PANS/PANDAS Treatment

GUIDE

PANS stands for Pediatric Acute-Onset Neuropsychiatric Syndrome. This is when an infectious trigger makes the child's immune system go haywire. Infections such as sinus infections, allergies, pneumonia, Lyme, and environmental triggers can trigger inflammation in a child’s brain and cause debilitating symptoms.

PANS/PANDAS is a relatively new diagnosis in the medical world and this PANS/PANDAS treatment guide can help. Teachers, mental health, and medical professionals have not entirely accepted it and often blame it on a psychological issue. Even some pediatricians are unfamiliar with the symptoms. That means getting the right help is a significant obstacle to healing. If we can’t even recognize this medical issue properly, then kids and families suffer even more.

What is PANS/PANDAS?

 

PANS, or Pediatric Acute-Onset Neuropsychiatric Syndrome, is a clinical disorder resulting in sudden symptoms such as OCD, including intrusive thoughts, compulsive behaviors, ritualistic behaviors, or disordered eating after an infection, multiple infections, or toxic trigger that results in inflammation. PANS occurs when an infectious trigger creates a misdirected immune response, leading to inflammation.

Common Infectious Sources of PANS

 

  • Lyme/Tick-Borne: Borrelia Burgdorferi, Bartonella, Babesia
  • Mycoplasma
  • Anaplasma/Ehrlichia
  • Epstein Barr
  • Pneumonia
  • Sinus Infections
  • Candida
  • Coxsackie, Croup, Flu, and other viruses
  • Allergies
  • Environmental, such as  mold, etc. 

PANDAS means Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections. It is a clinical disorder triggered by Group A strep infections, resulting in a sudden onset of neuropsychiatric behaviors, including either obsessive-compulsive Disorder (OCD) or tics.

Children with PANDAS often have a history of strep throat or a positive blood strep test, as streptococcal infections might not appear in a throat culture but can appear in the blood and organs. 

How are PANS and PANDAS the same?

 

Children with PANS and PANDAS share many of the same symptoms. The primary way PANS and PANDAS are the same, even though they are two different disorders, is that they have a sudden onset of neuropsychiatric and neurocognitive symptoms.

The three clinical conditions have overlapping symptoms and comorbid conditions. In addition, studies show that patients and their families have a high rate of medical issues and illnesses, including frequent and chronic infections, allergies, sore throats, ear infections, headaches, chemical sensitivity, urinary frequency, and a long list of other issues (Calaprice et al., 2017).

According to the same research studies, common developmental diagnoses of those with acute-onset neuropsychiatric syndrome include:

  • ADHD
  • Sensory Integration Disorder
  • Learning disability
  • Speech delay
  • Handwriting disorder (dysgraphia)
  • Math disorder
  • Reading disorder
  • Visual perception disorder
  • Coordination disorder

All three clinical issues significantly impact daily functioning at school, work, home, family, relationships, or some aspect of their life. Flares, or an uptick in symptoms, often occur in all three, often triggered by illness, infection, toxins, stress, fatigue, and diet.

How are PANS and PANDAS Different?

 

PANS and PANS differ primarily in the source of neuropsychiatric and neurocognitive symptoms. PANDAS initial onset results from a Group A strep infection, and PANS can result from an infectious or toxic trigger.

The two are different in age of onset, as PANDAS has a typical onset before puberty, and a PANS onset can occur at any age, even as an adult.

While PANS and PANDAS have a sudden onset of neuropsychiatric or neurocognitive issues (or a deep acceleration of a pre-existing clinical condition such as anxiety, OCD, ADHD, etc.), Autoimmune Encepathology is different from PANS and PANDAS because there is no requirement of sudden onset and the range of onset symptoms is broader. With AE, one can have a sudden or gradual onset of symptoms.

Clinical Guide: PANDAS and children.

What are the Common PANS/PANDAS Symptoms in Children and Teens?

 

PANS/PANDAS and AE symptoms can significantly impact a child's daily functioning ability, leading to difficulties at home, school, and social settings. Unfortunately, these disorders are often misdiagnosed, leaving children and their families struggling to understand the cause of their symptoms.

  • Obsessions (Perfectionism, fear of contamination, fear of choking, vomiting, etc.) – 
  • Compulsions (Checking, repeating, Washing/Cleaning)
  • Severe Eating Restriction (Avoidant of particular foods, fear of contamination, loss of appetite) – Anxiety (General anxiety, separation anxiety) 
  • Depression (Emotional lability/Mood Swings
  • Aggression (talk and actions)
  • Behavioral Regression (Developmental regression, Tantrums)
  • Sensory and Motoric Abnormalities
  • Changes in handwriting 
  • Somatic Symptoms (Bladder/bowel functioning) 

Note: Symptom presentation/severity can differ from patient to patient

Be on the lookout for:

 

    • Look for the common signs and symptoms associated with early or late-stage Lyme/Tick-Borne Disease, AE, and infectious disease. 
    • Look for a sudden change in behavior or cognitive, social, or physical functioning, especially after a known infection or case of Lyme or a tick bite.
    •  Infectious disease can create new symptoms or exasperate what was already there.
    • Patients may develop cognitive and psychiatric problems from the disease either early or many months or years after the initial infection, especially with Tick Borne
    •  There can be a waxing or waning of symptoms.

