The Alternative Press

This is the second part of an article about a controversial illness, which states that certain common childhood infections may lead to a variety of psychiatric and neurologic symptoms.  (See Alternative Press, January 30, 2012.)

Previously in this column I discussed PANDAS, an acronym for Pediatric Autoimmune Neuropsychiatric Disorders After Streptococcal Infections. In this condition, shortly following a common childhood “strep throat” a youngster develops (or experiences a recurrence or increase) of a variety of symptoms:  obsessive compulsive type behaviors, motor and/or vocal tics, moody or irritable behavior, anxiety symptoms (often in the form of separation anxiety), motor overactivity, ADHD type behavior, or
urinary complaints. 

In PANDAS the symptoms are not due to the bacteria itself, but the child’s immune system’s inappropriate response to the invading strep. Normally when exposed to a foreign agent we develop antibodies to attack and destroy the “enemy” (e.g. a bacteria.) Unfortunately in PANDAS instead
of only waging war against the strep, the antibodies target healthy tissue in the brain, causing inflammation.  The neurons in the basal ganglia, an area related to movement and behavior, are most at risk. This phenomenon in which the antibodies mistakenly “recognize” normal tissue as in some way similar to the strep bacteria is called “molecular mimicry.” This assault on the uninfected brain tissue is believed to result in the sudden onset or worsening of neuropsychiatric symptoms in predisposed individuals. This is similar to the mechanism that occurs when a child develops rheumatic heart disease, arthritis or abnormal movements following a strep throat.

The belief is that a child has to have the biologic vulnerability to develop this disorder. These symptoms obviously do not occur in everyone who has encountered this bacterial infection. Only those children with genetic predisposition are felt to be at risk. Currently the predisposing genetic factors remain unknown.

The initial five clinical characteristics that define PANDAS include: 
1. Pediatric onset of symptoms (age 3 to puberty)
2. Presence of obsessive-compulsive disorder symptoms and/or a tic disorder
3. Abrupt onset of and relapsing-recurring symptoms over time
4. Association with neurological abnormalities during exacerbations (purposeless  movements or motor overactivity)
5. Association with group A Beta-hemolytic streptoccal infection (GABHS) (a positive throat culture for strep or history of Scarlet Fever)

 
    As our knowledge base has increased it has been suggested the name of this group of illnesses be changed from PANDAS to PITANDS (Pediatric Infection Triggered Autoimmune Neuropsychiatric Disorders).  Although streptococcal infection has been the most studied, it appears that the condition can be triggered by many different and common infections. The suggested name change reflects the increasing awareness that this cluster of symptoms and subsequent episodes are not limited to strep infections. Viruses and other bacterial infections may result in the various symptoms discussed. Examples of possible offenders include Mycoplasma pneumonie (which causes “Walking Pneumonia”), Infectious Mononucleosis (“mono”), Influenza (the “flu”), etc. Remember it is not the invading agent that causes the symptoms, but the body’s inappropriate immune response. There is some evidence suggesting that GABHS infections are the inciting trigger that starts the process but future episodes may be brought out not only by GABHS infections but other illnesses as well.

A newer name that is also being considered for the disease now called PANDAS is PANS (Pediatric Autoimmune Neurological Syndrome.) This name does not indicate the initial associated infection for example viral or bacterial, but rather describes the proposed mechanism by which the symptoms of the illness are felt to occur.

Because of the potential for post infection neurologic and psychiatric symptoms, it is crucial for parents and physicians to keep an open mind and an ongoing dialogue about any sudden change in a young person’s neurologic or mental behavior. As a parent, no one knows your child better than you do. If you see a sudden change in behavior or emotions, make sure to discuss this with your child’s doctor.

For more on PANDAS: View the two cable television episodes of Kids First at www.kidsfirstrgmd.com devoted to the discussion of this disorder and visit the NIMH website at:  intramural.nimh.nih.gov/pdn/web.htm.