PANDAS where strep infection can be a factor

PANDAS

Did your child develop anxiety symptoms, motor tics or unusual physical movements quite suddenly? Even if you might be able to point to some change or event that might have triggered the anxiety, are you still left with a feeling that it doesn’t quite make sense?

The culprit might be PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection). In this condition, the body marshals its soldiers — the antibodies — to fight infection, but also engages in “friendly fire,” which is what happens in an autoimmune disorder. The antibodies attack the infection, but also attack the basal ganglia, a region of the brain involved in, among other things, movement. As a result, your child may suddenly develop fears, phobias, OCD-type behaviors or motor tics. When talking to your pediatrician about these symptoms, it is important to emphasize the sudden onset, which can differentiate PANDAS from more ongoing anxiety disorders. Ask your pediatrician if it makes sense to have your child tested for Group A strep. This test is useful because strep is a complicated creature, and can be present even when a child shows no obvious symptoms of infection.

There are controversies concerning PANDAS, which Lisa Belkin discusses in her article, “Can You Catch Obsessive-Compulsive Disorder?” (New York Times Magazine, May 22, 2005: pages 64-69). But frankly, clinicians who work with children who have OCD have no doubts about PANDAS as a real phenomenon. Beth Alison Maloney, a parent whose son struggled with a severe case of PANDAS, has written a very compelling account in her book, Saving Sammy: Curing the Boy Who Caught OCD. She provides a detailed reference list for those who would like to learn more about PANDAS, which is a very active area of research that generates new information every year. You can also Google Susan Swedo, MD, who is one of the leading authorities on PANDAS.