Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is a condition that affects children and can be brought on or made worse by an infection from Streptococcus bacteria. The symptoms are similar to those of obsessive-compulsive disorder (OCD) or a tic disorder. It’s a rare condition, although its exact prevalence is unknown.
Many of the treatment options for PANDAS involve the use of medications. In addition, some may be interested in exploring natural remedies for PANDAS as well.
Below, we’ll discuss some of the ways that PANDAS may be treated naturally, how these methods are intended to work, and the scientific evidence behind them.
PANDAS can generally occur from age 3 until a child reaches puberty. After this time, developing the condition is rare. In PANDAS, one of two things typically happens:
- A child suddenly develops OCD, a tic disorder, or both after a strep infection.
- A child who already has OCD or a tic disorder has symptoms that get noticeably worse after a strep infection.
How does PANDAS affect the mind and body?
Strep bacteria use a technique called molecular mimicry to hide from the immune system. To do this, they place molecules on their surface that resemble those that are found in healthy human tissues, including the brain and heart.
Molecular mimicry can allow the bacteria to hide from the immune system for a period of time. However, they’re eventually recognized as a foreign invader, which leads to an immune response. This includes the production of antibodies.
When the immune system makes antibodies against the strep bacteria, it can also make antibodies to the mimicry molecules. Because these mimicry molecules so closely resemble those on other tissues, some antibodies may react to healthy tissue.
These types of antibodies are called cross-reactive antibodies. Cross-reactive antibodies can mistakenly respond to and attack healthy tissues as if they were foreign invaders. In PANDAS, cross-reactive antibodies target tissues in the brain, causing neurological symptoms to appear.
The symptoms of PANDAS come on suddenly following a strep infection. They typically begin to improve gradually over time and can recur in response to another strep infection.
PANDAS symptoms can include:
- Motor tics. Motor tics are short repetitive movements like head jerking, eye blinking, or facial grimacing.
- Vocal tics. Vocal tics are brief repetitive noises like throat clearing, grunting, or sniffing.
- Obsessions. Obsessions are persistent thoughts or urges that lead to feelings of anxiety. Some examples include needing to have things perfectly ordered or having an intense fear of germs.
- Compulsions. Compulsions are repeated behaviors that are typically performed in response to obsessions. A few examples include excessive handwashing and repetitively organizing objects in a specific way.
- Other symptoms. In addition to the symptoms mentioned above, a child with PANDAS may also experience:
- moodiness or irritability
- a decline in academic performance
- changes in handwriting or other fine motor skills
- developmental regression, which can include temper tantrums or speaking in “baby talk”
Medical treatments for PANDAS may include:
- medications like antibiotics, steroids, and nonsteroidal anti-inflammatory drugs (NSAIDs)
- plasma exchange
- intravenous immunoglobulin (IVIG), which has been shown to reduce or eliminate symptoms in severe cases
- tonsillectomy, which
some studieshave shown can reduce PANDAS symptoms
It’s completely normal to want to explore adding natural treatments to a child’s treatment plan. Some examples of natural treatments that may be used in tandem with the medical treatments listed above include psychotherapy and complementary and alternative medicine (CAM).
CAM can include things like dietary supplements and homeopathy. A
Overall, little research has been done on natural treatments for PANDAS, particularly when it comes to CAM. If you’d like to try out one of the treatments below, always do so under the supervision of your child’s pediatrician.
There are several dietary supplements that have the potential to help with the symptoms of PANDAS. Let’s take a closer look at them below.
Vitamin D is a nutrient that’s important for overall good health. It can have beneficial health effects on bones as well as other parts of the body like the muscles, brain, and immune system.
Research indicates the same association may be seen in PANDAS:
2016 studycompared vitamin D levels in 33 children with PANDAS and 20 children without the condition. No significant difference in vitamin D levels was found between the two groups. However, vitamin D deficiency was more frequent in the PANDAS group.
2018 studylooked at vitamin D levels in 179 children with PANDAS and 224 children without the condition. Compared to the other children, children with PANDAS had:
- lower levels of vitamin D
- a higher frequency of vitamin D deficiency
- vitamin D levels that were related to their number of previous strep infections
Because of this, vitamin D supplementation has been proposed to help treat PANDAS. It’s possible that its effects on the immune system as well as its anti-inflammatory and antioxidant properties could help with symptoms.
