PANS, PANDAS, and Pediatric Neuroinflammatory Conditions

I am licensed to provide care only to children residing in North Carolina. I typically evaluate children and adolescents ages 4–19, with rare exceptions for young adults ages 19–21.

If you are seeking care outside North Carolina or for an adult, the following resources may help you identify clinicians or organizations with relevant experience. These directories and resources are provided for reference and do not constitute an endorsement of any individual practitioner. 

Provider directories can be found at The Neuroimmune Foundation, the PANDAS Physician Network, and ASPIRE. 

In addition to the wealth of information with the organizations above, additional resources can be found at The Alex Manfull Fund and at the Pace Foundation. 

PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome. Unlike PANDAS, PANS does not require evidence of a streptococcal infection and may be associated with a variety of potential infectious or noninfectious contributors.

It is characterized by abrupt onset of OCD and/or restrictive food intake as well as 2 or more of the following: anxiety; emotional lability; depression; irritability; aggression; severely oppositional behaviors; behavioral or developmental regression; decline in school performance, handwriting, or previously acquired academic skills; sensory abnormalities; sleep disturbances; enuresis (involuntary urination); urinary frequency.

PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. It describes a clinical presentation involving the abrupt onset of obsessive-compulsive symptoms and/or tics associated with Group A Streptococcus infection.

Symptoms typically begin between ages 3 and puberty, although presentations outside this age range can occur. PANDAS may follow a relapsing and remitting course, and some children require ongoing evaluation and management. PANDAS is generally considered a subtype within the broader PANS framework.

A PANS or PANDAS diagnosis is primarily clinical and involves careful consideration of the child’s history, symptoms, and physical examination. Laboratory testing and imaging may help evaluate potential contributors or other conditions, but they are not, by themselves, diagnostic.

A thorough evaluation is important because other medical, developmental, psychiatric, and neurologic conditions may cause similar symptoms and may require different approaches to management.

Sudden changes in behavior, anxiety, OCD symptoms, or school functioning can have many possible causes. A careful evaluation is important to consider PANS/PANDAS as well as other medical, developmental, psychiatric, neurologic, and environmental contributors.

Management of PANS and PANDAS is individualized and depends on the child’s symptoms, clinical findings, diagnostic assessment, and overall needs. Depending on the circumstances, management may involve:

• Evaluation and treatment of identified infections or other potential contributors when clinically appropriate
• Support for emotional and behavioral health, including evidence-based interventions such as CBT and ERP, when indicated
• Consideration of anti-inflammatory or immune-modulating treatments in selected circumstances, often in collaboration with other specialists
• Supportive care and treatment of associated symptoms, including sleep, nutritional, functional, and school-related concerns

The course of PANS and PANDAS varies considerably from child to child. Some children experience substantial improvement or resolution of symptoms, while others experience recurring or persistent symptoms and may require ongoing management. Outcomes depend on factors such as the child’s clinical presentation, severity, associated conditions, and response to treatment.

My goal is to understand each child’s individual situation and develop a thoughtful, individualized plan that supports their health and functioning.

IVIG may be considered for select children with significant immune-mediated illness when clinically appropriate. Although I can arrange and provide IVIG through a company I work with, this is rarely necessary and is not a routine part of my approach. When IVIG is being considered, I discuss its potential role in the context of the child's overall clinical picture, including potential benefits, risks, and alternatives.

I strongly support the work of the Neuroimmune Foundation, an excellent nonprofit organization that advocates for individuals with neuroimmune and inflammatory brain conditions. I encourage clinicians and families seeking to learn more about PANS, PANDAS, and related conditions to explore their resources to learn more about diagnosis and treatment.