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Case Report: Pandas And Persistent Lyme Disease With Neuropsychiatric Symptoms: Treatment Resolution And Recovery
- 1Moleculera Labs, Oklahoma City, OK, United States
- 2Advanced Allergy, Immunology and Asthma, Darien, CT, United States
- 3Private Medical Practice, New Haven, CT, United States
This case report describes the diagnosis and treatment of a pre-pubertal Caucasian female with serological evidence of Lyme disease accompanied by multiple neuropsychiatric symptoms 6 months following a vacation in a tick endemic area of the United States. Prior to the diagnosis of Lyme disease, the patient also met the clinical diagnostic criteria for PANDAS , with serological evidence of three distinct episodes of streptococcal pharyngitis. All three episodes of strep occurred during the 6-months interval between suspected Lyme disease exposure and the onset of multiple neuropsychiatric symptoms. Her sometimes incapacitating symptoms followed a relapsing and remitting course that impacted her personal, family, social, and academic domains. Over a span of 31 consecutive months of treatment with various antimicrobials and three courses of intravenous immunoglobulins she experienced complete remission and remains symptom free at the time of this publication. Written permission was obtained from the minor patient’s mother allowing the submission and publication of this case study.
A Childs First Eight Years Critical For Substance Abuse Prevention
NIH releases summary of research on early childhood risk and protective factorsMarch 09, 2016An online guide about interventions in early childhood that can help prevent drug use and other unhealthy behaviors was launched today by the National Institute on Drug Abuse , part of the National Institutes of Health. The guide offers research-based principles that affect a childs self-control and overall mental health, starting
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What Is The Best Treatment For Pans
It is important that these kids be treated with antibiotics,11 although careful titration is necessary because Herxheimer reactions can be severe.
Dr. Amiram Katz, a neurologist in Connecticut, has found that low-dose penicillin injections have been very effective.12 I have had the same experience. Katz recommends long-acting penicillin injections , 600,000 units once weekly if the patient weighs less than 100 lbs, and 1.2 million units once weekly if more than 100 lbs. If there is no significant improvement after 10 doses, then there is no reason to continue.
Intravenous gammaglobulin has helped many kids with PANS.13 IVIG is composed of human antibodies and has the paradoxical function of stimulating the immune system while decreasing inflammation. It is administered intravenously or subcutaneously, often every three weeks. However, it is quite expensive and insurance coverage is difficult to procureexcept for residents of Illinois.
Other interventions are often helpful. Many kids with PANS have mast cell activation syndrome , which contributes to inflammation.14 In these cases, interventions such as antihistamines can be helpful. Cromolyn, which inhibits the release of histamine and other inflammatory mediators from mast cells, is particularly beneficial.
Why This Center Is Needed
Currently, when individuals in Massachusetts seek treatment for Lyme disease, other tick-borne illnesses, or PANS/PANDAS, they have limited options. They often need to travel long distances , spend time on a waitlist, or jump from doctor to doctor in search of someone who will understand pieces of their complex situation. Some patients are fortunate to find a suitable medical provider. All too often, however, these patients need more than traditional medical care. Families dealing with Lyme or PANS often endure tremendous strain in various areas of their lives. They may have weakened their abilities to deal with stress, lost meaningful relationships, or suffered set-backs at work or in school. In our experience, the most effective approach is multidisciplinary treatment involving coordinated care at a single location.
The Lyme and PANS Treatment Center offers multidisciplinary services to patients at a single location in Hingham, Massachusetts. If you need assistance .
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These Are The Services We Have Available For All Patients
- Adult and child medical care, including holistic, functional, and integrative medical approaches
- Lyme disease and tick-borne illness evaluations and treatments
- PANS/PANDAS evaluations and treatments
- Support groups for children, teens, and parents
- Parenting support
Elena Monarch Ph.D.
Dr. Elena Monarch obtained her Ph.D. in Clinical Psychology from Emory University in Atlanta. She has worked in the field of neuropsychology for twenty years. Dr. Monarch has published research in the areas of health psychology, emotion/fear, and neuropsychology. Over the last eleven years, her expertise in evaluations enabled her to identify physical causes of numerous psychiatric symptoms. After attending conferences, coordinating care with physicians, and listening carefully to her patients, Dr. Monarch began identifying and treating children and teens with PANS/PANDAS and tick-borne illnesses. Dr. Monarch has had the opportunity to help patients recover from illnesses and resume their healthy lives.
