A typical “textbook” PANS case is a 6-year-old child diagnosed with strep throat. The physician treated the child with antibiotics, then a few weeks later, the child’s behavior rapidly changes.
The child suddenly exhibits facial blinking and creating humming sounds. They visibly show separation anxiety, exhibit proactive phobic avoidance of school, and experiences sleep problems.
A child with an acute-onset of neuropsychiatric symptoms could indicate a more significant problem. Pediatric acute-onset neuropsychiatric syndrome, commonly referred to as PANS. The underlying infections or co-infections remain untreated in the exampled “textbook” case.
PANS (or PANDAS) patients experience inflammatory processes that require simultaneous treatments to decrease suffering and improve disease intervention. Treatment depends on the child’s presentation – acute or chronic stage of illness.
PANS: Stage 1
The first stage of PANS involves an immune system communication messenger known as a cytokine. Cytokines are a large family of molecules that present as peptides, proteins, or glycoproteins. This phase typically includes a fever-like response due to increased immune system activity.
The cytokine helps the immune system regulate inflammation and infection. As a messenger, it also sends a signal to other cells that an immune response is needed. Generally, when a cell releases cytokines, the message sent indicates that the cell needs help. However, cytokines can also signal support for nearby cells and sometimes distant cells.
The cytokine message tells a cell to upregulate or downregulate its function. This regulation may lead to the formation of more cytokines or suppress the cytokine effect. Cytokines define the intensity and duration of the immune system’s response.
Most behavioral episodes are exhibited during this stage. If incidents can be linked back to the infection and have clear triggers, it usually means the child has been had PANS for a few months.
PANS: Stage 2
If a child reaches stage two, it usually means the child has had PANS for years and is in the auto-inflammatory phase. Signs of the second stage are two-fold: antibodies no longer work, and it’s harder to link behavioral episodes to infection.
Additionally, new issues develop. The body could produce new autoantibodies, and the child tests positive for antinuclear antibodies (ANA) or anti-thyroid. The immune system makes ANAs when the body cannot identify the difference between itself, pathogens, or invaders. These autoantibodies attack healthy cells, particularly the nucleus of a cell, causing inflammation.
PANS: Stage 3
PANS is now harder to reverse.
At this point, it has been a few years since the initial infection. It becomes more difficult to associate symptoms with a disease, and autoantibodies are in their dominant phase.
Antibiotics used to work, but now they have stopped working, and infections exacerbate issues.
PANS: Stage 4
PANS is irreversible.
The autoantibodies have been at work for at least a few years targeting the basal ganglia and thalamus. In the brain, the basal ganglia connect to the cerebral cortex, brainstem, and thalamus controlling voluntary motor movements, routine behaviors, and learning. The thalamus relays the signals for motor movements to the cerebral cortex and responsible for regulating sleep and alertness.
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