PANS ― PANDAS
PANS and PANDAS represent conditions that compromises the normal neurological functions of the brain, causing the onset of psychiatric disorders in pediatric individuals.
Find out what are their characteristics and how they can be effectively treated!
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) can be described as a series of immune and dermatological disorders related to psychiatric symptoms with acute onset, including:
Neuropsychiatric Pediatric Autoimmune Syndrome triggered by infections (PITAND);
Neuropsychiatric Pediatric Autoimmune Syndrome NOT triggered by infections.
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) is triggered by Streptococco Beta-Emolitico of group A “SBEA" or "SBEGA”; therefore, it represents a subspecies of PITAND.
What is PANS - PANDAS
PANS - PANDAS defines a condition that compromises the normal neurological function of the brain, causing the onset of psychiatric disorders; for example: Tics, Obsessive-Compulsive Disorder (OCD), Anxiety, Depression, ADHD, Hallucinations.
In the light of current knowledge, an integrated immuno-dermo-psychiatric approach prevails for psychiatric, immunological and dermatological disorders.
It remains common knowledge that a close correlation exists between the nervous, endocrine, and immune systems. Many immune disorders can present with psychiatric symptoms. Increasing evidence documents the involvement of the immune system in psychiatric disorders. Antineuronal antibodies have been found in about 20% of subjects with Obsessive-Compulsive Disorder.
Treatment with intravenous immunoglobulins in a subgroup of children with Obsessive-Compulsive Disorder and tics results in improvement of obsessive-compulsive symptoms and tics (1).
Furthermore, the nervous system shares the same embryological derivation from the neuroectoderm as the skin. Numerous dermatological diseases exacerbate in situations of stress or anxiety which, through the production of neuropeptides by our brain, the intervention of the endocrine organs and the peripheral nervous system, act directly on the immune system and on the skin (2).
Diagnosis should include:
Examination of inflammation panel;
Immunological and dermatological evaluations;
Cognitive function evaluation;
Over time, the complexity and individuality of psychological disorders has made it inappropriate the idea of treating them with a single drug or psychotherapy alone.
What are the symptoms of PANS-PANDAS?
Some of the most common symptoms of PANS-PANDAS are:
Attention and concentration deficit;
Autism spectrum disorders with acute onset (but not exclusively), after an infectious episode (fever, pharyngitis, ear infections, skin manifestations, etc.), with a recurrent course;
Resistance to common treatments (psychotropic drugs, psychotherapy) or with resistance while maintaining the treatment;
Altered indices of inflammation (ESR, CRP, fibrinogen), certain or probable laboratory data of infection, personal and / or family history positive for autoimmune diseases;
Psychosomatic dermatological disorders: psoriasis, vitiligo, chronic urticaria, atopic dermatitis, seborrheic dermatitis, contact eczema, chronic pruritus, itching peri anus genital, acne, rosacea, alopecia, telogen effluvium, trichotillomania, hyperhidrosis, dyshidrosis, neurodermatitis, morgellons syndrome Ekbom, glossodynia, pathomimias, recurrent herpes.
PANS - PANDAS and Gut Microbiota
The presence of an altered gut microbiota structure has been demonstrated in PANDAS patients.
Alterations in the gut microbiota may be factors that favor the development of PANDAS as well as potential markers for further diagnostic procedures of this syndrome (3).
Quagliariello A, Del Chierico F, Russo A, Reddel S, Conte G, Lopetuso LR, Ianiro G, Dallapiccola B, Cardona F, Gasbarrini A, Putignani L., Gut Microbiota Profiling and Gut-Brain Crosstalk in Children Affected by Pediatric Acute-Onset Neuropsychiatric Syndrome and Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections.
Initial Visit and Assessment;
Medical and psychiatric history;
Possible differential diagnosis.
At the Istituto di Neuroscienze, we offer multiple forms of therapy that have proven effective in the management of PANS-PANDAS, which are tailored with a multidisciplinary and multimodal method (that is, the Pallanti Method) according to the specific needs of the individual:
Therapy to restore the gut microbiota;
Transcranial Magnetic Stimulation (TMS);
Cognitive-Behavioral Therapy (CBT).
1) Perlmutter SJ, Leitman SF, Garvey MA, et al.
Therapeutic plasma excange and intravenous immunohlobulin for obsessive-compulsive disorder and tic disorders in childhood. Lancet 1999; 354:1153-1158.
2) Suárez AL, Feramisco JD, Koo J and Steinhoff M.
Psychoneuroimmunology of Psychological Stress and Atopic Dermatitis: Pathophysiologic and Therapeutic Updates. Acta Derm Venereol 2012; 92: 7–15.
3) Francesca Chiarello, Silvia Spitoni, Eric Hollander, Marco Matucci Cerinic, Stefano Pallanti
An expert opinion on PANDAS/PANS: highlights and controversies
Dr. Stefano Pallanti is member of the Protocol Advisory Board of PACE Foundation (a non-profit organization dedicated to improving the diagnosis, treatment and quality of life of children with Pediatric Autoimmune Neurological Disorders). He is also a member of PANDAS Physicians' Network.