When is Tics a Sign of PANS/PANDAS?

 

Tics are frequent in 70% of PANDAS cases, highlighting their importance in diagnosing the condition. In addition, comorbid neuropsychiatric symptoms are also typically present in both PANDAS and PANS, characterized by an abrupt onset or worsening of symptoms. 


Furthermore, PANDAS is distinguishable from other tic disorders, such as Tourette syndrome, as it presents with additional somatic symptoms like frequent urination, mydriasis, and difficulty sleeping.

Can PANS cause Tics?

Causes of PANS and PANDAS

 

In most cases, the specific cause of PANS remains unclear. However, it is presumed that infections, metabolic disturbances, and other inflammatory reactions are potential triggers. Additionally, non-infectious factors like metabolic disorders and environmental factors might contribute to the onset of the condition, but their exact role is yet to be fully understood.

In contrast, PANDAS patients test positive for a known trigger such as streptococcal infection (strep throat), perianal strep, or scarlet fever, which can bring on acute psychiatric symptoms. 

While we don't know why one child gets strep without PANDAS and another develops post-strep infection, we know that certain genetic and environmental conditions increase the likelihood of chronic disease. Genetic problems such as MTHFR and weakened immune systems create an environment conducive to the proliferation of infectious diseases.

There is no link between the frequency of infection and the likelihood of PANDAS. For example, one child may develop PANDAS after one strep infection, while another may develop it after their fifth infection. Streptococcus bacteria have evolved to hide in the body to survive by using molecules on their cell walls that closely resemble human molecules. 

This process, called “molecular mimicry,” enables strep bacteria to evade detection temporarily. Due to molecular mimicry, the antibodies respond to the strep molecules and the imitated human molecules. 

As a result, it triggers the immune system to attack normal body tissues mistakenly, resulting in inflammation in the brain and the sudden onset of neurocognitive or psychiatric symptoms.

How are PANS/PANDAS/AE Diagnosed?

 

PANS/PANDAS and Autoimmune Encephalopathy (AE) are clinical disorders that can be difficult to diagnose due to their complex and overlapping symptoms. Unfortunately, this can lead to delays in appropriate care, causing significant stress for children and their families. Therefore, it is essential to obtain a correct diagnosis, but there are challenges in differentiating these disorders from other neuropsychiatric conditions.

Criteria for PANS Diagnosis:

 

In children, PANS presents as an abrupt, dramatic onset of OCD (Obsessive-Compulsive Disorder) or severely restricted food intake. Please note that they have also broadened the criteria to include adult onset. 

Swedo (2012) stated that for a diagnosis to be made, there must be the presence of additional neuropsychiatric symptoms with acute onset from at least two of these seven categories simultaneously:

    • Anxiety, Separation Anxiety
    • Emotional Lability and Depression
    • Irritability, aggression, and severely oppositional behaviors
    • Behavioral (developmental) regression
    • Deterioration in School Performance
    • Sensory or Motor Abnormalities
    • Somatic signs and symptoms, including sleep disturbances, enuresis, or urinary frequency 

Criteria for PANDAS Diagnosis: 

 

For a diagnosis of PANDAS, all five of the following criteria must be met: 

 

    1. Presence of Obsessive-Compulsive Disorder (OCD) or a tic disorder
    2. Prepubertal symptom onset (now can be adult onset)
    3. Acute symptom onset and episodic (relapsing-remitting) course
    4. Temporal association between Group A streptococcal infection and symptom onset/exacerbations
    5. Association with neurological abnormalities 

 

Children who experience PANS and PANDAS exhibit a sudden onset of neuropsychiatric symptoms, including rage, OCD, anxiety, disordered eating, and regression in skills such as bladder functioning. These disorders occur due to a misdirected immune response, in which the body attacks its healthy cells and tissues in the brain or nervous system. 

 

While the exact cause of this immune response is not yet fully understood, it is often associated with a history of multiple infections and genetic mutations, such as MTHFR. In addition, the dramatic onset of these symptoms is a common thread among those with PANS/PANDAS and is not typical for normal mental health development in children.

How to Test For PANS/PANDAS

 

While PANS and PANDAS are triggered by infectious diseases or toxins that can typically be identified through lab work, the diagnosis process is not always straightforward. Unfortunately, there is a significant amount of misinformation and ignorance surrounding these disorders, making it challenging to obtain a proper diagnosis. It complicates the process of finding appropriate care and can lead to significant stress for both children and their families.

PANS/PANDAS/AE diagnoses are made after a clinical interview and exam. Therefore, a specific test or panel cannot diagnose these conditions. Nonetheless, laboratory examinations can be valuable in revealing the presence of infections and toxins and identifying nutrient deficiencies. As a result, lab work can serve as a useful tool for determining the underlying causes and guiding the treatment of these conditions.

