For the most updated information on PANS/PANDAS, visit the PANDAS Network website.
Pediatric Autoimmune Neuropsychiatric Disorders (PANDAS) was defined in 1998 by Dr. Sue Swedo. Abrupt, dramatic onset of OCD is the first diagnostic criterion for PANS. For those familiar with the CYBOCS (Childhood Yale Brown Obsessive Compulsive Scale) scores, some clinicians look for an increase in total score of more than 16 in the course of a few days. Children may have mild “quirks” or even some signs of OCD prior to this abrupt dramatic onset.
In retrospect some clinicians suggest that mild micro-episodes may even have occurred in the past. However, in the space of a few days, they “fall off a cliff,” dramatically causing a significant decrease in the child’s ability to function. Impairment is significant. Parents can usually name the day that the crisis occurred and have vivid memories of the first obsessions or compulsions because of their extreme nature. As an example, a normally joyful, balanced emotionally, independent, social child may turn into a child that has extreme temper tantrums that are out of character, and can no longer leave a parent’s side without accommodation. Panic attacks and unusual anxieties are not uncommon.
In addition to the typical obsessional fears and compulsive behaviors, this criterion also may be satisfied by the sudden severe onset of food avoidance, anorexia and eating restrictions. Clinically, these occur as solitary symptoms among PANS patients, as well as from complications resulting from obsessional fears of choking, vomiting or of contaminated foods.
Although there appears to be uniformity in the acuity and severity of onset of the co-occurring symptoms, there is great variability in the nature of the symptoms accompanying the OCD. As a result, the second major criterion for PANS is the concurrent acute onset of additional symptoms from at least two of the following seven categories:
- anxiety (particularly acute separation anxiety and irrational fears)
- emotional liability and/or depression
- irritability, aggression and/or oppositional behaviors
- behavioral (developmental) regression
- sudden deterioration in school performance
- sensory or motor abnormalities (particularly dysgraphia/ trouble with handwriting)
- somatic/physical signs and symptoms
As in most of psychiatry, PANS is a clinical diagnosis, meaning that there are currently no laboratory or genetic tests that can confirm the diagnosis. As such, a second opinion to find consensus on the diagnosis of PANS between two experienced physicians may be useful.