PANDAS/PANS: Beyond Cuddly Creatures and Kitchen Tools
Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) are two conditions that were once obscure but are now gaining widespread recognition. Both are autoimmune disorders stemming from chronic infections. The initial association with strep infections led to the specific diagnosis of PANDAS. However, it was later discovered that various infections could trigger similar symptoms, giving rise to the broader diagnosis of PANS.
PANDAS/PANS can develop when a child is exposed to an infection, such as a virus, bacteria, or fungi (like mold), that isn't fully treated. While recurrent strep throat significantly increases the risk of PANDAS, even a single exposure can set it off. Other known triggers for PANS include influenza, mold, Lyme disease, Bartonella, and numerous other infections.
When a pathogen invades the body, it seeks out the safest hiding spots to evade the immune system's detection. Often, this involves settling within tissues and biofilms—slimy, plaque-like substances where bacteria clump together, creating tiny habitats for microbes to thrive (similar to dental plaque). Biofilms can form in any part of the body, including major organs and the brain. Inside these biofilms, oxygen is scarce, allowing anaerobic (oxygen-avoiding) viruses and bacteria to multiply for extended periods, sometimes decades. During this time, the microbes are active and capable of causing infections and acute symptoms but mostly remain dormant. They also disguise themselves to blend in, so immune cells don't recognize them as foreign invaders. In adults, this can lead to no visible signs of infection for many years. However, when illness strikes, it may activate dormant microbes, causing an inflammatory "flare" that can range from mild to severe. Symptoms often include fever, lethargy, fatigue, joint and cartilage swelling, and allergy-like reactions. Frequently, the triggering microbe remains undiagnosed, leading to misdiagnoses like fibromyalgia or multiple sclerosis as flares worsen with each immune response.
In children, the impact of these conditions can be devastating. Exposure to environmental triggers or any immune response can cause a PANDAS/PANS flare, transforming a typically calm child into an unpredictable, raging one. Instead of producing antibodies to fight the infection, the body mistakenly attacks its own tissues, particularly the brain. This is what classifies PANDAS/PANS as an autoimmune disease. Symptoms can appear overnight in a child recently exposed to an infectious microbe. Additionally, exposure to toxic substances like pollution, pesticides, mold, and heavy metals can trigger flares. Initially, most parents notice a sudden onset of severe obsessive-compulsive disorder, which may manifest as sudden germaphobia or constant body movements (tics). Other symptoms include handwriting deterioration, anxiety, rage, suicidal talk, bed-wetting, separation anxiety, behavioral and age regression, sleep disturbances, overall physical pain, hallucinations, and a fight or flight response. Flares can last for weeks in some children, and once they subside, the child immediately returns to their pre-flare state. They can recall feeling helpless, angry, and uncontrollable during flares, often carrying residual depression afterward.
Treatment for PANDAS and PANS is not one-size-fits-all. Research is still catching up to the experiences of parents who have been dealing with this frightening disorder for years. Some top doctors don't yet believe it's a real disorder. Treatments vary widely and may include long-term strong antibiotics, herbal regimens, homeopathy, IVIG, neurofeedback, nutrition, detoxification, chiropractic care, behavioral therapy, acupuncture, hyperbaric oxygen therapy, and more. In many cases, multiple protocols must be implemented to control flares. Families often spend years and thousands of dollars searching for answers for their child, often without success. For children with mold triggers, simply removing them from the environment may be enough. Others have multiple triggering infections that each require targeted treatments. There is hope that as we learn more about PANDAS/PANS, cutting-edge research will reveal more standardized treatment protocols.
How can hyperbaric oxygen therapy specifically help with PANDAS/PANS? Firstly, it is an anti-inflammatory modality; the extra oxygen delivered to areas of infection can reduce inflammation and even break up anaerobic biofilms, releasing the triggering microbes into the bloodstream. While this may seem negative, it actually means that the microbes can no longer hide in the biofilm, making treatment protocols (including oxygen) more effective at eliminating the infection. HBOT can also help a child during a flare by inducing a relaxation effect, which can help take the child out of a fight or flight response. This can result in fewer anxiety and rage episodes. We highly recommend regular hyperbaric therapy for children with PANDAS or PANS to help treat infections and alleviate symptoms during flares.
