Understanding PANS/PANDAS: A Functional Medicine Approach to Healing the Brain and Body of Children

Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) are increasingly recognized conditions that affect children and adolescents, often causing a sudden and dramatic onset of psychiatric and neurological symptoms. These conditions are thought to be triggered by infections or environmental triggers that cause an immune response targeting the brain, particularly the basal ganglia, leading to neuroinflammation.

What Are PANS and PANDAS?

• PANDAS specifically refers to cases triggered by Group A Streptococcal infections.

• PANS is a broader diagnosis, encompassing cases triggered by various infections (e.g., Mycoplasma, Epstein-Barr virus, Lyme disease) or even environmental toxins and metabolic stress.

Both conditions involve a sudden onset of obsessive-compulsive behaviors, anxiety, episodes of aggression, tics, eating restrictions, and other neuropsychiatric symptoms, often appearing overnight.

Common Signs and Symptoms

• Sudden onset of Obsessive-Compulsive Disorder (OCD)

• Severe separation anxiety or other forms of irrational fear

• Tics (motor or vocal)

• Sensory sensitivities or behavioral regression

• Deterioration in handwriting or school performance

• Restrictive eating or sudden food aversions

• Mood swings, irritability, or aggression

• Sleep disturbances

• Frequent urination or enuresis (bedwetting)

• Physical symptoms such as joint pain, fatigue, or rashes

Symptoms can wax and wane and often correlate with immune system stress or re-exposure to triggering infections.

The Functional Medicine Perspective

PANS/PANDAS are not just psychiatric disorders; they are immune-mediated inflammatory conditions that affect the brain. Functional medicine recognizes the whole-body connection and treats the root cause, not just the symptoms.

A successful approach is based on a 3-pronged strategy:

1. Immune Modulation and Infection Control

• Identify and treat underlying infections: strep, Mycoplasma, EBV, Lyme, mold, or other stealth infections

• Use of antimicrobials (conventional or herbal), antivirals, or antifungals when necessary

• Immune support supplements: vitamin D, zinc, omega-3s, medicinal mushrooms (reishi, turkey tail), glutathione

• Low-dose naltrexone (LDN) to regulate immune response

• Avoid environmental triggers: mold, heavy metals, food sensitivities (esp. gluten and dairy)

2. Symptom Management and Neuroinflammation Support

• Anti-inflammatory supplements: curcumin, resveratrol, quercetin, fish oil

• Mitochondrial and neurological support: CoQ10, B vitamins, magnesium, phosphatidylserine

• Sleep support: melatonin, magnesium, L-theanine, glycine as appropriate

• Address gut-brain axis: addressing dysbiosis, use of probiotics if indicated, and use of gut healing nutrients.

• Pharmaceuticals as needed: SSRIs, anti-anxiety meds, or antipsychotics as short-term aids

3. Behavioral, Neurological & Limbic System Work

• Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) therapy for OCD and anxiety

• Occupational therapy for sensory integration issues

• Neurofeedback or biofeedback

• Limbic system retraining: DNRS, Gupta Program, or Primal Trust

• Mind-body techniques: meditation, breathwork, yoga, trauma-informed therapy

Final Thoughts

PANS and PANDAS are complex but treatable conditions when approached from a root-cause, whole-person perspective. With a personalized treatment plan that includes immune support, symptom relief, and neurological rehabilitation, many children can experience significant improvement or even full recovery.

Early recognition and a collaborative care team—pediatrician, functional medicine provider, therapist, and family—are essential for optimal outcomes.

If your child is showing sudden behavioral or neurological changes, don’t ignore the symptoms—seek support and consider a PANS/PANDAS evaluation.

Need help navigating a PANS/PANDAS diagnosis? Contact us for personalized guidance and integrative treatment options. I see little ones over the age of 8 and serve clients in Austin, San Antonio, Dallas, Houston, and the entire State of Texas.

Your Functional Med NP,

Xenia