"In-Search Of Cure"

Pandas Syndrome

            This is some research that I am studying, to find more of what can be done to treat this illness called Pandas. There are researchers throughout the United States, searching for a treatment for pandas syndrome, which attacks the brain, particularly an area known as the basal ganglia, an area at the base of the brain that helps to control our thoughts, movements, emotions, and behavior. Pandas is thought to be similar to Sydenham’s chorea or Saint Vitus’ dance, a type of rheumatic fever. Rheumatic fever occurs when a child has a prolonged step throat infection lasting at least five days before antibiotic treatment is started. A step throat infection cannot always be seen by the eye.

            A throat culture would be the answer. This would show if there is a step throat infection. Using an antibiotic to treat the infection would clear up the infection using Bicillin 1.200.000 units. This would be a one time injection, and may need repeated in four to six weeks. So how do we treat the Pandas Syndrome? How can we stop the side effects from causing Obsessive-compulsive disorder, Motor or vocal tics, hyperactivity disorder, Separation anxiety disorder, Abrupt mood swings, personality change, confusing thoughts, violent behavior, or acting out behaviors? 

            The diagnosis of PANDAS is a clinical diagnosis, which means that the child needs to exhibit a certain pattern of symptoms. There are 5 diagnostic criteria for the diagnosis of PANDAS (see below). However, the criteria only identify children likely to have PANDAS. In order to have definitive proof, a test indicating the presence of antineuronal (anti brain cell) antibodies in the child would be needed. At present, such a test does not exist. Since there is no test available, the clinical features of the illness are the only means of determining whether or not a child might have PANDAS.

What are the diagnostic criteria for PANDAS?

They are: Presence of OCD and/or a tic disorder

Pediatric onset of symptoms (age 3 years to puberty)

Episodic course of symptom severity

            Association with group A Beta hemolytic streptococcal infection (a positive throat culture for strep. And/or elevated anti streptococcal antibody titer)

            Association with neurological abnormalities (motoric hyperactivity, or adventitious movements, such as choreiform movements)

What is an episodic course of symptoms?

            Children with PANDAS seem to have dramatic ups and downs in their OCD and/or tic severity. Tics or OCD which is almost always present at a relatively consistent level do not represent an episodic course. Many kids with OCD or tics have good days & bad days, or even good weeks and bad weeks. However, patients with PANDAS have a very sudden onset or worsening of their symptoms, followed by a slow, gradual improvement. If one was to graph the course of the symptoms of these children, a "saw tooth" pattern would arise. 

            In other words, after exposure to the Streptococcal bacteria, the children have a dramatic worsening of their symptoms. Then upon clearing the infection from their bodies, the symptoms gradually go away. Parents will often say, "She woke up this morning a completely different child" or "All of a sudden he had an explosion of tics last Wednesday night." The increased symptom severity usually persists for at least several weeks, but may last for several months or longer. 

            The tics or OCD then seems to gradually fade away, and the children often enjoy a few weeks or several months without problems. When they have another strep throat infection and the tics or OCD return just as suddenly and dramatically as they did previously. My child has had Strep throat before, and he has tics and/or OCD. Does that mean he has PANDAS?

            Many children have OCD and/or tics, and almost all school aged children get strep throat at some point in their lives. Only when a child has a very episodic course of tics and/or OCD and seems to have a strep throat shortly before or at the time of a dramatic worsening of symptoms does this indicate the possibility of PANDAS. What does an elevated anti-streptococcal antibody titer mean?

Is this bad for my child?

            An elevated anti strep. titer (such as an ASO or an AntiDNAse B) means the child has had a strep infection sometime within the past few months, and his body created antibodies to fight the strep bacteria. This is not bad. All healthy people create antibodies to fight infections. The antibodies stay in the body for some time after the infection is gone, but the amount of time that the antibodies persist varies greatly between different individuals.

What is D8/17, and can my child be tested for it?

            D8/17 is the name of a test which appears to identify people who are susceptible to rheumatic fever. D8/17 has also been reported to be positive more often in patients with OCD than healthy controls. At the present time however, no one knows what the D8/17 marker is, or what it indicates. If a child does test positively for the D8/17 marker, this does not prove that he or she has PANDAS. (The D8/17 marker is positive in about 5% of the general population.)

            Tests for the marker are NOT generally available at this time, since researchers are still attempting to determine the significance of the test.

Will Penicillin treat PANDAS?

            Penicillin and other antibiotics kill streptococcus and other types of bacteria. The antibiotics treat the sore throat or pharyngitis caused by the Strep, by getting rid of the bacteria. However, in PANDAS, it appears that antibodies produced by the body in response to the Strep infection is the cause of the problem, not the bacteria themselves. Therefore, one could not expect antibiotics such as Penicillin to treat the symptoms of PANDAS. 

So how do we treat the side effects of Pandas?

            At this time there is one way to stop it and it would be with a medication drug called Risperidone. This would stop the side effects from getting control of your child mind. But please note this. This is still not the cure. The questions are still with us. What can we do? How can we over come this? What treatment is needed to defeat these attacks from the pandas? How can we destroy the pandas without causing severe damage to the nerves that is being pressured.

SIDE EFFECTS FROM THE DRUG

            Now in using this narcotic drug, one must consider the possibilities of side effects. Using this can cause, dizziness, drowsiness, nausea, increased dreaming, nervousness, loss of appetite, dry mouth or fatigue may occur the first several days as your body adjusts to the medication. Weight gain, vision changes, decreased sexual desire and insomnia have also been reported. This medication may make you more sensitive to the sun. avoid prolonged sun exposure.

            Caution is advised when using this drug in the elderly because they may be more sensitive to the effects of the drug. But remember this may not happen to all who takes this medication. I know it will stop the side effects from the illness. But how long will you need to be on it? This is another question as well. Medical Researcher are still studying this matter.

Can The Elderly Be Affected By Pandas Syndrome?

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