What Treatments Are Available For Pans And Pandas
The first step is to determine the underlying cause of your childs behavior. PANS and PANDAS isnt the only disease that can cause OCD and tics. Your doctor at Fairfield Family Health performs specialized testing to rule out other possibilities, such as Lyme disease.
Treatment for PANS and PANDAS includes several therapies to heal your childs immune system, eliminate the bacteria, reduce inflammation, and restore balance.
As naturopathic specialists, the team at Fairfield Family Health believes in the medical value of food and nutrition, so part of your childs treatment includes a healthy eating plan, vitamins, and supplements.
Your child may also receive herbal medicine or homeopathic mixtures to fight the bacteria, strengthen their immune system, and generally support their overall health.
If your child develops sudden, unexplainable behavioral and emotional changes, call Fairfield Family Health or book an appointment online.
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Welcome To The Lyme & Pans Treatment Center
It is increasingly clear that many children and adults in New England suffer from tick-borne illnesses such as Lyme disease. At the same time, there is confusion about the signs, symptoms, and treatment protocols for these disorders. When left untreated, bacteria, such as Lyme and certain strains of strep, can produce unexpected neuropsychiatric symptoms. Lack of awareness on the part of patients and their doctors can contribute to misdiagnosis, prolonged illness, and other complications, e.g., Pediatric Acute-onset Neuropsychiatric Syndrome or PANS.
The Lyme & PANS Treatment Center is a multidisciplinary practice that offers integrative, patient-centered, coordinated care. Our dedicated team of doctors, psychologists, dietary & health coaches, acupuncturists and other healing practitioners work together to treat adults and children who suffer from often persistent conditions including, but not limited to, Lyme Disease, tick-borne co-infections, PANS and PANDAS . We understand that these illnesses can be difficult to treat and the toll they can take both physically and emotionally for the patient as well as the entire family unit.
Our goal as a center is to provide treatment options and support patients with these complex, often misunderstood conditions using a combination of eastern and western medicine coupled with a whole body approach to healing.
Elena Monarch Ph.D.
About Lyme And Pans Treatment Center:
Lyme and Pans Treatment Center is located at 223 Chief Justice Cushing Hwy in Cohasset, MA – Norfolk County and is a business listed in the categories Outpatient Clinics, All Other Outpatient Care Centers, Specialty Outpatient Facilities, Nec and Treatment Centers. After you do business with Lyme and Pans Treatment Center, please leave a review to help other people and improve hubbiz. Also, don’t forget to mention Hubbiz to Lyme and Pans Treatment Center.
Categories: Outpatient Clinics, All Other Outpatient Care Centers, Specialty Outpatient Facilities, Nec and Treatment Centers
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Pans & Lyme Disease Dr Delaney
Lyme disease, PANS, and the Columbia University Lyme & Tick-borne Research Center.
Shannon L. Delaney, MD, Director, Child and Adolescent Evaluation, Lyme & Tick-borne Research Center, is a neuropsychiatrist at Columbia University Irving Medical Center who is co-investigator with Brian Fallon, MD on studies of adults and children with Lyme disease. Her clinical research has focused on immune and infectious contributions to psychiatric disease, especially psychosis in children and young adults. She specializes in seeing children and adults with complex neuropsychiatric presentations, especially those with suspected Lyme disease or other tick-borne illnesses, as well as those with Pediatric Acute-onset Neuropsychiatric Syndrome . Dr. Delaney provides assessments and a detailed referral with treatment recommendations for children and young adults with complex neuropsychiatric presentations due to a variety of infectious and immune causes of neuropsychiatric disorders. Dr. Delaneys profile
Gabriella: First, I would like to thank Dr. Delaney for being a member of the ASPIRE Professional Advisory Board. Thank you for taking the time to sit with us and talk about Lyme disease, PANS, and the Columbia University Lyme & Tick-borne Research Center.
Gabriella: So, who is treating your patients that you consult with?
Gabriella: Lets talk about testing. What labs are you currently using for Lyme and co-infections?
Gabriella: Can a treatment trial be used to form a clinical diagnosis?