Finding a PANS/PANDAS/AE literature provider who interprets blood work and coordinates proper care for your child or teen is essential. Here are our recommended lab tests for these clinical disorders:

Basic Lab Work: 

 
  • Strep throat culture, 48-hour culture, and perianal culture

Virus and Bacteria Blood Work:

 
  • Lyme Disease & Co-infections: Lyme Western Blot & Elisa, Babesia microti & Duncani, Bartonella, B. Miyamotoi, Ehrlichia, Anaplasma
  • Anti DNase B
  • Anti-Streptolysin (ASO)
  • Mycoplasma Pneumoniae
  • Streptozyme
  • Epstein Barr Virus Panel
  • Pneumococcal Antibody
  • HHV-6
  • Coxsackie A & B Titers
  • COVID

Autoimmune and Immune System Testing:

 

  • IgA, IgG, IgM
  • IgE Level
  • IgG (subclass 1, 2, 3, 4)
  • White blood cell count
  • Streptococcus pneumoniae Serotypes
  • Inflammation markers
  • ANA
  • CBC

For Further Testing:

 

  • Serum Copper
  • Ferritin
  • Vitamin D
  • B-6
  • B-12
  • Plasma Amino Acids
  • Thyroid test – Free T3 & T4 and TSH (Thyroid)
  • Organic Acids Test
  • Stool Testing

Other Testing: 

 
  • Testing for genetic mutations such as MTHFR
  • Food allergy testing
  • Mold testing
  • Full panel nutrient testing
  • Cunningham Panel (Not required for a PANS or PANDAS diagnosis)

Note: These lab tests are recommended for Lyme or tick-borne infections and viruses.

Why PANS/PANDAS is Hard to Diagnose in Children and Teens?

 

Diagnosing PANDAS and PANS can be difficult as their symptoms can imitate those of other disorders. Moreover, one of the challenges in diagnosing these conditions is that when patients manifest psychiatric problems, healthcare providers often overlook the possibility of underlying medical causes due to a lack of proper training. 

Due to this, children who suffer from PANS and PANDAS often receive an incorrect diagnosis of a psychiatric disorder and are treated solely with psychotropic medications to alleviate their symptoms. If the initial medication doesn't work, another one is tried, and this cycle may continue. Although some children may find relief through this approach, many may not.

In children, physicians often only encounter the psychiatric symptoms of PANS/PANDAS and fail to comprehend the medical origin of these sometimes severe behaviors. As a result of being perceived as having a psychological rather than a physical health condition, patients do not receive the appropriate treatment. 

Recognizing that neuropsychiatric and neurocognitive symptoms have an infectious basis is crucial in ensuring patients obtain the required care. It underscores the significance of the debate surrounding the condition, which is even more significant than the controversy surrounding PANS/PANDAS.

Children with PANS and PANDAS are often misdiagnosed with Oppositional Defiant Disorder (ODD) or other clinical ailments. One of the challenges in diagnosing PANS and PANDAS is that some symptoms are not always evident and may develop before they become noticeable. 

Obsessive-Compulsive Disorder (OCD) can be challenging to identify because of its intrinsic nature. For instance, a child who had to walk around the playground three times before joining in would tantrum for an extended period if interrupted was seen in our office. In addition, a child may display OCD behaviors or anxiety for some time before the parent or practitioner recognizes that OCD could be a contributing factor.

Detecting food restriction as a clinical issue in young children can be challenging as parents are frequently informed that it is typical for children to refuse food. For example, a family recalled that their pediatrician advised them that it was acceptable for their three-year-old to stop eating entirely and that they would eat when hungry. While this advice may be appropriate for some children, it was not practical for this particular child.

Why Should PANS/PANDAS be Important to You? 

 

PANS/PANDAS and Autoimmune Encephalopathy (AE) are clinical disorders that can have a significant impact on the lives of affected children and their families. 

With the prevalence of these disorders on the rise, it is crucial to raise awareness about their symptoms, diagnosis, and treatment options so kids and families don't suffer as much as they do. 

Understanding PANS/PANDAS and AE can help improve outcomes for affected children and promote better access to care.

Why Understanding PANS/PANDAS is Important

 

    • You may have an afflicted child.
    • We desperately need more people to know what PANS/PANDAS/AE is 
    • We desperately need more treatment providers.
    • It is on the rise
    • 1 out of 150 – 200 children have it
    • It is frequently misdiagnosed as ODD (Oppositional Defiant Disorder), ADHD (Attention-Deficit/Hyperactivity Disorder), Obsessive-Compulsive Disorder (OCD), Tic Disorder, Depression, etc.
    • It is treatable 
Obsessive Compulsive Disorder in Children

What is Autoimmune Encepathology (AE)? 

 

Autoimmune Encephalopathy (AE) is a form of brain inflammation that occurs when the body's immune system mistakenly attacks its healthy cells and tissues in the brain or nervous system, leading to physical and mental health changes.

AE's neuropsychiatric and neurocognitive symptoms can vary from person to person but often significantly impact their daily life, including at school, home, work, or in relationships.

Ruling out tumors, seizures, PANS/PANDAS, and other physical and mental health issues are essential in diagnosing AE. Therefore, testing often involves nuclear imaging, such as an MRI, blood work, and a spinal tap. 

