What’s the Difference Between PANDAS and PANS?

I’ve walked this road with countless families, and I know how confusing it can be to figure out whether your child’s struggles are PANS, PANDAS, or something else entirely. The acronyms alone can make your head spin, right? But here’s the deal: these aren’t just random diagnoses—they’re conditions that explain why your child is struggling.

“Are PANS and PANDAS the same thing?” It’s a common question—and understandably so. While PANS, and PANDAS share overlapping symptoms, they’re distinct conditions. Let me break it down in a way that’s easy to understand:

What are PANS and PANDAS?

• PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome): This condition involves a sudden onset of symptoms like OCD, anxiety, or eating restrictions, often triggered by infections, inflammation, or toxins affecting the immune system. It is a type of pediatric autoimmune neuropsychiatric disorder.
• PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections): A specific subset of PANS caused by Group A strep bacteria, leading to sudden neuropsychiatric symptoms such as OCD or tics. The sudden onset of OCD symptoms is a key diagnostic factor.

Key Differences Between PANS, PANDAS, and AE:

PANDAS: Always linked to strep infections, with a typical onset before puberty. Families with a history of autoimmune diseases, including rheumatic fever, may have higher rates of OCD and tic disorders.

PANS: Can result from various infections or triggers and may affect children at any age.

AE (Autoimmune Encephalopathy): Often gradual in onset and linked to broader brain inflammation, rather than a single event.

The Role Of Streptococcal Infections In Pediatric Autoimmune Neuropsychiatric Disorders

Streptococcal infections play a critical role in triggering Pediatric Autoimmune Neuropsychiatric Disorders (PANDAS) by causing an immune system response that mistakenly attacks healthy brain tissues. This immune reaction, spurred by a strep infection, leads to sudden onset neuropsychiatric symptoms such as obsessive-compulsive behaviors, tics, and emotional dysregulation in children. If you notice a significant change in your child's behavior, this could potentially be one of the underlying reasons.

Paul's Story

Paul was a teenager struggling with ADHD, executive functioning issues, and anxiety over his two siblings diagnosed with PANS, Lyme Disease, and tick-borne illness. His one brother was so behaviorally dysregulated that his needs dominated the family. His brother’s rages that led him to go in and out of the hospital had Paul and his family on edge. Paul’s mom, Jane, said, “We were a hot mess.”

Once Paul’s siblings got treatment for their infection, calmed their brain with neurofeedback, and the whole family did therapy to address the trauma of their years-long hell, it became apparent that Paul was stuck too. He was depressed, totally unmotivated, and just lying in his bed for days at a time. Despite trying a lot of interventions, Paul wasn’t shifting like the rest of his family.

The question was whether Paul was depressed from all he had endured after being the “functional” one in the family or if he had PANS, PANDAS, or AE.

Jane wanted Paul to come in after her boys’ success with a QEEG brain map and neurofeedback. Given that the QEEG brain map is an unbelievable diagnostic tool, I could see that Paul showed signs of inflammation and infection in his brain with clear patterning of depression and anxiety.

Despite a clinical diagnosis of ADHD, he didn’t have ADHD or even meet the clinical criteria, as the onset of neurological symptoms didn’t appear until he was a teen. His attention and executive functioning were impaired not because of clinical ADHD but because of inflammation in his brain, anxiety, and depression.

When we made a thorough clinical history, we found that Paul was treated for Bartonella and Lyme, and at that time, he had a sudden onset of ADHD symptoms, sensory issues, restricted eating, and urinary symptoms. His behavior was so mild compared to his siblings that they didn’t see him as having PANS and all, the focus issues disappeared with antibiotics.

We got Paul to a naturopathic physician to run lab work, address his infections, and replace nutrients, and he began our BrainBehaviorReset™ Program to calm his brain and get more alert. Antibiotic treatment was crucial in against other infections and addressing his symptoms, leading to significant improvement. We focused on science-backed natural remedies for his nervous system to get regulated so he could think, pay attention, and take action.

It is hard to describe how special Paul is and how much he found his stride when we calmed his brain, helped his body detoxify, and changed his diet. He said, “I didn’t know I could ever feel so happy.”

How are PANDAS and PANS the same?

Children with PANS and PANDAS share many of the same symptoms. The main 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. Additionally, there is often a sudden onset of neurological and psychiatric symptoms too.

The three clinical conditions have overlapping symptoms and comorbid conditions. Studies show that patients and their families also have a high rate of medical issues and illnesses, including frequent and chronic infections, allergies, frequent sore throats, ear infections, headaches, chemical sensitivity, urinary frequency, and many other issues (Calaprice et al., 2017). Sleep disturbances are also common.

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

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

Both PANS / PANDAS and AE s significantly impact daily functioning at school, work, school performance, home, family, relationships, or some aspect of their life.

Flares, or an uptick in symptoms, often occur in all three, triggered by illness, infection, toxins, stress, fatigue, and diet.