Even though strep is the most cited trigger for PANDAS/PANS, all bacteria, viruses and even environmental factors can create the misdirected immune response, including Mycoplasma pneumoniae (also known as walking pneumonia), staph infections, Lyme disease, influenza, Coxsackievirus, Epstein-Barr virus and herpes simplex virus, and Covid 19. Other possible triggers include exposure to illness, allergies, stress, artificial food dyes and additives, chlorine, fluoride, commercial personal care products, poor diet and yeast overgrowth.
PANDAS/PANS symptoms may cause deficits in performance, particularly in the areas of:
- Attendance (due to lack of sleep, fatigue)
- Cognition (affecting behavior; academics, including reading, writing and math; sensory overload)
- Fine motor skills (handwriting and task completion)
- Perceptual and physical issues that affect fine/gross motor skills
- Urinary frequency and control
- Ability to eat normally
- Social issues with peers
Depending on the severity, which may change over time, PANDAS/PANS may impact a student’s ability to:
- Attend and travel to school-related activities
- Sustain focused attention and executive functioning
- Adapt to transitions and stresses
- Understand and remember information
- Communicate effectively, both orally and in writing
- Behave in age-appropriate ways and demonstrate self-care and daily living skills
- Maintain their previous level of physical and mental stamina
PANDAS/PANS patients may display the following:
- Sudden onset of OCD symptoms
- Irritability or aggressive behavior
- Extreme moodiness or depression
- Deterioration of motor skills
- Tics and unusual movements
- Visual or auditory hallucinations
- Sensitivity to light, sound and touch
- Sleep disturbance or fatigue
- Urinary symptoms (enuresis) and Bedwetting (frequent or occasional)
A conservative estimate is that 1 in 200 children in the U.S. alone experience PANDAS/PANS. However, the true lifetime prevalence of PANDAS/PANS is not known because the disorder is still misunderstood and underdiagnosed.