PANS/PANDAS, AE, and ODD

 

When it comes to PANS, PANDAS, and AE, it can be challenging to distinguish between oppositional behaviors and symptoms of these disorders. For example, infections and toxins can trigger dysregulated behaviors, which can be mistaken for oppositional defiant Disorder (ODD). 

However, in my 30 years of clinical experience, I have never seen oppositional behaviors occur without an underlying cause. Therefore, parents should be wary of accepting a diagnosis of ODD without exploring potential underlying factors. PANS/PANDAS and AE should always be considered due to their behavioral similarities.

Common reasons for PANS/PANDAS restrictive eating - Dr. Roseann Capanna-Hodge
PANS and PANDAS Diagnosis - Roseann Capanna-Hodge

PANS/PANDAS and Autism

 

Growing evidence suggests a possible link between Lyme Disease, Autism, and susceptibility to infectious diseases. Research estimates that up to 30% of individuals with Autism also have PANS/PANDAS (Wood, et. al 2021), but detecting it in children with Autism can be challenging due to the already high behavioral issues associated with the disorder. In addition, post-mortem studies have found that over 70% of autistics have brain inflammation (Croonenberghs et al., 2002). 

 

In our office, we often come across children and teens with a dual diagnosis of PANS and Autism, which enables me to observe the correlation between the two conditions frequently. 

PANS/PANDAS and OCD

 

OCD stands for Obsessive-Compulsive Disorder, a mental health disorder characterized by repetitive, intrusive thoughts and behaviors. People with OCD may experience unwanted and distressing thoughts, images, or impulses they cannot control. 

As a result, they may feel compelled to engage in repetitive behaviors or mental acts to reduce anxiety or prevent harm. These behaviors can be time-consuming and interfere with daily activities, relationships, and overall quality of life. OCD can occur in children, adolescents, and adults and can be chronic if left untreated.

Although not all individuals with PANS or PANDAS exhibit Obsessive-Compulsive Disorder (OCD), there is a significant overlap between the two conditions, with many children with OCD also being diagnosed with PANS/PANDAS and vice versa. 

While the onset of symptoms can be abrupt for some, anxiety-related indicators may appear before OCD symptoms become more pronounced, reflecting the internalizing aspects of the disorder.

With our increased understanding of the impact of infectious disease on the brain, we now recognize that both pediatric acute onset and adult onset of OCD or other neuropsychiatric symptoms can be associated with PANS/PANDAS.

PANDAS and PANS can lead to an abrupt onset of intense OCD symptoms and alterations in a child's behavior, cognition, and motor functions.

Signs of Acute Onset OCD

 

    • OCD symptoms start almost overnight 
    • Displays restricted eating
    • Displays fears about eating
    • Repetitive questioning
    • Frequent urination
    • Begins bed wetting
    • Displays motor or handwriting issues
    • Irritable or angry behaviors are present 
    • Emotional lability
    • Sensory sensitivity 
    • Generalized anxiety
    • Separation anxiety
    • Panic attacks
    • Suicidal thoughts
    • Sleep problems 
    • History of infections or illness

PANS and Long Haulers COVID 

 

Long haulers and PANS are both conditions that result from an infection and can cause lingering neuropsychiatric symptoms. However, they differ in their infectious sources, with PANS resulting from a misdirected immune response and long COVID resulting from COVID-19 infection.

Long COVID, also known as long haulers, refers to the persistence or emergence of new symptoms that occur three months after the initial SARS-CoV-2 infection and last for at least two months without a clear explanation. Some of the common symptoms associated with long COVID include chronic fatigue, shortness of breath, and cognitive or memory dysfunction.

PANS and PANDAS are pediatric autoimmune neuropsychiatric disorders that can result from any infection, including the coronavirus infection. Symptoms of these conditions overlap with long COVID due to the inflammation's impact on the brain, including OCD, separation anxiety, mood changes, and attention problems.

The underlying biology of both long COVID and PANS is associated with inflammation in the brain. Long haulers with COVID-19 exhibit high levels of a cytokine called interleukin-6, indicating the possibility of chronic inflammation. 

However, some research subjects show persistent low-level inflammation. In PANS/PANDAS, the basal ganglia in the brain is mistakenly targeted by the immune system, leading to neurocognitive and neuropsychiatric symptoms (Croonenberghs et al., 2002).

Access to care is problematic for children and teens with PANS and PANDAS, with the reported lag between the onset of symptoms and age at diagnosis ranging from 0.8 to 4.7 years. With such misinformation about PANS and so few trained providers, getting the proper help to address psychiatric and neurocognitive symptoms is even more challenging.

Recognizing the similarities and differences between long haulers and PANS is essential to ensure proper diagnosis and treatment for those experiencing neurocognitive and neuropsychiatric symptoms after infection. In addition, education and access to care for these conditions are crucial to improving outcomes for those affected.

How Do You Treat PANS/PANDAS and AE?

 

There are many triggers for PANS, PANDAS, and AE, but Lyme Disease and Tick-borne infection are among the most common sources. I have supported hundreds of kids and adults affected by tick-borne illness for over two decades. It is an awful disease because of medical and mental health providers' ignorance in identifying and treating it.

As a specialist in PANS, PANDAS, AE, and Lyme, we use science-backed natural solutions to regulate the nervous system so that the body can learn to reset and regulate. Calming the brain is an essential part of healing the brain and body.

