Podcast Guest: Brain Power with Dr. Eko – Understanding and Managing PANDAS/PANS Symptoms and Treatments
PANDAS and PANS are pediatric neuropsychiatric conditions in which immune responses trigger abrupt changes in behavior and cognition, undermining a child’s brain power and daily functioning. This article unpacks the biology, diagnostic approach, and both conventional and integrative treatments discussed on the "Brain Power with Dr. Eko" podcast, showing families and clinicians how to move from sudden symptom recognition to coordinated care. Readers will learn clear definitions of PANDAS versus PANS, how neuroinflammation affects basal ganglia circuits and executive function, stepwise diagnostic testing, and practical interventions—ranging from antibiotics and immunomodulation to diet, supplements, and mind-body strategies. We also summarize Dr. Eko’s clinical insights and anonymized recovery vignettes to illustrate measurable improvements in attention, school performance, and behavior. Finally, the piece provides family-centered flare plans, vetted resources, and notes about accessing specialist evaluation, including virtual PANS/PANDAS clinic options for families seeking consultation. The goal is to translate recent research and expert guidance into actionable steps families can use to restore cognitive resilience and long-term brainhealth.
What Are PANDAS and PANS? Defining Pediatric Autoimmune Neuropsychiatric Syndromes
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections) and PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) are clinical syndromes defined by sudden, dramatic onset of neuropsychiatric symptoms precipitated by immune triggers. In both conditions, the mechanism centers on immune dysregulation causing neuroinflammation, often affecting basal ganglia circuits involved in movement, habit learning, and executive control, which explains acute onset OCD, tics, and cognitive regression. Recognizing the abruptness of onset and symptom clustering is essential because earlier evaluation improves options for targeted treatment and rehabilitation. Families and clinicians should prioritize timely assessment when a previously well child experiences rapid behavioral decline, as this pattern differentiates PANDAS/PANS from more gradual developmental disorders.
What is Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections?
PANDAS refers specifically to cases where a Group A Streptococcal infection precedes an abrupt onset of obsessive-compulsive symptoms or motor/vocal tics. The hypothesized mechanism is molecular mimicry: anti-streptococcal antibodies cross-react with neural antigens in the basal ganglia, producing inflammation that disrupts neural circuits for inhibition and habit control. Clinically, onset often follows a documented strep throat or scarlet fever episode within days to weeks, with symptoms appearing rapidly and severely enough to impair school and daily life. This timeline and infectious link guide early testing and consideration of antimicrobial strategies before broader immune-modulating therapies are considered.
How Does Pediatric Acute-onset Neuropsychiatric Syndrome Differ from PANDAS?
PANS is an umbrella diagnosis for abrupt-onset neuropsychiatric symptoms triggered by a wider array of insults beyond streptococcal infection, including viral, fungal, or environmental triggers and sometimes noninfectious immune dysregulation. Because PANS is etiologically broader, evaluation emphasizes a wide infectious and immune workup rather than a strep-focused approach, and treatment pathways are often individualized to the identified trigger. Both PANDAS and PANS share core presentation—sudden OCD, tics, anxiety, or cognitive regression—but the broader trigger set in PANS means clinicians must consider metabolic, toxic, or microbiome-related contributors. Understanding this distinction helps families anticipate multi-domain testing and a potentially multidisciplinary treatment plan.
What Are the Common Symptoms of PANDAS/PANS in Children?
The hallmark is abrupt-onset obsessive-compulsive behaviors or severe tics, often accompanied by anxiety, mood lability, sleep disruption, and cognitive or scholastic regression. Cognitive effects can include impaired working memory, reduced processing speed, attention lapses, and executive dysfunction—collectively reducing what we call a child’s "brain power" in academic and social settings. Neurological signs such as motor abnormalities, sensory changes, and urinary frequency can appear alongside psychiatric symptoms, making multidisciplinary assessment essential. Early symptom recognition and symptom tracking create a baseline that helps guide treatment choices and measure recovery over time.
What Role Do Strep and Other Infections Play in Triggering PANDAS/PANS?
Infections can act as immune triggers that initiate or amplify neuroinflammatory cascades through antibody production or cytokine signaling, with Group A Streptococcus being historically linked to PANDAS. Other pathogens—adenovirus, mycoplasma, influenza, and certain fungal exposures—are implicated in PANS cases, and noninfectious triggers like environmental toxins or major immunologic shifts may also precipitate flares. The immune timeline typically shows infection then acute neuropsychiatric symptoms within days to weeks, and recurrent infections or immune activations can drive relapses. Recognizing infectious triggers focuses early evaluation on throat cultures and serologies while also prompting clinicians to consider broader immune testing if symptoms persist or escalate.