However, as of this writing, no clinical trials have been performed to evaluate the effectiveness of vitamin D supplementation in treating PANDAS.
Probiotics are microorganisms that can have a beneficial effect on digestive health. They can be found in the form of dietary supplements as well as in foods like yogurt, sauerkraut, and kimchi.
One way that probiotics may be helpful for PANDAS is in preventing digestive problems due to antibiotics, a common treatment for PANDAS. Research has found that probiotics show promise for this purpose.
Another way is through the gut-brain axis, or how digestive health and brain health can impact each other. Microorganisms in the digestive tract can potentially affect this connection.
It’s unknown if probiotics can change the makeup of the microbial communities in children with PANDAS and significantly improve their symptoms. Clinical trials are needed to help provide this information.
Omega-3 fatty acids are found in many of the foods that we eat, particularly seafood. They can also be taken in supplement form.
Omega-3s are essential, which means that the body cannot make them on its own. Because of this, we must get them through food or supplements.
Omega-3s are vital for many tissues of the body, including the brain. They’re important for the maintenance of brain tissue and can also have an anti-inflammatory effect.
Because of these properties, some choose to use omega-3 supplementation as a part of a PANDAS treatment plan. However, scientific data is limited as to how effective it is for easing PANDAS symptoms.
Different types of therapy provided by a mental health professional can also help to relieve the symptoms of PANDAS. Let’s look at them in more detail.
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is one of the most popular types of therapy. In CBT, a therapist will work with a child to examine the relationships between their thoughts, feelings, and behaviors.
Through this process, they can uncover thought patterns that may be contributing to unhealthy or destructive behaviors and beliefs. The therapist and child can then work together on fostering new, more constructive ways of thinking.
CBT is one type of therapy commonly used to treat OCD. As such, it can also be helpful for PANDAS.
A 2018 review article notes that two studies have looked at the effect of CBT on PANDAS symptoms. Both studies showed a significant reduction in symptoms. However, the review authors note that both studies were small and lacked a control group for comparison.
Exposure and response prevention
Exposure and response prevention (ERP) is actually a specific type of CBT. Like CBT, it can be useful for treating OCD and may help with some of the symptoms of PANDAS.
In ERP, a child is exposed to a situation that may trigger compulsions. However, instead of being allowed to engage in these compulsions, they’re prevented from doing so.
An example of this would be asking a child to touch an object that’s dirty, but then preventing them from washing their hands immediately afterward.
It’s believed that repeatedly performing compulsions in response to an anxiety-causing obsession only reinforces both the obsession and the compulsion. ERP aims to break this cycle and teach children how to cope with distress without engaging in compulsions.
The same 2018 review mentioned above notes that survey studies and case reports have reported that ERP is an effective form of therapy for PANDAS. However, no larger studies have been carried out to date to confirm this benefit.
Homeopathy is a system that uses the principle of “like heals like.” Practitioners believe that conditions can be treated with very small doses of substances that cause similar symptoms. Ingredients for homeopathic remedies come from a variety of natural sources, including:
Homeopathic remedies are highly individualized. This means that two people with the same health condition may receive very different homeopathic remedies.
It’s important to know that the National Center for Complementary and Integrative Health states that there’s little evidence to support homeopathy as a treatment for any health condition.
Currently, no research has been performed on the effectiveness of homeopathic remedies for PANDAS. If you’re interested in trying out homeopathic remedies for your child’s symptoms, always consult their pediatrician first.
PANDAS is a condition in which symptoms of OCD, a tic disorder, or both come on following a strep infection. Other symptoms like irritability and separation anxiety may happen as well.
The treatment of PANDAS typically involves antibiotics or IVIG. Natural treatments that can be used along with these include therapy and CAM. However, research on the effectiveness of many of these treatments is limited.
PANDAS symptoms typically improve over time, although they can become worse again due to a repeat strep infection. Always talk with your child’s pediatrician before adding any natural therapies to your child’s treatment plan.