Natural Remedies for PANS/PANDAS:

 

Using holistic health remedies for PANS/PANDAS is essential. We want to calm the brain and support the body's ability to address toxins and infections while maintaining a healthy microbiome. It is also vital to support detoxification so the body can excrete harmful toxins to the brain and body. 

  • Detoxification
  • Diet/Nutrition 
  • Essential oils 
  • Neurofeedback
  • PEMF
  • Homeopathy, herbs, supplements 
  • Psychotherapy and coaching
  • Exposure and Response Prevention (ERP for OCD)
  • EFT tapping
  • Family support/Lifestyle 

Neurofeedback for PANS and PANDAS 

 

Neurofeedback is a safe and effective tool designed to calm the nervous system, improve attention and cognitive functioning, and is often part of the treatment protocol. However, when it comes to PANS/PANDAS, it is essential to work with a highly skilled neurofeedback provider because it requires a tremendous amount of experience to understand how to regulate the brain of someone impacted by infection or toxins. 

A neurofeedback session involves computers giving visual and auditory feedback to the subconscious brain every time it gets into a healthy rhythm. Over time, the brain learns to stay healthy and regulated. When the brain is regulated, then behaviors reflect that.

Neurofeedback addresses dysfunction in brain structures, such as impulse control and executive functioning in the frontal lobes. It also gets the brain's online communication system so one can pay attention, calm racing thoughts, and not behaviorally overreact or under-react to stimuli. 

Neurofeedback impacts brain waves, influences neurotransmitter activity, and calms the nervous system so that a child can slow down enough to learn new ways of responding, which means emotional wellness and stability for the child and family. 

Neurofeedback is a powerful tool that addresses rigidity, rage, and emotional and behavioral reactivity. Alleviating the negative behaviors associated with PANS and PANDAS safely and effectively is paramount for healing and the whole family's mental health. 

Common PANS/PANDAS Issues Addressed with Neurofeedback: 

 

    • Agitation 
    • Anxiety
    • Attention 
    • Brain fog
    • Bed wetting
    • Chronic pain 
    • Eating disorder
    • Executive functioning
    • Impulse control
    • Learning, memory, and processing
    • Mood swings and emotional lability
    • Obsessions and compulsions
    • Rage and anger
    • Separation anxiety
    • Sleep disturbance
    • Tics
    • Withdrawn behaviors

Nutrition for PANS and PANDAS

 

Nutrition helps many mental health and behavioral conditions. However, navigating nutrition with PANS, PANDAS, and AE is a challenge that must be done carefully.

A glass of carrot juice on a wooden table.

Nutrition Improves the Microbiome

 

Diet strongly influences the microbiome, and consuming nutrient-rich foods is essential for promoting a healthy gut. A well-balanced diet can encourage beneficial microbiota in the gut, which can aid in immune system function, detoxification of harmful food compounds, and synthesis of critical vitamins and amino acids needed by the brain and nervous system. 

Conversely, an unhealthy microbiome, dysbiosis, has been linked to various health issues. For example, studies by Morita (2015) have found that gut dysbiosis is more prevalent in those with anorexia, a common symptom in PANS and PANDAS.

Nutrition Increases Cognitive Function

 

Studies show that a Mediterranean Diet and other anti-inflammatory diets high in antioxidants, omega-3 fatty acids, and B vitamins have been shown to improve brain functioning (Finelli, 2017). Logically, what you eat impacts your attention, memory, and processing, and the more nutrient-dense food you eat, the better your brain functions.

Nutrition Improves Mental and Behavioral Health

 

An anti-inflammatory diet, particularly the Mediterranean diet, has been found to reduce inflammation and alleviate anxiety and depression symptoms. In addition, consuming nutrient-dense foods and maintaining stable blood sugar levels can counteract mood and behavioral dysregulation and mitigate the impact of stress on the brain.

Foods such as vegetables, fruits, nuts, whole grains, and oily fish possess anti-inflammatory properties, which can influence the concentrations of brain chemicals that regulate emotions and cognition. Research suggests that individuals with more severe mental health issues tend to consume more pro-inflammatory foods (Haghighatdoost et al., 2019).

Nutrition Affects Neurotransmitter Function

 

It may be surprising to learn that one's diet can affect neurotransmitter function in a world where every commercial seems to be pushing a pill for this or that. However, diet can affect multiple brain processes by regulating neurotransmitter pathways, synaptic transmission, membrane fluidity, and signal-transduction pathways.

Nutrition Reduces Inflammation

 

Eating foods rich in polyphenols has been found to reduce inflammation, and reducing inflammation should be a part of all PANS/PANDAS treatment plans. Polyphenols are compounds in plant foods, such as fruits, vegetables, herbs, spices, tea, and dark chocolate.

Polyphenols exert their neuroprotective actions by protecting neurons against injury induced by neurotoxins, can suppress neuroinflammation, and have the potential to promote learning, cognitive function, and memory.

