Definition:

PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are autoimmune disorders thought to be triggered by infections such as streptococcal infections through a process called molecular mimicry.

• The autoimmune process, following a strep infection, produces “anti-brain” antibodies that can target the brain, causing mainly basal ganglia encephalitis, causing symptoms associated with PANDA. The basal ganglia are associated with a variety of functions, including regulating voluntary motor movements, procedural learning, habit formation, conditional learning, eye movements, cognition, and emotion.
• Mothers of patients with PANDA have a 25% chance of having an autoimmune disorder.
• These events are mostly associated with infections, both at the initial presentation and subsequent relapses. Group A Strep (GAS) is the most common infection associated with PANDA; other infections may include mycoplasma, influenza, Lyme disease, and sinusitis.
• Recurrent GAS mucosal infections induce a strong antigen-specific Th17 cellular response in mice and humans. Th17 cells have been implicated in many autoimmune diseases, including multiple sclerosis, where they trigger inflammation and destruction of the blood-brain barrier (BBB).
• T cells specifically home to the brain, localizing primarily in the olfactory bulb (OB) and along the olfactory nerve, as well as some other brain regions where OB neurons send projections and eventually make synaptic connections. These T cells induce neuronal damage and BBB breakdown, and the consequences for behavioral outcomes. 

PAN/PANDA Symptoms

• Sudden onset of emotional/behavioral/neurological changes, relapsing/remitting course
• Anxiety
• Symptoms of obsessive-compulsive disorder (OCD)
• Sydenham Chorea, including sudden, jerky movements
• Tic disorders can include motor and/or vocal tics
• Restrictive eating
• Mood disorders such as becoming moody or irritable, experiencing anxiety attacks, or separation anxiety, or ODD behavior
• Trouble sleeping, nighttime bed-wetting, daytime frequent urination, or both
• Changes in motor skills (e.g., changes in handwriting)
• Joint pains
• ADHD symptoms (hyperactivity, inattention, fidgeting)
• Personality changes
• Behavioral regression
• The decline in school performance, such as in math
• Sensory sensitivities
• Urinary frequency
• and more.

Core Treatment Framework (3-Pronged Model)

Addressing Infection and Triggers:

• Identify and treat infections: group A strep (throat, skin, perianal, vaginal), sinusitis, other infections in the child and close contacts.
• Antibiotics: Penicillin, azithromycin, and other antibiotic regimens.

Anti‑inflammatory / Immune‑Modulating Care

• NSAIDs and short steroid “bursts” are commonly used to shorten flares and target presumed neuroinflammation, though controlled trials are lacking.
• Recent work also explores oxidative stress and gut permeability as targets, especially in PANDAS, suggesting scope for gut‑focused or antioxidant strategies.

Psychiatric / “Brain‑Based” and Lifestyle Interventions

• Psychological treatments, especially CBT with family involvement, can give substantial symptom reduction.
• Medications such as SSRIs are sometimes considered
• Daily function & support, such as school accommodations, family counseling, routines