‘Paediatric autoimmune neuropsychiatric disorder associated with streptococcal infection’ (PANDAS) is a neuropsychiatric disease found in children. The onset is sudden and is characterised by symptoms akin with obsessive compulsive disorder (OCD), such as tics and anxiety (including separation anxiety, as well as recent exposure to sore throat or streptococcal infection1.
The PANDAS Network has estimated that the condition may affect 1 in 200 children in the United States2. It has also reported that common onset is between the ages of 6 and 10 years, with 81% of patients reposting a streptococcal infection2.
Researchers believe PANDAS is the result of a faulty immune response to a streptococcal infection (like strep throat or scarlet fever). Normally, a child’s immune system will produce antibodies to fight streptococcal bacteria, but in cases of PANDAS these antibodies cross the blood-brain barrier and attack a part of the child’s brain called the basal ganglia, which is critical for smooth motor function. The violent tics that result are characteristic of PANDAS1.
PANDAS share many symptoms with other conditions, such as OCD and attention deficit hyperactivity disorder (ADHD), so it can be difficult to diagnose. Strep throat is very common in children. Typically, the symptoms are fever, sore throat and white spots on the tonsils. Some children present with an upset stomach and headaches. Additionally, some people may not exhibit any symptoms.
For children with PANDAS, behaviour changes are an indication of a possible infection. Diagnosing a strep A infection is simple with a rapid antigen test and treatment is with penicillin. The earlier the strep A infection is diagnosed and treated then a better outcome is likely2.
In the UK, PANS PANDAS UK is a support group for parents and the education of clinicians. Pharmacists should be vigilant around children, particularly between the aged of 6 and 10 years, presenting with symptoms of a streptococcal infection — however mild — and consider a rapid antigen test to exclude infection.
Mark Robinson BPharm, MSc MRPharmS, Retired
- 1.What is PANDAS and how do I spot it in my child? BBC . Accessed January 2025. https://www.bbc.co.uk/programmes/articles/5KRm8Yw1w6lmkTKbdPvTnBB/what-is-pandas-and-how-do-i-spot-it-in-my-child
- 2.PANDAS/PANS diagnosis. PANDAS Network. Accessed January 2025. https://pandasnetwork.org/understanding-pandas/diagnosis/
