This information is provided by the National Institutes of Health (NIH) Genetic and Rare Diseases Information Center (GARD).
Pediatric acute-onset neuropsychiatric syndrome (PANS) is a condition defined by sudden onset of obsessive-compulsive symptoms and/or severe eating restrictions, along with at least two other cognitive, behavioral, or neurological symptoms. Examples of other symptoms include anxiety, depression, tics, personality changes, decline in school performance, and sensory sensitivities. Symptoms typically begin during childhood but may begin at any age. Symptoms may go away for a while and then come back (referred to as a relapsing and remitting course). However, symptoms may be worse and last longer with each episode.
PANS is thought to have a variety of possible causes. In more than 80% of cases, there is evidence of an abnormal autoimmune or inflammatory response in the brain following any of various infections in the body. When the associated infection is known to be strep, the condition is called PANDAS (a subtype of PANS). Other possible causes of PANS include psychological trauma and underlying autoimmune, neurological, endocrine, or metabolic disorders. There are likely non-infectious triggers that have not yet been identified.
The diagnosis of PANS is made only when all other possible causes of symptoms are ruled out (this is a called a diagnosis of exclusion). Depending on the symptoms present, this process may rely on factors such as medical and psychiatric history, a physical exam, evaluation by various specialists, and a variety of tests or imaging studies such as blood tests, an electroencephalogram (EEG), sleep study (polysomnography) and/or brain MRI.
Treatment depends on the symptoms and severity in each person and may involve improving symptoms with psychiatric medicines and behavioral interventions, treating underlying infections or sources of inflammation with antibiotics, and/or stabilizing the immune system with immunotherapy and/or anti-inflammatory therapies (in immune-related PANS). Treatment may be tapered down or stopped when symptoms resolve but may be needed again if symptoms return.
Many people with PANS who undergo treatment show overall improvement over months to years or will recover completely. However, relapses may still occur after long periods of remission. Others will have ongoing symptoms that require continuous treatment. If not treated, PANS can lead to permanent debilitation. Unfortunately, at this time it is not possible to predict the course of the condition in each person.
For more information, visit GARD.