As parents and caregivers of children with DMDD, we often explore every avenue for our children. One of those avenues often explored is called PANS/PANDAS. The acronym stands for Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections. While there are some similarities, the differences outweigh the similarities. We will discuss both in hopes of providing some guidance as either something to consider, or, to rule out.
Let’s start with the basics. PANDAS can resemble the same symptoms as DMDD such as ADHD tendencies, mood changes, anxiety, depression, and sleep disruptions. These sound pretty familiar, right? Now to explain where the biggest difference lies between both DMDD and PANDAS. PANDAS appears seemingly out of nowhere, typically includes extreme OCD tendencies, tic disorders, and comes in conjunction with an active strep infection or up to a month following a strep infection.On the other hand, once a child receives a DMDD diagnosis, the caregiver, often realizes their child has been cranky and irritable for a majority of their childhood; a sudden onset of mood dysregulation, like PANDAS.
Now let’s delve a little deeper into the differences. DMDD involves a dysregulation of the limbic system, mainly the amygdala and the prefrontal lobe. Each of these play a significant role in how emotions and impulse control are regulated. The amygdala is the emotional “fight or flight” control center responsible for how people react to outside stimuli.The frontal lobe is our ability to control what we do with the stimuli. It allows us to think and apply the brakes. If both of these areas are out of sync, it creates a perfect storm, if you will. It creates an act before thinking about the situation.
PANDAS involves an entirely different region of the brain, the basal ganglia. The strep autoantibodies are able to cross the blood-brain barrier causing brain inflammation. Like other autoimmune diseases, the immune system attacks the healthy tissue and PANDAS attacks the healthy tissue in the basal ganglia portion of the brain. The basal ganglia is responsible for movement, speech, posture, and more recently being researched as possibly playing a role in behavior and cognition. So what happens if your basal ganglia becomes inflamed due to a strep infection? Movement and motor control issues begin to appear, as well as increased anxiety, depression, and other psychiatric symptoms.
Unfortunately, are no definitive tests for the diagnosis of PANDAS. A combination of medical history, lab tests, strep cultures, and immunological testing can sometimes pinpoint a diagnosis of PANDAS. PANDAS is also more likely to occur in children with a family history of autoimmune diseases.
Children with PANS/PANDAS have similar battles to that of children with DMDD. Many medical professionals have never heard of PANDAS, and therefore not entirely sure how to treat it. It has been seen as a “fictitious disease”. The battle for these children have been just as exhausting as it has been for children with DMDD. Due to the fact that PANDAS mimics psychiatric disorders, such as ADHD, Autism, and sensory processing disorders, the medication go-to was often harmful antipsychotics. Does this also sound familiar? Due to significant scientific studies, PANDAS is working its way to being recognized as a physical condition versus a severe mental health condition that is untreatable.
With significant differences in DMDD and PANDAS, the treatment is also very different. Depending on the severity of the PANDAS determines the treatment. They range from a course of antibiotics, prophylactic antibiotics, and intravenous immune globulin (IVIG). DMDD has been shown to improve with the use of anticonvulsants and amantadine.
We hope you find this information useful as you put the pieces together to determine whether your child has DMDD or PANDAS.
REFERENCES:
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 19-MH-8092 Revised 2019
What is PANS/PANDAS?
PANDAS Network 2024
How common infections can spark psychiatric illnesses in children
The Economist 2024