The Latest Research on Treating PANS and PANDAS

Focusing on Immune Health and the Gut Microbiome in PANS and PANDAS treatment

I recently attended a integrative medicine symposium focusing on children’s health and PANS and PANDAS was a topic covered extensively. More and more children are being diagnosed with this conditions and research is starting to focus in on the immune system and microbiome for a resolution.

Paediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) are conditions characterised by the sudden onset of obsessive-compulsive symptoms, tics, and other severe neuropsychiatric symptoms in children. Emerging research is increasingly highlighting the role of immune health and the gut microbiome in managing and treating these conditions.

Understanding PANS and PANDAS

PANS is a broad term that includes various triggers for the sudden onset of neuropsychiatric symptoms, while PANDAS is a subset of PANS specifically associated with streptococcal infections. Both conditions are thought to involve an autoimmune mechanism where an infection or other trigger leads to an abnormal immune response, affecting the brain.

The Immune System and Neuropsychiatric Symptoms

Recent studies have focused on the role of the immune system in the development and progression of PANS and PANDAS. One key aspect is the concept of molecular mimicry, where the immune system mistakenly targets brain tissues after a streptococcal infection due to similarities between bacterial antigens and neuronal cells.

1. Inflammation: Research has shown inflammations play a crucial role in PANS and PANDAS. But the medical experts are still spilt on whether there is an autoimmune mechanism in play. Swedo et al. (2015) provides evidence for the autoimmune nature of PANDAS, demonstrating that anti-neuronal antibodies and inflammatory cytokines are elevated in affected children. Either way we know these immune components can disrupt normal brain function, leading to neuropsychiatric symptoms .

2. Immunomodulatory Therapies: Treatments targeting the immune system with Intravenous immunoglobulin (IVIG) and plasmapheresis are therapies aimed at reducing autoantibodies and modulating the immune response initially showed promise. A study by Frankovich et al. (2015) reported significant improvements in neuropsychiatric symptoms following IVIG treatment, suggesting its potential as a therapeutic option. However, Professor Russell Dale from Westmead Children’s hospital in Sydney has found these treatments have no long term benefits with symptoms returning soon.

The Gut-Brain Axis and Microbiome

The gut-brain axis is a bidirectional communication system between the gastrointestinal tract and the central nervous system. The gut microbiome, composed of billions of microorganisms, plays a vital role in maintaining immune homeostasis and brain health.

1. Microbiome Diversity and Immune Regulation: Dysbiosis, or an imbalance in the gut microbiome, has been implicated in various autoimmune and neuropsychiatric disorders. Research by Hsiao et al. (2013) highlighted that gut bacteria influence immune responses and behavior in animal models, suggesting a potential link between gut microbiota and PANS/PANDAS .

2. Probiotics and Prebiotics: Interventions aimed at restoring gut microbiota balance, such as probiotics and prebiotics, are being explored. Probiotics are beneficial bacteria that can modulate the immune system, while prebiotics are non-digestible fibers that promote the growth of these beneficial microbes. A study by Borre et al. (2014) found that probiotic supplementation reduced anxiety-like behavior and modulated immune responses in mice, indicating potential benefits for children with PANS/PANDAS .

3. Dietary Interventions: Diet plays a crucial role in shaping the gut microbiome. Anti-inflammatory diets rich in fruits, vegetables, and omega-3 fatty acids can support gut health and reduce systemic inflammation. Research suggests that specific dietary interventions might help manage neuropsychiatric symptoms by promoting a healthy gut microbiome and reducing inflammation (Venter et al., 2016) .

Integrative Approaches to Treatment

Combining immune modulation with gut health optimization offers a holistic approach to managing PANS and PANDAS. Integrative treatments may include:

Antimicrobial herbal therapy: Targeting underlying infections as identified by microbe mapping is often the first course of action.
Immune Modulation: Supporting the immune response and addressing any allergies or removing any antagonists such as mould or allergens.
Gut Health: Implementing dietary changes, probiotics, and prebiotic to restore gut microbiome balance and addressing any intestinal permeability.
Lifestyle Modifications: Incorporating stress reduction techniques, regular exercise, and adequate sleep to enhance immune health and support the gut-brain axis.

Conclusion

The latest research underscores the importance of immune health and the gut microbiome in treating PANS and PANDAS. By addressing both the immune dysregulation and gut microbiome imbalances, integrative approaches hold promise for improving the lives of affected children. Ongoing research and clinical trials will continue to refine these strategies, providing a clearer understanding of how to best manage these complex neuropsychiatric conditions.

References

1. Swedo, S. E., Leckman, J. F., & Rose, N. R. (2015). From Research Subgroup to Clinical Syndrome: Modifying the PANDAS Criteria to Describe PANS (Pediatric Acute-onset Neuropsychiatric Syndrome). Pediatric Therapeutics, 5(3), 24-28.
1. Frankovich, J., Swedo, S., Murphy, T., Dale, R. C., & Agalliu, D. (2015). Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part I-Psychiatric and Behavioral Interventions. Journal of Child and Adolescent Psychopharmacology, 25(1), 3-13.
1. Hsiao, E. Y., McBride, S. W., Hsien, S., Sharon, G., Hyde, E. R., McCue, T., & Mazmanian, S. K. (2013). Microbiota modulate behavioral and physiological abnormalities associated with neurodevelopmental disorders. Cell, 155(7), 1451-1463.
1. Borre, Y. E., Moloney, R. D., Clarke, G., Dinan, T. G., & Cryan, J. F. (2014). The impact of microbiota on brain and behavior: mechanisms & therapeutic potential. Advances in Experimental Medicine and Biology, 817, 373-403.
1. Venter, C., & Meyer, R. (2016). Nutritional management of allergic diseases in childhood. Pediatric Clinics of North America, 64(6), 1439-1451.