Anti-Inflammatory Diet for PANS/PANDAS

 

In my clinical experience of 30 years and supported by research, an anti-inflammatory diet is highly recommended for children with PANDAS and PANS (Johnson et al., 2021). A nutrient-rich diet helps heal the body and brain while reducing inflammation. In addition, such a clean diet supports blood sugar and promotes cognitive, mood, and behavioral regulation, which is crucial for kids with PANS, PANDAS, and AE.

Parents must tread carefully and get the proper support when navigating nutrition, especially when a child has food restrictions, aversions, or an eating disorder. It will be a long-term process but slow and steady is how you should tread and with guidance from a professional for any child with an eating disorder or OCD around food.

An Anti-Inflammatory Diet Encompasses:

 

  • Reduced or eliminated sugar, gluten, and dairy
  • Gluten-free grains (Brown rice, quinoa, sweet potatoes, potato, cassava, almond, tapioca, etc.)
  • Increased non-dairy protein (Chicken, beef, shellfish, fish, pork, lamb, pea protein, etc.) 
  • Healthy fats (avocado, nuts, eggs, bacon, salmon, humus, coconut oil, other oils) 
  • Variety of vegetables and fruits
Anti-inflammatory diet for PANS/PANDAS with Dr. Roseann Capanna-Hodge

Consistent protein and fat throughout the day help stabilize blood sugar, essential in mood and behavioral regulation. Often non-dairy protein shakes are the place to increase protein and nutrition while stabilizing blood sugar.

Magnesium for PANS/PANDAS

 

Magnesium is an essential nutrient critical in supporting optimal brain and body function. 

In the case of PANS/PANDAS, magnesium can be especially helpful in managing symptoms of OCD. 

Magnesium is a vital cofactor in more than 300 enzyme systems that regulate diverse biochemical and enzymatic reactions within the body. Many chemical functions are required to support the central nervous system in managing stress. 

For example, it synthesizes neurotransmitters crucial for proper brain function. Magnesium also plays an essential role in regulating the HPA axis, which controls the body's stress response system.

Studies suggest that magnesium can be effective in reducing symptoms of anxiety, OCD, and depression (Boyle et al., 2017). It inhibits the release of excitatory neurotransmitters and can increase feel-good brain chemicals such as serotonin. 

In addition, it is beneficial in calming down the excitatory neurotransmitters associated with OCD, which can cause the brain to get stuck in an intrusive thought loop. Calming down these neurotransmitters gives someone with OCD enough room to employ the tools they learn in Exposure and Response Prevention (ERP) therapy.

Magnesium deficiency can cause many symptoms, including stress or anxiety, poor sleep quality, fatigue and muscle weakness, poor appetite, nausea, muscle twitches and cramps, high blood pressure, and irregular heartbeat. 

With our stress-filled world, it is so easy to run low on magnesium because it is so needed to help other body functions. Testing your magnesium levels is always a good idea if you have any of these clinical issues. 

Magnesium supplements can be taken through dietary supplements, creams and sprays, bath salts, and magnesium-rich foods. It can be combined with other supplements, such as vitamin B6 for sleep and vitamin D for mental health issues such as ADHD and anxiety. 

A bottle of lemon oil is being poured onto a wooden table, harnessing the power of essential oils for stress and anxiety relief.

Essential Oils for PANS/PANDAS and OCD

 

PANS combined with OCD can be an extremely challenging condition to manage. However, essential oils help manage OCD symptoms. Essential oils can help the OCD brain by promoting relaxation, reducing stress, enhancing mood, and boosting cognitive function. 

For instance, essential oils like lavender and chamomile have calming properties that can help to reduce anxiety and promote relaxation, which can be particularly helpful for those with OCD who may experience high levels of stress and anxiety related to their compulsions or obsessions.

PEMF for PANS/PANDAS


Pulsed Electromagnetic Field Therapy (PEMF) is a non-invasive treatment that has been shown to benefit patients with comorbid conditions with PANS/PANDAS, such as OCD, anxiety, and depression. PEMF therapy involves applying low-frequency electromagnetic waves to the body to stimulate and enhance cellular functioning. 

As a result, PEMF therapy can help to reduce inflammation in the body, which is often a critical factor in PANS/PANDAS. Additionally, PEMF therapy has been shown to help regulate the immune system, which is often dysregulated in patients with PANS/PANDAS.

PEMF to Enhance Memory and Focus in ADHD Kids

PEMF therapy has also improved circulation and blood flow, which can benefit patients with PANS/PANDAS. Improved blood flow can help deliver vital nutrients and oxygen to the brain, which is essential for maintaining healthy brain function. 

In addition, PEMF therapy has also been shown to promote the regeneration and growth of nerve tissue, which can be helpful for patients with PANS/PANDAS who may experience neurological symptoms. CALM PEMFTM is a mobile device designed to help regulate the brain anywhere you go.

What to Do if Your Child has PANS/PANDAS

 

There's help and hope for children with PANS/PANDAS. Although PANS and PANDAS are complex disorders and often very challenging to get the best support possible, it will be okay.

Consider PANS and PANDAS if your child has an abrupt onset of tics, food restriction, or OCD. However, the sudden onset of psychiatric issues is not a common occurrence, and underlying medical conditions should be taken into consideration. 

