Neuropsychiatric symptoms

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection) and PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) are described as presenting with an acute onset of OCD (obsessive-compulsive disorder) and/or motor tics in children with a recent infection. The disorders include neurological symptoms that may be presented as tics, dyskinesia, hyperactivity, obsessions and compulsions. The OCD and tic symptoms are accompanied by a variety of neuropsychiatric symptoms, including separation anxiety, “anxiety attacks,” irritability, extreme mood swings, temper tantrums, and immature behaviours, hyperactivity, problems with attention and concentration, handwriting changes, and problems with school subjects.

Molecular mimicry

The streptococcal bacteria is an organism which survives in its human host by hiding from the immune system as long as possible, by “molecular mimicry”. The molecules on the streptococcal bacteria are eventually recognized as foreign and the child’s immune system reacts to them by producing antibodies. Because of the molecular mimicry, the antibodies react not only with the streptococcal molecules, but also with the human host molecules that are mimicked. This reaction can be in the child’s heart and cause carditis, or tissues in the brain (particularly the basal ganglia) and cause Sydenham chorea. In 2010 it was clear that while streptococcal throat seems to be a trigger, it may not be the only trigger. Sudden onset OCD could be triggered by other infections, including Lyme, Mono, Mycoplasma and the flu virus (such as H1N1). Based on this and other clinical reports, the panel modified the research definition of PANDAS to PANS. Studies show that some cross-reactive “anti-brain” antibodies don’t produce full-blown Sydenham chorea, but instead cause OCD, tics, and the other neuropsychiatric symptoms of PANDAS.


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