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| Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus |
| Is there a test for PANDAS? |
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Have you noticed how different your child has been acting ever since he had that sore throat? He seems hyperactive, moody and keeps blinking his eyes. He also has become very particular about the way he does certain things. His teachers say that he's not paying attention in class and they're having trouble reading his handwriting.
Your child may have developed what the medical community has named PANDAS. Although rare, PANDAS stands for Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus. What does all that mean? Basically, it means that when the body's defences are trying to attack the Streptococcal bacteria causing the sore throat, there is some degree of mistaken identity and it also attacks some parts of the brain.
The autoimmune attack is thought to occur on closely related parts of the brain, causing a range of behavioural and emotional problems. When first discovered PANDAS was linked to obsessive-compulsive disorder, Tics and Tourettes syndrome. Mostly because these abnormal behaviours are overt and easily recognised.
Tics can be uncontrollable movements, such as eye-blinking or shoulder-shrugging, or automatic noises such as throat clearing, grunting or saying certain words repeatedly. More recently PANDAS has been associated with a wider range of related behaviours. Affected children can have any combination of the following symptoms:
- Cognitive inflexibility, difficult to reason with, as if stuck on an idea,
- Obsessive/repetitive/compulsive argumentative behaviours,
- TICS (repetitive vocalisations of body movements),
- Tourettes Syndrome,
- Attention deficits and oppositional/defiant behaviours.
The bacteria associated with this disorder are known as Group A Beta-Haemolytic Streptococcus (GABHS). They are also the bacteria associated with rheumatic fever, a disease characterised by heart and joint inflammation that can occur after an untreated strep throat. A type of rheumatic fever with mostly neurological symptoms is Sydenham's chorea (also known as St. Vitus Dance). Symptoms of Sydenham chorea may occur several weeks to months after the infection and may include poor or diminished muscle control and tone, poor coordination and awkward movements of the face, body, arms and legs.
Children may also have changes in their behaviours. Generally, after several weeks, all or most of the symptoms go away and may return if the child develops another Strep throat infection (detected or undetected). However, in a number of cases recent outbreaks of rheumatic fever, signs of a recent sore throat were absent or minimal. To prevent relapses, doctors will treat patients with a history of rheumatic fever (including Sydenham chorea) with a daily dose of antibiotics as a preventative measure against future infections.
| Typically, a child with undiagnosed PANDAS may be taken to the Psychologist and/or Paediatrician for treatment of an onset or exacerbation of ADHD symptoms, oppositional behaviours or OCD. Stimulant or anti-depressant medication may be prescribed and/or a behavioural intervention or counselling initiated. As the infection passes and the strep antibodies reduce, the symptoms gradually subside and parents and clinicians believe that the intervention was successful. However then there is another strep infection, the symptoms return and the process is repeated. The problem is that the brain is being continuously damaged by the repeated attacks by streptococcus antibodies; and after each attack the recovery of damaged brain tissues may not be as complete as we would hope. Eventually the child may develop a chronic psychiatric disorder |
At the clinic, we check for evidence of a recent strep infection by ordering a special blood test that looks for Streptococcus antibodies (Serology for ASOT and AntiDNAseB). Evidence of a recent streptococcal infection may or may not mean that your child has PANDAS. Many children, up to 30 percent, will show evidence by blood test of a recent streptococcal infection. So connecting symptoms with a streptococcal infection will not necessarily mean that the infection was the cause of the child's behaviour change. PANDAS will not develop in every child with a strep infection.
Research is currently being done at the NIMH to find out whether the select few are genetically predisposed, or perhaps were exposed to a special strain of Strep. But for now, until we can determine the exact cause and catch it before it acts, have your child properly treated. When a sore throat persists, seek medical attention from a doctor experienced in PANDAS. If your child does have GABHS strep throat, as determined by a throat culture, the symptoms of rheumatic fever could be prevented if a course of antibiotics is taken within nine days of the onset of the infection. We believe that it is important to put the child on specific nutrient supplements that target brain structures and the right probiotics (beneficial bacteria) to replace the ones that antibiotics kill in the gut.
Watch for changes in the child's behaviours that are unexplained or out of character, such as mood changes, clinginess, hyperactivity, inattentiveness, obsessive thoughts, checking behaviours, repetitive noises or vocalisations, poor muscle control or coordination, ants in the pants movements or even new-onset bedwetting. At this time, this constellation of symptoms is under research investigation and it is not recommended that children with behaviour symptoms receive long-term treatment with antibiotics.
| PANDAS treatment at the Behavioural Neurotherapy Clinic When PANDAS is suspected due to the diagnostic criteria being met, we hypothesise that a short period on antibiotics (every time an episode of GABHS infection is confirmed) concurrent with and followed by ongoing nutrient supplementation to promote optimum Brain cell plasma membranes and Brain tissues may help brain recovery and protect against the full development of serious chronic psychiatric disorders. (Jacques Duff and Dr. Joe Nastasi) |