Pediatric autoimmune neuropsychiatric disorder, or PANDAS, is caused by group strep A, the same infection that causes strep throat. Strep is a vicious bacteria, and when the body’s antibodies fight it off, they can mistakenly attack healthy tissue such as the heart and kidneys. PANDAS results when strep antibodies attack the brain, specifically the basal ganglia, which is responsible for movement and behavior. When the antibodies interact with this area of the brain, it can cause obsessive-compulsive disorder or Tourette syndrome-like tics.

“It’s a fairly new disorder,” pediatrician Dr. Jim Sears adds. “But what we do know is when someone gets a strep infection, and if prescribed treatment isn’t completed and you stop antibiotics [early], those antibodies still circulate and can cause [PANDAS].”

Common symptoms:
• Obsessive-compulsive behaviors, such as repetitive motions, excess fear of germs, hair pulling and bizarre eating habits
• Motor and verbal tics, similar to those with Tourette syndrome

• ADHD symptoms, such as hyperactivity, inattention, fidgety behavior
• Extreme separation anxiety: Child is clingy and has difficulty separating from his or her caregivers
• Mood changes, such as irritability, sadness or emotional swings
• Sleep disturbance
• Nighttime bedwetting and/or daytime urinary frequency
• Fine motor changes, such as changes in handwriting
• Joint pain
• Loss of math skills and sensory sensitivities
• Age regression

Treatment options
There are three tests for detecting strep: a rapid throat swab, a throat culture and a blood test, which is the only definitive screening for strep.

Treatments vary and can include:
• Long-term antibiotics
• Probiotics
• Intermittent steroids
• Natural anti-inflammatory medications
• Psychiatric medications
• Intravenous immunoglobins
• Plasmapheresis

PANDAS symptoms can only be stopped once the infection is fully treated. Doctors should perform follow-up throat cultures and check family members to make sure it is no longer present.

Beth's Story
My son Sammy was a perfectly happy, healthy, normal child,” Beth says. “Just after he turned 12, he started showing strange behaviors. [The] first thing [I noticed], he would close his eyes and put his hands out, feeling his way around as if he was blind. Every day [he exhibited] a new behavior, such as stepping over and ducking under invisible walls. It was like he was in a totally separate world.”

One day, Sammy’s behaviors became so severe, he was unable to speak. He wrote a life-changing message on a piece of paper: “Help.”

Beth took Sammy to the psychiatrist, where he was diagnosed with obsessive-compulsive disorder and prescribed medication. But Beth says his condition worsened.

Feeling helpless and confused, Beth called her mother, who then suggested Sammy get tested for strep throat. Though Sammy had never suffered from a sore throat, he was ultimately diagnosed by pediatrician Dr. Catherine Nicolaides with pediatric autoimmune neuropsychiatric disorder.

“What’s important here is to make the connection between the preceding strep infections,” Dr. Nicolaides says. “That connection wasn’t made initially."

Since his diagnosis, Sammy’s OCD symptoms have cleared. “I’m doing well,” Sammy says. “I don’t have any symptoms left, and I’m in college now.”

• Signs of strep throat
• How to treat a sore throat
Designer Jeff Lewis on coping with obsessive compulsive personality disorder