For families seeking specialist evaluation, some pediatric clinics offer dedicated PANS/PANDAS clinics and virtual consultations to streamline testing and care planning; such options can be valuable when local specialists are scarce. Culver Pediatrics Center, for example, is listed in clinical resources as offering virtual PANS/PANDAS consultations and integrated care models for families needing coordinated assessment and follow-up. This pathway can help families access multidisciplinary input while pursuing the targeted diagnostic steps described next.
How Does Neuroinflammation Affect Brain Power in Children with PANDAS/PANS?
Neuroinflammation describes immune-mediated processes within the central nervous system that alter neuronal signaling, synaptic plasticity, and network function—key determinants of cognitive capacity and behavioral regulation. In PANDAS/PANS, inflammatory mediators and autoantibodies preferentially disturb basal ganglia circuits and connected frontal networks, undermining inhibitory control, attention, and procedural learning, which together reduce a child’s effective "brain power." These immune-brain interactions can produce both acute behavioral symptoms (OCD, tics) and subacute cognitive slowing or regression, making early anti-inflammatory and rehabilitative strategies important. Understanding the cellular mechanisms informs choices about immunomodulatory therapies, neuro rehabilitation, and supportive interventions that aim to restore network function and cognitive resilience.
What Is Neuroinflammation and How Does It Impact the Basal Ganglia?
Neuroinflammation involves activated microglia, cytokine release, and sometimes pathogenic autoantibodies that alter neuronal firing and synaptic connectivity—effects that are especially disruptive in the basal ganglia. The basal ganglia regulate motor programs and habit learning, so inflammation here commonly produces tics, motor disturbances, and compulsive behaviors through disinhibition of cortical-subcortical loops. Functionally, basal ganglia inflammation can slow decision-making, impair habit suppression, and reduce cognitive flexibility, leading to measurable declines in school performance and behavior. Visualizing these circuits helps families and clinicians understand why psychiatric and movement symptoms often coexist and why targeted therapies can improve both motor and cognitive outcomes.
How Does Immune Dysregulation Contribute to PANDAS/PANS Symptoms?
Immune dysregulation in PANDAS/PANS encompasses aberrant antibody production, cross-reactivity with neural antigens, and dysregulated cytokine signaling that impacts neuronal health and synaptic transmission. Autoantibodies may bind to neuronal surface proteins and trigger inflammatory cascades, while pro-inflammatory cytokines can transiently impair neurotransmitter systems and neuronal metabolism. Clinically, this explains why some children respond to antibiotics for infection control and why others require immune-directed therapies during severe or refractory flares. Determining the degree of immune involvement informs the escalation from symptomatic psychiatric care to immunotherapies in select cases.
What Is the Gut-Brain Connection in PANDAS/PANS?
The gut-brain axis links microbiome composition, mucosal immunity, and systemic inflammatory tone to central nervous system function, so dysbiosis can promote pro-inflammatory states that exacerbate neuropsychiatric symptoms. Changes in gut flora after antibiotics or infections may alter short-chain fatty acid production, increase intestinal permeability, and prime peripheral immune activation—all mechanisms that can influence brain inflammation. Clinically, assessing diet, recent antibiotic exposure, and gastrointestinal symptoms can identify modifiable contributors, and targeted dietary or probiotic interventions may support recovery when combined with other therapies. Addressing the gut-brain axis complements immune and neurobehavioral treatments aimed at restoring cognitive function.
How Does Mitochondrial Dysfunction Affect Energy and Brain Function in PANDAS/PANS?
Mitochondrial dysfunction reduces cellular energy availability, increasing neuronal vulnerability to inflammatory stress and impairing processes like synaptic maintenance, neurotransmitter cycling, and neural plasticity critical for learning and attention. In children with PANDAS/PANS, mitochondrial stress can manifest as chronic fatigue, cognitive sluggishness, and poor tolerance of inflammatory flares, prolonging recovery periods. Screening for markers of metabolic strain and providing nutritional and targeted mitochondrial support can improve energy metabolism and cognitive stamina as part of an integrative plan. These metabolic supports work in tandem with anti-inflammatory and psychiatric interventions to restore day-to-day brain performance.
