Expanding our Understanding of PANDAS and Introducing PANS: Microbe Influenced Immune-Behavior Dysfunction
March 6, 2012 9 Comments
For years many of use have been frustrated by a symptom cluster that looks for all intents to be PANDAS (see prior posts on this blog) and yet where there was NO streptococcus relationship. I recall a conversation with Dr. Sue Swedo, from NIMH several years ago. Dr. Swedo was instrumental in framing our understanding of strep bacteria causing OCD behaviors. At that meeting I asked her if they had data that other microbes caused PANDAS- like symptoms. She was clear at that time that they had very little data to support other microbes in PANDAS. I have known Dr Swedo for a long time and always respected her willingness to buck the status quo. She is a good clinician and a thoughtful researcher.
Clinically however, it was obvious something other than strep was causing strep-like PANDAS symptoms. Enter now a new syndrome which fills that gap, PANS (Pediatric Acute-onset Neuropsychiatric Syndrome). Just published is this article abstracted below.
Here are the accepted PANDAS criteria.
Here is what Dr. Swedo and colleagues from NIMH are proposing for PANS.
More importantly Swedo and colleagues paint a picture very similar to the historical and landmark observations of Dr. Doris Rapp. Over a decade ago my foundation gave Doris (a longtime friend of mine) money to convert her archive of videos recording allergy reactions over to DVD to preserve her observations. Please see: http://www.drrapp.com/
In Dr. Rapp’s work she observed allergies doing the same things that Dr. Swedo is now observing and calling PANS. Let’s compare this from Swedo’s publication –
to what Doris Rapp MD presented two decades ago as reactions to a large variety of allergens and environmental exposures.
From: Is This Your Child? Doris Rapp, M.D. 1992
And furthering this parallel of observations between the two presentations evaluate these observations of allergy and PANS:
Swedo, et al 2012.
In the Rapp example you can see food rapidly makes Andy crash and look also at the mood and behavioral changes demonstrated in his writing and drawings. Now go back and re-read the PANS category II criteria.
So I feel comfortable with the idea that in certain children, their brain is highly responsive and inappropriately reactive to minor immunological stimuli.
Think about how this influences your child and then I will talk more about this in a separate post.