PANDAS

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) is an autoimmune response to a strep infection. The disorder involves sudden and often major changes in personality and movement.

Symptoms can arise as many as 4-6 weeks after the initial infection. PANDAS symptoms often interfere with daily routines and can become debilitating. The symptoms worsen over time and can have a relapsing and remitting pattern. The psychological symptoms may include OCD and repetitive behavior, severe or panic disorder, mood changes, emotional and developmental regression, depression, and suicidal thoughts. Physical symptoms may include and/or unusual movements, increased sensitivities to light, sound and touch, deterioration of small motor skills such as handwriting, sleeping difficulty, memory issues, refusal to eat, and near catatonic state. (Pietrangelo, 2018)

PANDAS is thought to be caused by the antibodies that are produced to attack the strep bacteria. The antibodies become confused and attack the body’s tissue due to streptococci’s camouflaging abilities. The antibodies target an area of the brain called the .

PANDAS is typically found in children ages 3 to 12 years old who have had a recent strep infection and exhibit symptoms as noted above. A single course of antibiotics can be successful in treating PANDAS, but symptoms may return with another strep infection. In many cases, long-term, low-dose antibiotics may be used to prevent flares. Chronic cases can require a combination of treatments including corticosteroids and NSAIDS. For severe cases, IVIG treatment or blood plasma exchange may be recommended. Read JCAP Treatment Guidelines Here

I chose this medical condition because it has affected me personally. Several years ago, a member of my family who was 10 years old at the time, suddenly became debilitated by OCD intrusive with frequent thoughts of dying or harming themselves. We noticed an onset of tics and an impairment of the child’s daily functioning. The child was literally afraid of their own thoughts and unable to escape them to function as they normally would. As family members witnessing these sudden and unexplainable symptoms it was hard to know where to turn for help.

Through the help of several psychologists and a pediatrician we tried to make sense of what was going on. We saw improvements for periods of time only to relapse several months later. This pattern continued for several years. The breaking point came about a year ago. When the thoughts of self-harm were so severe and asked us to take them to the hospital, and was admitted. We were devastated by this news. However, this event was likely the best thing that could have happened. The psychiatrist assigned to this child specialized in OCD intrusive thought disorder, and with a description of the child’s history she immediately suspected PANDAS. She ordered strep and blood tests which were all positive. Immediate treatment was started with NSAIDS, steroids, and antibiotics, and within several days the child had finally begun to feel normal again.

The doctor suspected that one of the family members may be a strep carrier and had all of us tested. The child’s father was positive for strep with no symptoms at all and was likely the carrier. The father was also treated with antibiotics while continuing to treat the child with low-dose antibiotics on an ongoing basis. The child has had a full recovery with no repeat of symptoms.

1 I would like to bring awareness to this medical condition so that others are aware of the potential risks of strep infection, and how it can affect not only the heart and kidneys but the brain as well. Below are my recommendations for life ratings based on my research and personal knowledge of this medical condition.

Recommended Underwriting Guidelines Life Ratings Ages 0-18 Onset less than 3 years Postpone Mild symptoms +50 Otherwise Decline

Ages 18 and older Onset less than 3 years Postpone Mild symptoms Stable less than 2 years +50 stable more than years +0 Moderate symptoms Favorable features +150 Unfavorable features Decline Severe symptoms Decline

Additional rating factors With history of other psychiatric or Decline behavioral disorders With attempted suicide Less than 2 years ago Decline More than 2 years IC With alcohol suspi- Decline cion or substance abuse

2 Disease Classification Mild minimal anxiety symptoms; no tics; no restrictive eating; quick response to antibiotic treatment; resolution within 6 months to 1 year

Moderate mild tics; mild to moderate anxiety with low dose anti-anxiety medications; use of NSAIDS and/or corticosteroids for short term; resolution within 2 years of onset

Severe ongoing or chronic with restrictive eating; severe anxiety or severe behavior changes including regression; treatment with IVIG or plasma exchange

Favorable features Unfavorable features Symptoms lasting less than 2 years Symptoms lasting more than 2 years Good support system History of restrictive eating Good response to treatment Missed time from work/school No family history of mental disorders In-patient treatment Compliance with treatment Plasma exchange No time off school/work Associated mental disorders Treated with IVIG Poor compliance with treatment

Laurie Kaiser Senior Underwriting Consultant SCOR Global Life Americas

Sources: https://www.medicinenet.com/pandas/article.htm#what_is_the_history_of_pandas http://view.liebertpubmail.com/?qs=96fe299c9aa8dd4a19dfbc80aa826564ae2ec58 bbce35 15043820952c61d 8a4ccf7005d7cc19a460298f7ac1cbb7b67e2f5417a130e823f5e 115e9beae3312e6de4cca617224cca0 https://www.healthline.com/health/pandas-syndrome#symptoms

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