How Is PANDAS/PANS Diagnosed? Key Criteria and Challenges in Pediatric Assessment
Diagnosis relies on careful clinical history emphasizing abrupt onset, specific symptom clustering, and temporal relationship to infections, combined with targeted laboratory testing and neuropsychological assessment to rule out alternative explanations. Because there is no single diagnostic biomarker, clinicians use a combination of throat culture/serologies, inflammatory markers, autoimmune screens, structured psychiatric assessments, and standardized scales for OCD and tics to construct a working diagnosis. Common pitfalls include misattributing abrupt symptoms to ADHD, anxiety, or behavioral issues without recognizing the sudden onset and infection link; this underscores the need for multidisciplinary evaluation. The table below summarizes recommended tests, their purposes, and limitations to support accurate clinical decision-making.
Below is a concise mapping of common diagnostic tests and what they add to the assessment.
This table clarifies that tests inform but do not alone confirm diagnosis; clinical context remains central to decision-making. Understanding these limitations leads naturally to standardized symptom assessments and referral thresholds.
What Are the Diagnostic Criteria for PANDAS and PANS?
Diagnostic criteria emphasize abrupt, dramatic onset of core symptoms and exclusion of other causes; for PANDAS, the criteria specifically include temporal association with streptococcal infection and presence of OCD or tics. Core features include sudden onset, pediatric age of onset, episodic course with dramatic symptom exacerbations, and neurological abnormalities such as choreiform movements in some cases. PANS criteria broaden the trigger list but retain the requirement of acute onset and impairment across mood, cognition, or behavior. Clinicians must also apply exclusionary criteria for metabolic, neurologic, and primary psychiatric disorders to avoid misdiagnosis.
How Are OCD and Tic Disorders Evaluated in PANDAS/PANS Diagnosis?
Standardized scales—such as pediatric OCD and tic rating scales—combined with clinical interviews and observation provide reproducible measures of severity and change over time. Neuropsychological testing assesses attention, working memory, processing speed, and other executive functions that are commonly impacted, creating a measurable baseline for treatment response. Involving child psychiatrists, neurologists, and neuropsychologists ensures objective assessment and helps guide whether pharmacologic, behavioral, or immunologic interventions are indicated. Regular re-evaluation using the same instruments supports tracking of recovery and informs adjustments to the care plan.
Why Are PANDAS/PANS Often Misdiagnosed as ADHD or Anxiety?
Symptom overlap—poor attention, impulsivity, anxiety, and behavioral dysregulation—can mimic ADHD or anxiety disorders, especially when clinicians focus on individual symptoms rather than the acute onset pattern. The critical distinguishing features are abrupt onset, symptom clustering (OCD/tics with cognitive regression), and temporal association with infection or immune events, which are less typical in primary ADHD or generalized anxiety. Failure to elicit a precise timeline or to consider immune triggers contributes to delayed recognition and inappropriate monotherapy, so clinicians should use red flags (sudden decline, episodic course) to broaden evaluation. Recognizing these differences directs clinicians toward targeted testing and multidisciplinary management.
What Tests and Evaluations Support Accurate Diagnosis?
A practical diagnostic workup pairs infection-focused testing (throat culture, ASO/anti-DNase B) with broader inflammatory and autoimmune screening, neuropsychological evaluation, and psychiatric assessment to map symptom severity and functional impact. Imaging such as MRI is reserved for atypical presentations or focal neurologic signs, while EEG may be considered if seizures are suspected. The EAV-style table above summarizes common tests' purposes and limitations, emphasizing that results must be interpreted in the clinical context rather than used as standalone proof. This combined approach reduces diagnostic uncertainty and informs appropriate sequencing of treatments from antimicrobials to immunomodulation.
What Holistic and Integrative Treatments Improve Brain Power in PANDAS/PANS?
Integrative strategies target inflammation, support immune regulation, optimize mitochondrial function, and enhance cognitive recovery through diet, targeted supplements, environmental remediation, and mind-body therapies. Evidence-informed choices—such as N-acetylcysteine for neuroinflammation modulation, magnesium for neuronal stabilization, and probiotics for microbiome support—can complement medical care while minimizing side effects when overseen by clinicians. Lifestyle interventions including sleep optimization, structured cognitive rehabilitation, and family-based behavioral strategies amplify gains in attention and executive function. Clinics offering concierge or virtual pediatric services may integrate evaluation with coordinated nutritional and supplement plans, enabling families to access combined assessment and follow-up in settings where local multidisciplinary teams are limited.
