Strep May Trigger Mental Illness in Kids

Strep may trigger mental illness in kids, according to this latest Primary – Urgent Care spotlight from Evolve Direct Primary Care. PANDAS is the acronym doctors use to describe Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections. It is important to remember that the vast majority of kids who develop strep never have anything more but in rare cases, but for the children who do get PANDAS, they have a rapid onset of psychiatric and neurologic problems.

The progression of PANDAS can be very rapid, seemingly overnight. Some children will have unusual arm or finger movements, to obsessive-compulsive behaviors, or even psychosis (which is losing touch with reality entirely). “We watched the child that we knew disappear in front of our eyes,” the mother of a 12-year-old in England diagnosed with PANDAS (and now in recovery) told local news of his battle last month, and reported in the Daily Beast recently.

In another example, published in 2014 by the New York Times, Denise Watkins described how shortly after a sore throat her son developed bizarre obsessions, constant nightmares about snakes and alligators, then relentless hand washing that left her son’s skin raw and chapped. Will was only 5 years old, and his illness seemed to burst out of nowhere.

PANDAS continues to be a controversial diagnosis and is relatively new, having been first described by scientists at the National Institutes of Health in the mid-1990’s. Few doctors have even heard of it though reporting continues to come out periodically and many feel the symptoms are unmistakable.

Children, sometimes as young as 2 or 3, develop odd verbal and motor tics. They feel compelled to engage in repetitive behaviors. They develop irrational fears of germs, bugs, intruders, almost everything around them. Separation anxiety is another hallmark. Even getting them to perform routine activities like going to school becomes a struggle. Many of the symptoms – ritualistic behaviors and disturbing thoughts, for example – mirror those of obsessive-compulsive disorder.

Summary:

• PANDAS is an acronym for “pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections.”
• It is a fairly recently described disorder (1990s).
• An autoimmune response to a streptococcal infection causes PANDAS.
• It is diagnosed if there is a history of abruptly developing a number of neuropsychiatric symptoms associated with a strep infection.
• Medication and cognitive behavioral therapy are the primary treatments for PANDAS.

 

Dr. Susan Swedo is the Chief of the Pediatrics and Developmental Neuroscience Branch at the National Institute of Mental Health, author of that first major PANDAS study and very active in this field. More information about her and her contact information is found at this link.

Diana Pohlman is the Executive Director of the PANDAS Network. She warns against inappropriate use of antibiotics to treat it for longer than is necessary, and suggested that the usual antibiotics for strep work well for many children with the illness.

Dr. Elizabeth Latimer, a Bethesda, MD pediatric neurologist who specializes in the treatment of PANDAS, expressed similar reservations about long-term antibiotic use. She first became involved in the treatment of the disease after caring for the sibling of a patient described in Dr. Swedo’s paper, who also had symptoms of the illness.

“One day they are behaving and developing normally, the next, they’re incontinent, or afraid of a hug, or battling a tic, or losing the ability to write.” PANDAS is often described as a variant form of Syndenham chorea, a rare but well-established complication of strep infections characterized by irregular and involuntary movements of the extremities, trunk and facial muscles, and caused by an autoimmune reaction that affects part of the brain controlling motor movements.

“I treated that child and she was cured almost immediately,” Dr. Latimer continued. “I thought this was probably uncommon or rare, but then saw one of my own long standing patients who came in with the same syndrome. Knowing the signs, it was pretty easy to pick up and he had the highest strep titre I have ever seen.”

The lessons we at Evolve Medical take from this story are two fold. The first, is preventative: If you are not sure whether your child’s illness is strep or viral, please don’t feel you are wasting your doctor’s time by having this checked out. An in-office test can give you the answer in 5 minutes or less. The 2nd lesson is that if your child does develop sudden, unexpected behaviors such as described above, particularly if they have had a recent upper respiratory infection, please be sure to have them properly evaluated by someone familiar with PANDAS.

 

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