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P.A.N.D.A.S. is an abbreviation for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections, a term used to describe a subset of children who have Obsessive Compulsive Disorder (OCD) and/or tic disorders such as Tourette syndrome, and in whom symptoms typically worsen following strep infections such as "strep throat" and scarlet fever.
Symptoms
The children are hypothesized to have dramatic, "overnight" onset of symptoms, including motor or vocal tics, obsessions, and/or compulsions, although this has not been proven with rigorous studies, and some studies have shown no acute exacerbations among PANDAS subjects. In addition to these symptoms, it is also thought that children may also become moody, irritable or show concerns about separating from parents or loved ones. This abrupt onset is hypothesized to be preceded by a strep throat infection.
Mechanism
At present, the mechanism behind this infection is unknown but researchers at the NIMH are pursuing a theory that the mechanism is similar to that of rheumatic fever, an autoimmune disorder triggered by a reaction to the antibodies to streptococcal infections, in which these antibodies attack similar regions of the brain that are affected in some neuropsychiatric conditions. In every bacterial infection, the body produces antibodies against the invading bacteria, and the antibodies help eliminate the bacteria from the body. However in rheumatic fever, the antibodies mistakenly recognize and "attack" the heart valves, joints, and/or certain parts of the brain. This phenomenon is called "molecular mimicry", which means that proteins on the cell wall of the strep. bacteria are similar in some way to the proteins of the heart valve, joints, or brain. Because the antibodies set off an immune reaction which damages those tissues, the child with rheumatic fever can get heart disease (especially mitral valve regurgitation), arthritis, and/or abnormal movements known as Sydenham's chorea or Tourette syndrome.
In PANDAS, it is believed that something very similar to Tourette syndrome occurs. One part of the brain that is affected in PANDAS is the basal ganglia, which is believed to be responsible for movement and behavior. Thus, the antibodies interact with the brain to cause tics and/or OCD, instead of Tourette syndrome.
Controversy
The PANDAS theory is only a hypothesis, and a highly controversial one, that has yet to be proven. ***" target="_blank" >It has engendered the use of controversial, dangerous and unproven treatment methodologies for children with tics and OCD, such as intravenous immunoglobulin (IVIG), plasma exchange, and the use of prophylactic antibiotics for the prevention of streptococcal infections. The Advisory Boards of the NIH have also issued a warning about the use of these unproven methodologies. [http://www.findarticles.com/p/articles/mi_m0BJI/is_18_30/ai_66168916" target="_blank" >*
External links
"P.A.N.D.A.S."