several mechanisms for POTS
- Hyperadrenergic
- Hypovolemic
- Neuropathic
- Mast Cell-activated
- Autoimmunogenic
- In a few patients, urticaria suggested a role for mast cells in POTS
- They list several studies (3,10,52-58 in bibliography) which suggest a link from PANS/PANDAS to immune dysfunction.
- The first case of POTS related to COVID 19 was reported in September of 2020 (67).
- The first case of PANS related to COVID 19 was reported in May of 2021 (68).
Caring for children with POTS and PANS requires diligence and patience. The child’s neuropsychiatric symptoms greatly disrupt families and send terror through the hearts of parents. While many in conventional medicine continue to deny its existence, at least clinicians at Stanford are taking this seriously and trying to find the connections and causes of POTS and PANS/PANDAS. Helping parents restore healthier, more abundant lives in their children requires open minds in researchers and clinicians as they diligently seek to better understand these conditions so we can help restore children’s lives.
Original Article
An updated review of pediatric autoimmune neuropsychiatric disorders associated with Streptococcus/pediatric acute-onset neuropsychiatric syndrome, also known as idiopathic autoimmune encephalitis: What the allergist should know. Hardin, Hannah et al. Annals of Allergy, Asthma & Immunology, Volume 131, Issue 5, 567 – 575
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 article.
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.
