A Mom sent a question over the DrClaudia.net "Ask Me" button about her 14-year old son who has a history of Attention-Deficit/Hyperactivity Disorder. She reported that his behavior has deteriorated dramatically and the school's response was to suggest he stay home.
He has "severe temper tantrums, extreme obsessive behaviors to the point where he can't get his homework done because he says he can't write anymore". He isn't sleeping or eating much and "cries out of frustration". She also described him as being "intensely anxious" to the point that he cannot be left alone, that he screams constantly and complains about bright lights and loud noises".
Mother did not indicate that he had been ill or even complained of a sore throat, but I'm suspicious he has PANDAS or PANS.
PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorder after Strep (or "associated with Strep") and PANS stands for Pediatric Acute onset Neuropsychiatric Syndrome. PANS appears to be the term evolving to describe the group of psychiatric behaviors after an infection, not just those associated with strep.
The obsessive behaviors peak (but continue) about 2-3 days after the strep/other infection takes hold. However, if your child has had a strep infection within the past 4-6 weeks, they can still erupt with these behaviors. You've forgotten about the strep infection and if you did remember that your child had a cold or flu or whatever, you don't think the bizarre behaviors are related.
When strep hits some kids, their immune systems generate a faulty response, whereby antibodies seem to run amuck, creating serious psychiatric symptoms which are confusing to parents because they "just show up".
These kids, usually between ages 3 and 12, need immediate medical treatment because of the potential for lifelong problems with cognition (thinking) and the possible development of a chronic autoimmune problem...both "big ticket" items.
This condition is dangerous because it impacts the basal ganglia which is the part of the brain involved in purposeful motor movement such as feeding, writing, self-care (dressing, tooth-brushing, etc.) learning, eye movements, cognition and emotions. Untreated PANDAS/PANS leads to lesions on the basal ganglia which may lead to those permanent side-effects.
I've had 3 clients in my practice end up with a diagnosis of PANDAS. At the time, PANDAS was less well-known than it is today and it took some fancy dancing to get my first client evaluated which led to a diagnosis, but did not protect him from permanent disability.
Now, what to do. Get your kid into see the pediatrician. If the pediatrician cannot see your kids for days, go to a pediatric-certified emergency room. Get the strep treated immediately so the body can stop creating these damaging antibodies.
Depending on the level of psychiatric symptoms, your child may be given a prescription of Prozac, which is a SSRI antidepressant that is effective for the pediatric population and for obsessive behaviors and anxiety.
If the symptoms do not subside, your child may be given a short-course of steroids and then, possibly a blood plasma exchange in the form of intravenous immunoglobulin.
If your child has been sick in the past 2 months and has a sudden decline with the behaviors listed in the link below, act FAST.
This autoimmune condition typically strikes in late fall and early winter, so perk up your ears and pay attention. Tell others.
Here's the link to the PANDAS Network which is a terrific resource.
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At DrClaudia.net, click on the "Ask Me" button and send me a question.
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