The ideal thing to do is to seek out a PANS/PANDAS expert, but this is challenging, as experts are hard to find. In addition, there are many barriers to getting the right help for your child and building the right team is essential to helping your child recover.

You want to go to a national organization such as ASPIRE,  Epidemic Answers, and Pandas Physicians Network or find a provider with a lot of experience. You want a provider who knows what they are doing because the longer it is left untreated, the harder it becomes to treat it. 

It is recommended that you ask your child's doctor to conduct a rapid strep test and a blood culture. If the results are positive, most professionals agree that antibiotics should be administered.

Furthermore, if your child had infections such as the flu, mono, walking pneumonia, and others, it is recommended to conduct additional laboratory tests. Competent physicians typically conduct a Cunningham panel blood test to obtain more detailed information. 

If you or your child has a history of unexplained medical and mental health symptoms or hasn't gotten better with traditional therapies and psychotherapy, consider that infectious disease might be the source of their mental health issue. 

It is important to note that infectious disease takes many forms and that one may have a single illness. Still, the child is more likely to be affected by more than one infection, including strep, virus, other bacteria, or environmental contaminants such as mold.

The first step is to find a Lyme-literate medical or mental health professional for proper diagnosis and treatment. It would help if you also had support from like-minded parents who want to see their children thrive, and you can get that by joining our free Facebook community, Natural Parenting Solutions. 

Always follow your parent gut and keep searching until you find the root cause. 

To learn more about PANS/PANDAS, check out my book “Brain Under Attack.”

Case Study: Maya

 

Maya, a 14 yr-old-girl with a history of numerous infectious diseases, including Lyme, Bartonella, streptococcus, Epstein-Barr, and mold exposure. 

READ FULL CASE STUDY

Case Study: Ben

 

Ben is a 15 yr-old-boy who experienced the sudden onset of medical and mental health issues after having the COVID virus. 

READ FULL CASE STUDY

How Our BrainBehaviorReset™ Program Can Help

 

As parents, we want the best for our child and family. But dealing with PANS/PANDAS can be overwhelming. However, getting the right help can improve your child's mental health and overall well-being. 

In our BrainBehaviorReset™ Program, treatment for PANS and PANDAS involves treating the infection and toxin, reducing inflammation, and behavioral/psychological treatment. Integrative treatments should always be a part of the treatment plan. 

Without nervous system regulation, the body cannot heal itself; therefore, our kids with PANS, PANDAS, and AE are at an automatic disadvantage because they are agitated. Our trademarked BrainBehaviorReset™ program is designed to help children and families manage PANS/PANDAS effectively and improve their quality of life. 

When you are accepted into our program, you'll have access to expert guidance, tools, and strategies to help them overcome their anxiety and thrive in school. Your child can develop the necessary skills to manage challenges and get back on track with our support. 

Our center provides a comprehensive one-to-one BrainBehaviorReset™ Program for individuals with PANS/PANDAS. In addition, we offer both remote and in-person treatment options, focus on brain-based therapies, and provide support for parents. 

With years of experience, we have helped numerous families dealing with PANS and PANDAS. We are also dedicated to educating healthcare providers about these conditions and the importance of early identification and treatment. Early intervention is crucial for the best outcomes for children and teens with PANS/PANDAS.

So, don't let PANS/PANDAS hold your child about – take the first step towards a better future by applying to be in our BrainBehaviorReset™ program today.

Citations:

Boyle, N., Lawton, C., & Dye, L. (2017). The Effects of Magnesium Supplementation on Subjective Anxiety and Stress—A Systematic Review. Nutrients, 9(5), 429. https://doi.org/10.3390/nu9050429

Calaprice, D., Tona, J., Parker-Athill, E. C., & Murphy, T. K. (2017). A Survey of Pediatric Acute-Onset Neuropsychiatric Syndrome Characteristics and Course. Journal of Child and Adolescent Psychopharmacology, 27(7), 607–618. https://doi.org/10.1089/cap.2016.0105

Croonenberghs, J., Bosmans, E., Deboutte, D., Kenis, G., & Maes, M. (2002). Activation of the Inflammatory Response System in Autism. Neuropsychobiology, 45(1), 1–6. https://doi.org/10.1159/000048665

Finelli, C. (2017). The Mediterranean diet: an “evergreen” diet. Journal of Public Health and Emergency, 1, 54–54. https://doi.org/10.21037/jphe.2017.05.02

Haghighatdoost, F., Feizi, A., Esmaillzadeh, A., Feinle-Bisset, C., Keshteli, A. H., Afshar, H., & Adibi, P. (2019). Association between the dietary inflammatory index and common mental health disorders profile scores. Clinical Nutrition, 38(4), 1643–1650. https://doi.org/10.1016/j.clnu.2018.08.016

Jaspers-Fayer, F., Han, S. H. J., Chan, E., McKenney, K., Simpson, A., Boyle, A., Ellwyn, R., & Stewart, S. E. (2017). Prevalence of Acute-Onset Subtypes in Pediatric Obsessive-Compulsive Disorder. Journal of Child and Adolescent Psychopharmacology, 27(4), 332–341. https://doi.org/10.1089/cap.2016.0031

