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PANS (Paediatric Acute-onset Neuropsychiatric Syndrome)

PANS is a neuropsychiatric condition which is triggered by a misdirected immune response to a variety of triggers, resulting in a constellation of symptoms as outlined below. 

PANS is a clinical diagnosis and there is no specific test which will prove or disprove the condition.  In order for a diagnosis to be made, presentation of the following symptoms must occur:

PANS Diagnostic Criteria

An abrupt, acute, dramatic onset* (usually within 24-48 hours) of obsessive compulsive disorder (OCD)** or severely restricted food intake*** along with two or more of the following symptoms which are not better explained by a known neurologic or medical disorder.

  • Anxiety (heightened anxiety, separation anxiety, irrational fears, panic episodes)

  • Tics

  • Emotional lability and/or Depression

  • Irritability, Aggression, and/or Severely Oppositional Behaviours

  • Behavioural (Developmental) Regression (increase in temper tantrums, loss of age-appropriate language, clingy behaviour not related to anxiety).

  • Sudden Deterioration in School Performance (due to difficulties with memory, concentration, hyperactivity, impulsivity, new deficits of visuospatial skills)

  • Motor or Sensory Abnormalities (dysgraphia, clumsiness, tics, new sensory sensitivities to light, noise, smell, taste or texture).

  • Insomnia and/or Sleep disturbances

  • Enuresis and/or Urinary frequency

  • Whilst not part of the diagnostic criteria, in approximately 25% of cases there have been reports of Psychosis and/or Hallucinations

For more information on diagnosis and treatment please click here.

PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)

PANDAS is a subset of PANS.  Similarly, it is a neuropsychiatric condition which is triggered by a misdirected immune response to a Streptococcal infection which results in a variety of symptoms as outlined below.  

PANDAS Diagnostic Criteria

Usually starting with an acute onset of obsessive compulsive disorder and/or tics, particularly multiple, complex or unusual tics.  PANDAS symptoms can then appear to wax and wane with the child experiencing flares periodically, following illness or periods of stress.  The child is usually between the ages of 3 and puberty when first symptoms occur and usually appear following a streptococcal infection such as Sinusitus, Ear infections or Scarlet Fever.  In some cases children can carry the streptococcus bacteria without showing signs of illness.

Whilst it is not a diagnostic requirement, in addition to OCD** and/or tics, children may also experience co-morbid symptoms similar to those seen in PANS.


For more information on diagnosis and treatment please click here.

We would like to note that the requirement within the diagnostic criteria for an abrupt or acute onset was originally stipulated in order to create a well-defined cohort of patients for research purposes. It is beginning to be acknowledged that onset may not always be as rapid as the diagnostic criteria currently state, however they have yet to be updated to reflect this.

** OCD may include any of the following:

  • Contamination obsessions and compulsions

  • Obsessions that harm will come to others and/or related compulsions

  • Sexual or religious obsessions

  • Repeating compulsions

  • Symmetry and exactness obsessions

  • Ordering/arranging compulsions

  • Counting compulsions

  • Checking obsessions or compulsions

  • Excessive reassurance seeking

  • Need to touch, tap or rub

  • Intrusive images, words, music or nonsense sounds

  • Ritualised eating behaviours

*** Severely restricted food intake may be related to contamination fears, obsessional fears of choking, or other obsessional fears including a new obsession with body image or weight.

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