As a Naturopathic Doctor that sees many patients with PANDAS/PANS, I often get parents inquiring about what can be done for their child naturally and if it can be combined with what is being done by their pediatrician.

Let start with some general info in case you’re at the start of your journey and need some background info.

What is PANDAS/PANS?

According to the National Institute of Mental Health, PANDAS is short for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. A child may be diagnosed with PANDAS when:

• Obsessive-compulsive disorder (OCD), tic disorder, or both suddenly appear following a streptococcal (strep) infection, such as strep throat or scarlet fever.
• The symptoms of OCD or tic symptoms suddenly become worse following a strep infection.

The symptoms are usually dramatic, happen “overnight and out of the blue,” and can include motor or vocal tics or both and obsessions, compulsions, or both. In addition to these symptoms, children may become moody or irritable, experience anxiety attacks, or show concerns about separating from parents or loved ones.

The diagnostic criteria for PANDAS includes:

• Presence of OCD, a tic disorder, or both
• Pediatric onset of symptoms (i.e., age 3 to puberty)
• Episodic course of symptom severity (see information below)
• Association with group A Beta-hemolytic strep infection, such as a positive throat culture for strep or history of scarlet fever
• Association with neurological abnormalities, such as physical hyperactivity or unusual, jerky movements that are not in the child’s control
• Very abrupt onset or worsening of symptoms

Symptoms may be very episodic, changing form one day or week to the next. Some other symptoms may include:

• Symptoms of attention-deficit/hyperactivity disorder (ADHD), such as hyperactivity, inattention, or fidgeting
• Separation anxiety (e.g., child is “clingy” and has difficulty separating from his or her caregivers; for example, the child may not want to be in a different room in the house from his or her parents)
• Mood changes, such as irritability, sadness, or emotional lability (i.e., tendency to laugh or cry unexpectedly at what might seem the wrong moment)
• Trouble sleeping
• Night-time bed-wetting, frequent daytime urination, or both
• Changes in motor skills, such as changes in handwriting
• Joint pains

What testing should be done for assessment purposes:

Basics:

• IgA
• IgM
• IgG (subclass 1,2,3,4)
• Vitamin D
• Vitamin B12
• CBC
• ANA
• Ferritin

Vital/Bacterial Testing:

• Anti-streptolysin O (ASO)
• Anti DNase B
• Streptozyme
• Lyme and co-infections
• Mycoplasma pneumonia IgA &  IgM
• Pneumococcal Antibody titres
• EBV
• Coxsackie A & B Titres
• HHV-6 Titres

Other:

• Cunningham Panel

Some traditional treatments available from your pediatrician include:

• antibiotics such as azithromycin, penicillin, cephalosporin’s
• IVIG
• plasmapheresis
• steroids
• cognitive behavioural therapy

So now let’s get into my role as an ND, and how I can support your journey.

People are at very different stages of their journey and many times they have a hard time finding anyone to offer support. PANDAS is NOT a widely recognized condition amongst the traditional medicine community, perhaps because it is more of a newly diagnosable condition and many are not aware, and therefore not often open to offering support due to their ignorance in this area of medicine. More often than not this is the situation and I get many inquiries from parents hoping to get all of the answers.

As an ND, I can help navigate these muddy waters and often  start by getting some of the testing ordered, especially the tests that may be more difficult to get from your medical doctor such as Lyme and co-infections.

Natural ways to support your child with PANDAS/PANS

1. Start with diet – ensuring that your child is eating a whole foods, clean diet is very important. We know there are certain foods, and food groups that can lead to increased neuro-inflammation, meaning activation of the brains immune system in response to an inflammatory challenge. By reducing and replacing foods that may be inflammatory, we are reducing the chance of neuro-inflammation at a foundational level. I frequently start with a gluten free, dairy free diet, and make further adjustments based on the child’s specific needs (such as food sensitivities).
2. Supporting the body’s detoxification process – a functioning detoxification process is very important to supporting a child with PANDAS. Detoxification is what allows the body to ‘get rid of’ whatever is affecting the body, whether it be infectious (strep, staph, Lyme, EBV, etc), toxic such as heavy metals or mold, or even inflammatory like from food sensitivities.

Methylation is an essential process in almost all of our bodies systems, it is responsible for DNA repair, hormone regulation, energy production, and supports many systems such as the immune and nervous system. Methylation provides the body with the basics for proper detoxification such as folate and B12 metabolism, as well, there are many cofactors required for proper detox such as vitamin B6 and magnesium. The detox pathway, supported by glutathione production,  is a key pathway in helping the body recover from an infection associated with PANDAS.

• Treat the infection – many people opt to use antibiotics for the treatment of PANDAS.  I am not opposed to this but also like my patients to know that treatment with natural antimicrobials/antibacterials such as berberine and neem can be just as effective, and often times the patient may not have a positive response to the traditional antibiotics and have to use the natural form anyways.

Digestive health always has to be supported, especially is using traditional antibiotics or even natural antimicrobials.

• Symptomatic relief – depending on which symptoms are of most concern…tics, sleep, behavioural outburst, mood, certain supplements can be very effective in helping relieve some symptoms while the root cause is being treated.

For more information on helping support your child with PANDAS/PANS naturally as well as testing and dietary support please contact Dr. Danielle O’Connor ND.

To get started immediately on a 7-day gluten free, dairy-free diet, find a meal plan HERE.

References:

1. National Institute of Mental Health. PANDAS. https://www.nimh.nih.gov/health/publications/pandas
2. PANDAS Network. https://pandasnetwork.org/