PANDAS Disease: Symptoms, Causes, Diagnosis & Treatment

Daisy Oliveira
Created by: Daisy Oliveira Registered Nurse CNO #13564387
Key points
  • PANDAS disease causes a sudden onset of obsessive-compulsive behaviors and tics in children after a strep infection, linked to an abnormal immune response.
  • Common symptoms include anxiety, mood swings, sleep problems, and changes in behavior or handwriting that appear abruptly.
  • Treatment combines antibiotics, anti-inflammatory therapy, and behavioral support, with most children recovering well after early diagnosis.

PANDAS disease, short for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, is a condition in which a child suddenly develops obsessive-compulsive disorder (OCD) or tic symptoms after a strep infection. It happens when the immune system, while fighting the infection, mistakenly targets areas of the brain that control movement and behavior.

Symptoms of PANDAS disease appear very suddenly, often described by parents as “overnight changes,” and may include anxiety, mood swings, or a return to earlier childhood behaviors. These symptoms can come and go, usually flaring up after new infections.

Treatment for PANDAS focuses on eliminating any lingering strep bacteria, calming inflammation, and managing emotional or behavioral symptoms. With early diagnosis and proper care, most children improve significantly, although some may experience repeated flare-ups.

Child attending therapy

Main symptoms

PANDAS disease is known for the sudden onset of symptoms that greatly affect a child’s emotions, behavior, and ability to function at home or school.

Common symptoms include:

  • Obsessive-compulsive behaviors (repetitive thoughts or actions)

  • Motor or vocal tics

  • Anxiety or separation anxiety

  • Sudden mood changes and irritability

  • Behavioral regression, such as baby talk or temper tantrums

  • Trouble sleeping or nighttime fears

  • Decline in school performance

  • Frequent urination or bedwetting

  • Sensitivity to sounds, textures, or changes in handwriting

These symptoms usually appear shortly after a streptococcal infection and may come and go over time, improving between flare-ups.

Common causes

PANDAS disease develops after an infection with Group A Streptococcus, the same bacteria that cause strep throat and scarlet fever. Experts believe it occurs because of an autoimmune reaction known as molecular mimicry, where antibodies created to fight the bacteria mistakenly attack brain cells involved in movement and behavior.

How it is transmitted

The strep infection that triggers PANDAS spreads through:

  • Respiratory droplets from coughing or sneezing

  • Close contact with someone who has strep throat

  • Sharing eating utensils, cups, or toothbrushes

PANDAS itself is not contagious, but the strep infection that can lead to it is.

Confirming a diagnosis

PANDAS disease is diagnosed based on the sudden appearance of OCD or tic symptoms following a strep infection. Doctors usually confirm recent exposure to strep through a throat culture or blood tests that check for anti-streptolysin O (ASO) and anti-DNase B antibodies.

In some cases, brain imaging may be used to rule out other neurological conditions. Specialized blood tests, such as the Cunningham Panel, can identify antibodies linked to PANDAS. Because its symptoms can resemble those of conditions like Tourette syndrome, ADHD, or autism spectrum disorder, evaluation by a pediatrician, neurologist, and psychiatrist is often recommended.

Treatment options

Treatment for PANDAS disease focuses on three main goals: eliminating the infection, reducing inflammation, and managing emotional or behavioral symptoms. Most children respond well when treatment begins early.

1. Antibiotic therapy

Antibiotics such as penicillin, amoxicillin, or azithromycin are commonly used to treat or prevent Group A streptococcal infections. Children who experience frequent recurrences may be prescribed longer-term antibiotic therapy to prevent future flare-ups.

2. Anti-inflammatory treatments

Anti-inflammatory medications like nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids help reduce swelling and immune system activity. For more severe cases, intravenous immunoglobulin (IVIG) or plasma exchange may be used to calm inflammation in the brain.

3. Behavioral and psychological support

Cognitive-behavioral therapy (CBT), especially Exposure and Response Prevention (ERP), is often recommended to help children manage OCD and anxiety symptoms. Low-dose selective serotonin reuptake inhibitors (SSRIs) may also be prescribed, but they should be started carefully at very low doses to avoid side effects such as agitation or behavioral changes.

4. Multidisciplinary care

Because PANDAS affects both the immune system and mental health, a team approach is often best. Pediatricians, psychiatrists, neurologists, and immunologists typically work together to provide comprehensive care for the child and family.

Prevention

Preventing PANDAS disease mainly involves reducing the risk of strep infections. Helpful preventive steps include:

  • Regular handwashing with soap and water

  • Covering coughs and sneezes with a tissue or elbow

  • Avoiding close contact with anyone who has strep throat

  • Cleaning frequently touched objects and shared surfaces

  • Ensuring children complete their prescribed antibiotic treatments for strep infections

According to the Centers for Disease Control and Prevention (CDC), good hygiene practices such as frequent handwashing, covering coughs and sneezes, and staying home when sick are key to preventing the spread of Group A Streptococcus infections, which can lead to conditions like PANDAS disease.

For children who have had PANDAS, doctors may suggest preventive antibiotics or screening family members to avoid recurrent infections.

Prognosis

Most children with PANDAS disease recover well, especially when it is identified and treated early. Some children may experience flare-ups during later infections, but ongoing medical care and early treatment of strep can help prevent long-term complications and support full recovery.

Update History
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References
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