Johnson, M., Ehlers, S., Fernell, E., Hajjari, P., Wartenberg, C., & Wallerstedt, S. M. (2021). Anti-inflammatory, antibacterial and immunomodulatory treatment in children with symptoms corresponding to the research condition PANS (Pediatric Acute-onset Neuropsychiatric Syndrome): A systematic review. PLOS ONE, 16(7), e0253844. https://doi.org/10.1371/journal.pone.0253844

Lassale, C., Batty, G. D., Baghdadli, A., Jacka, F., Sánchez-Villegas, A., Kivimäki, M., & Akbaraly, T. (2019). Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies. Molecular Psychiatry, 24(7), 965–986. https://doi.org/10.1038/s41380-018-0237-8

Marazziti, D., Mucci, F., & Fontenelle, L. F. (2018). Immune system and obsessive-compulsive disorder. Psychoneuroendocrinology, 93, 39–44. https://doi.org/10.1016/j.psyneuen.2018.04.013

Maria Rickert Hong. (2018). Brain Under Attack. Answers Publications.Messmer, K. (2019). Art and Play Therapy for Children with Anxiety. Undergraduate Honors College Theses 2016-. https://digitalcommons.liu.edu/post_honors_theses/73/

Mirfazeli, F. S., Sarabi-Jamab, A., Jahanbakhshi, A., Kordi, A., Javadnia, P., Shariat, S. V., Aloosh, O., Almasi-Dooghaee, M., & Faiz, S. H. R. (2020). Neuropsychiatric manifestations of COVID-19 can be clustered in three distinct symptom categories. Scientific Reports, 10(1). https://doi.org/10.1038/s41598-020-78050-6

NIMH» PANDAS—Questions and Answers. (2019). Www.nimh.nih.gov. https://www.nimh.nih.gov/health/publications/pandas

Nunn, A. V. W., Guy, G. W., Brysch, W., & Bell, J. D. (2022). Understanding Long COVID; Mitochondrial Health and Adaptation—Old Pathways, New Problems. Biomedicines, 10(12), 3113. https://doi.org/10.3390/biomedicines10123113

Parletta, N., Milte, C. M., & Meyer, B. J. (2013). Nutritional modulation of cognitive function and mental health. The Journal of Nutritional Biochemistry, 24(5), 725–743. https://doi.org/10.1016/j.jnutbio.2013.01.002

Quagliariello, A., Del Chierico, F., Russo, A., Reddel, S., Conte, G., Lopetuso, L. R., Ianiro, G., Dallapiccola, B., Cardona, F., Gasbarrini, A., & Putignani, L. (2018). Gut Microbiota Profiling and Gut-Brain Crosstalk in Children Affected by Pediatric Acute-Onset Neuropsychiatric Syndrome and Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections. Frontiers in Microbiology, 9, 675. https://doi.org/10.3389/fmicb.2018.00675

Wood, J. N., Wood, A., & Murdick, N. L. (2021). Is It PANDAS/PANS or Is It Autism?. DADD Online, 178. 

Disclaimer: This article is not intended to give health advice and it is recommended to consult with a physician before beginning any new wellness regime. *The effectiveness of diagnosis and treatment vary by patient and condition. Dr. Roseann Capanna-Hodge, LLC does not guarantee certain results.

Always remember… “Calm Brain, Happy Family™”

Are you looking for SOLUTIONS for your struggling child or teen? 

Dr. Roseann and her team are all about solutions, so you are in the right place! 

There are 3 ways to work with Dr. Roseann: 

 

You can get her books for parents and professionals, including: It’s Gonna Be OK™: Proven Ways to Improve Your Child’s Mental Health, Teletherapy Toolkit™ and Brain Under Attack: A Resource For Parents and Caregivers of Children With PANS, PANDAS, and Autoimmune Encephalopathy.

If you are a business or organization that needs proactive guidance to support employee mental health or an organization looking for a brand representative, check out Dr. Roseann’s media page and professional speaking page to see how we can work together. 

 

Dr. Roseann is a Children’s Mental Health Expert and Therapist who has been featured in/on hundreds of  media outlets including, CBS, NBC, FOX News, PIX11 NYC, The New York Times, The Washington Post,, Business Insider, USA Today, CNET, Marth Stewart, and PARENTS. FORBES called her, “A thought leader in children’s mental health.” 

She is the founder and director of The Global Institute of Children’s Mental Health and Dr. Roseann Capanna-Hodge. Dr. Roseann is a Board Certified Neurofeedback (BCN) Practitioner, a Board Member of the Northeast Region Biofeedback Society (NRBS), Certified Integrative Medicine Mental Health Provider (CMHIMP) and an Amen Clinic Certified Brain Health Coach.  She is also a member of The International Lyme Disease and Associated Disease Society (ILADS), The American Psychological Association (APA), Anxiety and Depression Association of America (ADAA) National Association of School Psychologists (NASP), International OCD Foundation (IOCDF) International Society for Neurofeedback and Research (ISNR) and The Association of Applied Psychophysiology and Biofeedback (AAPB).

© Roseann-Capanna-Hodge, LLC 2022

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147 Therapist-Endorsed

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147 therapist endorsed self-regulation strategies for children a practical guide for parents