PANDAS, Pediatric Autoimmune Neuropsychiatric Disorders

PANDAS is an acronym. It stands for pediatric autoimmune neuropsychiatric disorders. There is a controversial theory about how children get this disorder. The theory is that the body's immune response against a streptococcal infection also attacks the part of the brain that controls certain movements and behaviors that cause Tourette syndrome.

The main feature of Tourette syndrome are tics. Tics are a sudden, repetitive, movement or sound that occurs over and over again. Common muscle (motor) tics include eye twitching, facial grimacing, shoulder shrugs, head jerk, limb jerk or any quick movement of a muscle group. Vocal tics can be any sound such as yelping or clearing the throat. Saying socially unacceptable words or cussing (coprolalia) is an uncommon type of vocal tic.

When PANDAS begins there may be:

  • Motor and vocal tics for more than one year.

  • The type of tics changing from month to month.

  • Increases and decreases, month to month, in the severity of the tics.

  • Tics that are worsened by stress or fatigue.

  • No tics during sleep.

  • Tics that are bothersome to the patient.

  • Obsessive-compulsive disorder, ADHD and Mood Disorders associated with Tourette Syndrome.

The problems begin in children between 3 years of age and the beginning of puberty.

DIAGNOSIS

At this time there is not a diagnostic test for PANDAS. The strep throat may be completely cured before the tics occur. The theory connecting strep throat to PANDAS is controversial because:

  • It has been difficult to show that the immune system of Tourette's patients is different from people who do not have tics.

  • Immune treatments have not been helpful for Tourette's patients.

TREATMENT

The treatment for suspected PANDAS is the same as for Tourette's Syndrome at this time. Once the strep infection has been treated, medications are used to treat whichever symptoms are causing the most problems. In many patients, the tics are relatively mild but behavioral issues cause problems. Ongoing research is being done in this area.