Which Nutritional Strategies and Anti-inflammatory Diets Support Recovery?
Anti-inflammatory dietary patterns—emphasizing whole foods, omega-3-rich fish, colorful vegetables, low processed sugar, and limited dairy or gluten when indicated—help reduce systemic inflammatory load and support microbiome diversity. A practical one-day sample (breakfast: omega-3 smoothie with greens and berries; lunch: quinoa bowl with fatty fish and mixed vegetables; dinner: roasted vegetables with lean protein and turmeric-spiced dressing) illustrates how meals can be anti-inflammatory and nutrient-dense. Eliminating obvious triggers (processed foods, artificial additives) and ensuring consistent meal timing supports metabolic stability and cognitive performance. Dietary changes are adjunctive; their effects compound when combined with targeted supplements and medical treatment.
Here are core dietary principles for recovery:
Emphasize anti-inflammatory whole foods: prioritize fruits, vegetables, omega-3 sources, and polyphenol-rich spices.
Reduce processed sugars and additives: minimize items that promote dysbiosis and inflammation.
Consider elimination trials when GI symptoms present: guided reintroduction helps identify individual triggers.
These steps create a nutritional foundation for other interventions that improve brain power and behavioral stability.
What Key Supplements Enhance Brain and Immune Health in PANDAS/PANS?
Targeted supplements can modulate oxidative stress, support mitochondrial function, and influence neurotransmitter balance; common choices include N-acetylcysteine (NAC), magnesium, curcumin, probiotics, and mitochondrial cofactors like coenzyme Q10 and B vitamins. Below is an EAV table mapping key supplements to mechanisms, suggested dosing ranges, evidence level, and cautions to assist clinicians and families in informed selection and safe use.
This table emphasizes that dosing and choice should be individualized and supervised, and supplements complement rather than replace targeted medical treatments.
How Does Detoxification and Environmental Remediation Help Manage Symptoms?
Environmental toxins such as mold or heavy metals can sustain immune activation and cognitive symptoms, so remediation and targeted testing can reduce chronic inflammatory drivers and aid recovery. A practical home-evaluation checklist includes checking for water damage, persistent dampness, musty odors, and recent mold exposure history, and recommending professional environmental assessment if suspected. Stepwise remediation prioritizes source control (fix leaks, remove contaminated materials), air filtration, and, when indicated, professional mold remediation services. Addressing environmental contributors often reduces symptom burden and supports the efficacy of dietary, supplement, and medical interventions.
What Mind-Body Therapies and Stress Reduction Techniques Are Effective?
Mind-body interventions—such as cognitive behavioral therapy (CBT) including exposure and response prevention (ERP), family-based behavioral therapy, biofeedback, paced breathing, and sleep hygiene—help stabilize mood, reduce symptom severity, and improve executive functioning. Regular practices like daily breathing exercises, structured routines, and graded cognitive tasks support neural recovery by reducing stress-related cytokine surges and improving sleep-dependent consolidation. When combined with medical and nutritional strategies, these therapies accelerate gains in attention, learning, and emotional regulation. Referral to therapists experienced with pediatric OCD and neuroinflammatory conditions ensures appropriate adaptation of techniques to the child’s cognitive and developmental level.
What Conventional Medical Treatments Are Available for PANDAS/PANS?
Conventional treatments range from targeted antimicrobials for acute infections to immunomodulatory therapies for cases with clear immune-driven pathology, alongside psychiatric medications and behavioral therapies to manage symptoms. Antibiotics may address active streptococcal infections or be used prophylactically in select recurrent cases, while IVIG or plasma exchange are considered when severe, treatment-resistant immune-mediated symptoms threaten functioning. SSRIs and structured behavioral therapies remain foundational for OCD and anxiety management, often initiated in parallel with infection or immune-directed care. Below is a comparative table summarizing typical protocols, indications, and considerations for these conventional approaches.
How Are Antibiotics and Antimicrobials Used in Treatment?
Antibiotics are used to treat confirmed infections and, in some clinical algorithms, as short-term prophylaxis in children with recurrent streptococcal-driven flares, balancing benefits with microbiome disruption risk. Clinicians typically confirm infection with culture or serology before prolonged use, and consider adjunctive probiotic strategies to mitigate dysbiosis. Evidence supports antibiotic use for acute infection control, while prophylactic strategies require individualized risk-benefit assessment and careful monitoring. Coordination with primary pediatricians, infectious disease, and immunology specialists helps ensure appropriate antimicrobial stewardship.
