The onset of PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections) is influenced by an interplay of various factors, making it a challenging condition to fully understand and manage. These factors exacerbate the symptoms and contribute to the unpredictable nature of flare-ups. That's why there's a need for us to have a comprehensive understanding and a holistic approach when it comes to dealing with PANS/PANDAS and providing support for our children.
In this episode, we’ll dive deep into uncovering the causes behind PANS/PANDAS onset and trigger flares. By exploring these underlying factors, we can better equip ourselves to recognize, address, and manage PANS and PANDAS more holistically. This will help us develop a deeper understanding of the condition and enhance our ability to support our children.
Common Causes of PANS and PANDAS
PANS stands for Pediatric Acute-Onset Neuropsychiatric Syndrome, whereas PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep. Both conditions involve a trigger, whether it's an infection, toxin, or autoimmune response, that leads to neuroinflammation and other symptoms. For PANDAS, it's specifically strep, while PANS can be triggered by a variety of infections, such as COVID, Epstein-Barr, or tick-borne diseases. The key is that these triggers provoke a misdirected immune response, which causes the body to attack itself and affect the brain. There are many factors contributing to the onset and flare-ups of PANS and PANDAS but what we do know for sure is that both conditions involve neuroinflammation and a sudden onset of symptoms.
PANS can affect not just children, but adults as well, though it’s most commonly diagnosed in kids. Infections, tick-borne diseases, Epstein-Barr, the flu, and even common viruses like herpes or coxsackie are all known triggers. And for some children, even a seemingly mild infection can set off a tipping point, resulting in the onset or flare of symptoms, including neuropsychiatric and neurocognitive issues. Understanding that a multi-pronged approach, which includes regulating the nervous system, reducing inflammation, and offering additional layers of support, is essential to helping kids recover.
If you haven't already, I recommend watching my “Five-Pronged Approach to PANS and PANDAS” video, which goes into more detail on this. So if you’re noticing unexpected changes in your child’s behavior, take a step back and consider if an infection or toxin might be the hidden trigger. And remember, symptoms don’t always show up immediately—they can develop over time, even if the initial infection didn’t seem like a big deal.
Environmental and Immune System Triggers
Environmental factors and immune system dysfunction, combined with infections and other stressors, can cause PANS and PANDAS to develop or flare. Inflammation within the body can build up over time, and when trying to connect the dots, it's clear that several factors contribute to the onset of PANS and PANDAS. Infections are often the top reason, but genetics, environmental triggers, and immune system dysregulation also play crucial roles. Environmental factors like mold, toxins, and allergens can trigger the same misdirected immune response that leads to neuroinflammation.
I've seen children develop PANS after a severe allergic reaction, and mold is often a key trigger—either exacerbating an existing condition or causing flares. In extreme cases, mold exposure alone has triggered PANS. While mold can be present in up to 50% of homes, its effects vary. Some people are more sensitive than others, and multiple factors can amplify the risk. Immune system dysregulation is another common trigger. When the immune system is either overactive or poorly regulated, it can lead to inflammation. This can stem from genetics, compounded illnesses, stress, or poor diet. Nutrient deficiencies, restrictive eating, and poor food quality further contribute to immune system imbalances, making the body more susceptible to triggers.
Nervous System Dysregulation and Physical Injuries
Nervous system dysregulation and physical injuries can both contribute to the onset and flare-ups of PANS and PANDAS. The body's need for essential nutrients, like magnesium, vitamin D, and vitamin C, is crucial for maintaining physical and brain functions. Without these nutrients, the immune system can become dysregulated, leading to issues like adrenal burnout, which can increase the risk of developing PANS. Chronic stress and trauma are major contributors to nervous system dysregulation. When the nervous system is stuck in a state of constant activation, the body’s resources are diverted to defend against stressors, leaving the immune system vulnerable and preventing healing. This constant activation can be a tipping point for the onset of PANS or PANDAS.
The field of psychoimmunology studies how stress impacts the immune system, showing that a chronically activated nervous system hinders the body’s ability to heal. A key solution is moving the nervous system back to a calm, parasympathetic state. There are various techniques to achieve this, and calming the nervous system can help prevent or manage the effects of PANS and PANDAS. Physical injuries, especially head trauma, can also trigger PANS. When the blood-brain barrier is compromised due to injury, toxins and infections in the body can flood into the brain, potentially triggering neuroinflammation. This is particularly true in cases of tick-borne illnesses, which can remain hidden in the body for years, only becoming problematic when the brain is vulnerable after an injury. These connections between physical trauma and PANS highlight the importance of addressing both nervous system health and physical well-being in managing the condition.
Triggers for Flares and Managing Symptoms
Understanding the triggers for PANS and PANDAS flares is essential for managing symptoms, whether they involve OCD, attention issues, or mood disturbances. Identifying these triggers gives hope because it empowers families to take proactive steps in reducing flare-ups and improving their child's overall well-being.
Recurrent infections are a major trigger, especially when infections are not fully treated or when new infections arise. Incomplete treatment can also cause flares, as stopping treatment prematurely may prevent full recovery, leading to a flare-up later on. It's vital to follow through with treatment plans and consult with a reliable provider to monitor progress, looking for small, incremental changes along the way. Stress and nervous system overload are also significant flare triggers. Stress can destabilize individuals with PANS/PANDAS, sometimes leading to behaviors similar to those triggered by infections. Actively managing and countering stress is crucial, as is regulating the nervous system and developing coping skills to handle stress effectively.
Physical injuries, such as head trauma, can also trigger flares. While not all falls will cause a flare, it's essential to have any head injury assessed by a medical professional. Neurofeedback has proven beneficial in managing concussions and head injuries. For those with a history of head injuries, it’s important to consider whether these might be contributing to recurring flare cycles, even if the injury was some time ago.
Dietary and Nutritional Deficiencies
Dietary and nutritional deficiencies are major contributors to PANS and PANDAS flares. Nutrients are essential when dealing with these conditions, and while it may be challenging, especially for children with restrictive eating or eating disorders, it's important to ensure they receive adequate nutrition.
Supplements, bone broth, smoothies, and other creative strategies can help meet nutritional needs. In addition to deficiencies, the wrong foods, especially inflammatory ones like wheat, dairy, and sugar, can exacerbate symptoms. Wheat, in particular, is often contaminated with glyphosate, a harmful pesticide, which can trigger flares.
Managing food allergies and sensitivities is critical in addressing these triggers. Environmental toxins, such as mold, cleaning products, and synthetic materials like polyester and plastics, can also contribute to flares. Hormonal changes, which can either trigger or help manage symptoms, may also play a role. While hormonal shifts can bring challenges, they can also lead to improvements as children mature and develop better self-regulation.
To manage and identify these triggers, tracking patterns is essential. Rather than focusing on daily fluctuations, it's helpful to note patterns over the course of a week or more. This allows you to link flares to potential triggers, such as infections or environmental allergens, even when symptoms aren't immediately obvious. Identifying and understanding these patterns can lead to more effective management of the condition.
By being proactive, tracking patterns, and incorporating healthy habits such as proper nutrition, hydration, and detoxification, families can effectively reduce flare severity and improve overall well-being. And while testing can provide insights, ongoing support, consistency, and tailored strategies are essential for long-term improvement. When the appropriate treatment is applied at the right time, many children can regain stability and find relief.
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