Medical Condition

The recognition of PANS has significant implications for pediatric neuropsychiatric care. It underscores the importance of considering immune-mediated mechanisms in acute-onset psychiatric presentations and highlights the need for interdisciplinary collaboration in diagnosis and treatment. Increased awareness and research into PANS can lead to improved outcomes for affected children and their families.

PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) is characterized by the sudden onset of obsessive-compulsive behaviors and/or severely restricted food intake, accompanied by concurrent symptoms from at least 2 categories: (1) anxiety, (2) emotional dysregulation, (3) irritability, aggression, and/or oppositional behaviors, (4) behavioral regression, (5) academic deterioration, (6) motor/sensory abnormalities, and (7) somatic abnormalities The onset is typically abrupt, with symptoms developing over 24 to 48 hours. The severity of symptoms range from mild to severe/life threatening.

The exact prevalence of PANS is unknown. However, studies suggest that a subset of children with sudden-onset OCD or eating restrictions may meet criteria for PANS. Genetic predisposition is suspected.

Beyond OCD and eating restrictions, PANS presents with a range of neuropsychiatric symptoms. These can include mood swings, anxiety, irritability, aggression, developmental regression, sensory or motor abnormalities, sleep disturbances, urinary symptoms, and academic decline. The acute onset and severity of these symptoms can significantly impair a child’s functioning and quality of life.

The pathogenesis of PANS is thought to involve an autoimmune response triggered by infections or other environmental factors. This immune response may lead to the production of autoantibodies that cross-react with neuronal tissue, particularly in the basal ganglia, resulting in neuroinflammation and the observed neuropsychiatric symptoms.​

Early identification and treatment are crucial to improving outcomes. Management of PANS requires a multidisciplinary approach, including:​

• Antimicrobial Treatment: Targeting underlying infections that may have triggered the immune response.​
• Immunomodulatory Therapies: Such as corticosteroids, intravenous immunoglobulin (IVIG), or plasmapheresis, aimed at reducing neuroinflammation.
• Psychiatric Interventions: Including cognitive-behavioral therapy (CBT) and pharmacologic treatments to manage OCD and other psychiatric symptoms.

PANS is hypothesized to result from molecular mimicry, where the immune system’s response to an infection leads to the production of antibodies that mistakenly target neuronal tissue. This autoimmune reaction causes inflammation in brain regions responsible for behavior, emotion, and movement, leading to the rapid onset of neuropsychiatric symptoms.​

PANS represents a complex interplay between the immune system and the central nervous system, resulting in sudden and severe neuropsychiatric symptoms. Recognition of the syndrome’s clinical features and underlying mechanisms is essential for timely diagnosis and effective treatment. Ongoing research is needed to further elucidate the pathophysiology and optimize management strategies.

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Frankovich, J., Swedo, S., Murphy, T., Dale, R. C., Agalliu, D., Williams, K., Daines, M., Hornig, M., Chugani, H., Sanger, T., Muscal, E., Pasternack, M., Cooperstock, M., Gans, H., Zhang, Y., Cunningham, M., Bernstein, G., Bromberg, R., Willett, T., Brown, K., Farhadian, B., Chang, K., Geller, D., Hernandez, J., Sherr, J., Shaw, R., Latimer, E., Leckman, J. F., & Thienemann, M. (2017). Clinical management of pediatric acute‑onset neuropsychiatric syndrome: Part II — Use of immunomodulatory therapies. Journal of Child and Adolescent Psychopharmacology, 27(7), 574–593. https://doi.org/10.1089/cap.2016.0148

Cooperstock, M. S., Swedo, S. E., Pasternack, M. S., & Murphy, T. K. (2017). Clinical management of pediatric acute‑onset neuropsychiatric syndrome: Part III — Treatment and prevention of infections. Journal of Child and Adolescent Psychopharmacology, 27(7), 594–606. https://doi.org/10.1089/cap.2016.0151

Chang, K., Frankovich, J., Cooperstock, M., Cunningham, M. W., Latimer, M. E., Murphy, T. K., Pasternack, M., Thienemann, M., Williams, K., Walter, J., & Swedo, S. E. (2015). Clinical evaluation of youth with pediatric acute‑onset neuropsychiatric syndrome (PANS): Recommendations from the 2013 PANS Consensus Conference. Journal of Child and Adolescent Psychopharmacology, 25(1), 3–13. https://doi.org/10.1089/cap.2014.0084

Swedo, S. E., Leckman, J. F., & Rose, N. R. (2012). From research subgroup to clinical syndrome: Modifying the PANDAS criteria to describe PANS (pediatric acute‑onset neuropsychiatric syndrome). Pediatrics & Therapeutics, 2(2), Article 113. https://doi.org/10.4172/2161‑0665.1000113

Leonardi, L., Perna, C., Bernabei, I., Fiore, M., Ma, M., Frankovich, J., Tarani, L., & Spalice, A. (2024). Pediatric acute‑onset neuropsychiatric syndrome (PANS) and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): Immunological features underpinning controversial entities. Children, 11(9), 1043. https://doi.org/10.3390/children11091043

Stanford Medicine. (n.d.). Q & A: Pediatric acute‑onset neuropsychiatric syndrome (PANS/PANDAS). Stanford University School of Medicine. https://med.stanford.edu/pans/about/Q-and-A.html

Vreeland, A., & PANDAS Physicians Network Diagnostics and Therapeutics Committee. (2025). Seeing your first child with PANS/PANDAS. PANDAS Physicians Network. https://www.pandasppn.org/seeingyourfirstchild/