What Role Do IVIG and Plasma Exchange Play in Immune Modulation?
IVIG and plasma exchange aim to modulate pathogenic antibodies and reset immune signaling in severe or refractory cases, with documented benefits in selected cohorts but variable evidence across studies. IVIG provides pooled immunoglobulins that can neutralize autoantibodies and modulate immune responses; plasma exchange physically removes circulating antibodies in rapidly progressive scenarios. These therapies are reserved for cases where immune-mediated mechanisms are strongly suspected and when symptom severity justifies invasive treatment, with careful monitoring for adverse events and close collaboration with immunology teams. Families should understand that these are specialized options after thorough evaluation.
How Are SSRIs and Behavioral Therapies Applied for Symptom Management?
SSRIs remain a mainstay for controlling OCD and severe anxiety when combined with CBT/ERP, offering measurable symptom reduction while other interventions address underlying triggers. Behavioral therapies—particularly ERP and family-based approaches—teach coping strategies, reduce avoidance, and support habituation to distressing thoughts or stimuli, accelerating functional recovery. Timing matters: initiating behavioral therapy early stabilizes daily functioning, and SSRIs can be added or adjusted based on symptom severity and response. Integrated care that sequences infection control, immune modulation (if needed), and psychiatric therapies yields the best outcomes for restoring cognitive capacity.
How Can Families Support Children Living with PANDAS/PANS for Long-Term Wellness?
Long-term wellness emphasizes structured flare management, supportive routines for sleep and nutrition, cognitive rehabilitation, and connection to vetted resources and support networks to reduce isolation and inform care decisions. Families benefit from symptom-tracking tools, a written flare-response plan, and access to clinicians experienced in pediatric neuroinflammatory conditions. Community and peer support groups provide emotional validation and practical tips, but parents should vet groups for evidence-based orientation and avoid unverified therapies. Below are concrete resources and stepwise strategies families can implement to promote resilience and preserve their child’s brain power over time.
What Resources and Support Groups Are Available for Parents?
Families should seek national and regional organizations focused on pediatric neuropsychiatric and neuroimmune conditions, clinician networks with expertise in PANDAS/PANS, and moderated online communities that emphasize evidence-based discussion. When evaluating groups, prioritize those that reference medical professionals, provide clear vetting of information, and offer practical guides for symptom tracking and school accommodations. Local multidisciplinary clinics and virtual consultation services can connect families to specialists for comprehensive plans. These curated resources help families navigate complex treatment choices and find peer support without sacrificing scientific rigor.
How Can Families Manage Symptom Flares and Promote Stability?
A stepwise flare-management plan should include immediate symptom documentation, contacting the child’s care team for triage, implementing calming routines (structured sleep, reduced stimulation), starting short-term anti-inflammatory dietary measures, and considering urgent evaluation for infection or immune escalation. The plan should define red flags for urgent care (rapid neurologic changes, severe suicidality, marked functional decline) and include prearranged clinician contacts to expedite assessment. Daily maintenance—consistent sleep, nutrition, medication adherence, and behavioral strategies—reduces flare frequency and supports steady cognitive performance. Regular review of the plan ensures families and clinicians respond consistently across episodes.
What Lifestyle Changes Encourage Brain Power and Holistic Wellness?
Four lifestyle pillars—sleep hygiene, regular physical activity, anti-inflammatory nutrition, and cognitive stimulation—form the backbone of long-term brain health and resilience. A pragmatic 4-week plan sets small weekly goals: stabilize sleep schedule in week one, introduce daily movement and outdoor time in week two, optimize anti-inflammatory meals in week three, and add structured cognitive tasks and therapy routines in week four. Monitoring progress via school reports, symptom scales, and cognitive tasks quantifies gains and keeps interventions aligned with goals. These incremental changes compound with medical and integrative therapies to restore attention, learning capacity, and emotional regulation in children recovering from PANDAS/PANS.
Consistent sleep schedule: improves consolidation and cognitive recovery.
Daily movement: supports mood regulation and neuroplasticity.
Structured learning tasks: rebuilds executive function and academic stamina.
These lifestyle steps, combined with clinical care, rebuild the child’s brain power progressively and sustainably.