Integrative Medicine Clinic & Lyme Disease Specialists Located In Fairfield Ct
PANS and PANDAS is the acronym for one of the most confusing and distressing problems a parent can face, as it causes a sudden and severe change in their childs emotional and behavioral health. The doctors at Fairfield Family Health are uniquely equipped to help children with PANS and PANDAS by using natural treatments that relieve symptoms and restore health and balance to your child without causing side effects. If you need help with your childs health, call the office in Fairfield, Connecticut, or schedule an appointment online.
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Pans Can Be Characterized By An Abrupt Onset Of Ocd Behaviors
The PANS classification was introduced in 2012 by a team of researchers and medical experts from the National Institute of Mental Health . PANS is caused when an infectious agent triggers your childs immune system to malfunction. The body produces antibodies to fight the infection. But with PANS patients, those antibodies are misguided and instead of attacking the infectious agent, they attack the healthy cells in the basal ganglia section of the brain, causing inflammation and symptoms.
PANS is characterized by an abrupt onset of obsessive-compulsive behaviors or severely restricted food intake, along with the concurrent presence of severe and acute neuropsychiatric symptoms from at least two of the following categories: anxiety emotional lability or depression irritability, aggression and/or severe oppositional behaviors behavioral regression sudden deterioration in school performance motor or sensory abnormalities somatic signs and symptoms .
Problem Foods Can Trigger Inflammation
Food sensitivities can also contribute to inflammation,15 so parents should consider specialized testing or an elimination/challenge diet. Be particularly suspicious of food cravingsthe foods people crave are often the worst offenders.16
In my practice, sugar, yeast, gluten, and dairy products are the most common culprits. Mold can trigger inflammation as well. Even though I live in Colorado, a low-humidity state, I am amazed at how many of my patients suffer from mold issues.
Other interventions are occasionally beneficial. Anti-inflammatory agents, whether ibuprofen or natural products such as curcumin, may help. Some people find that low-dose naltrexone decreases symptoms. Family counseling and support groups are also a good idea. Occasionally, antidepressantsparticularly sertralinecan lessen symptoms.
These kids are suffering a great deal. If we do careful detective work and treat the sources of their inflammation as well as the inflammation itself, we can help them get their lives back.
Other modalities that sometimes prove helpful include biofeedback and plasmapheresis, a procedure in which blood is removed and antibodies are filtered out before the blood is replaced.12
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Neurology And Psychiatry Join Forces To Study Pediatric Acute
To help children with infection- or immune-triggered neuropsychiatric disorders, a team of clinical researchers at Columbia University Irving Medical Center will join basic scientists to both study and care for children and young adults afflicted with these serious disorders. The criteria for PANDAS were modified in 2012 by Dr. Susan Swedo of the NIH to include a larger group of acute-onset environmentally-triggered disorders, now known collectively as PANS . The diagnosis of PANDAS is made when it is clear that infection with Group A Strep is connected to the onset of Obsessive Compulsive Disorder and/or Tics. PANS widens the scope to include neuropsychiatric disorders triggered by any infectious agent as well as non-infectious environmental triggers.
Frequently Asked Questions :
- Where is Lyme and PANS Treatment Center?
Lyme and PANS Treatment Center is located at: 223 Chief Justice Cushing Hwy, Cohasset, Massachusetts 02025.
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- What is the phone number of Lyme and PANS Treatment Center?
You can try to dialing this number: 923-7000 – or find more information on their website: www.lymeandpanstreatmentcenter.com
- What is the opening hours of Lyme and PANS Treatment Center?
Monday: 09:00 – 17:00
- Where are the coordinates of the Lyme and PANS Treatment Center?
Latitude: 42.2405080257 Longitude: -70.830120589
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Elevation Of Antineuronal Antibodies In Pans
Elevation of these antibodies, along with activation of a specific enzyme is the laboratory hallmark of PANS.7
In the 1990s, Dr. Madeleine Cunningham and colleagues performed groundbreaking research to demonstrate the association of these lab abnormalities in kids with this disorder.8
It turns out that antibodies that target some microbes attack neuronal tissue and activate CaMKII, which disrupts dopamine transmission.9 The result is brain on fireneuroinflammation that triggers a host of neuropsychiatric symptoms.
Children with PANS display a wide array of mood and behavior issues, especially anxiety, obsessive-compulsive disorder, depression, and irritability/oppositional/anger issues, which can reach epic proportions like Brads. Interestingly, many outbursts are followed by remorse.
Children with PANS often fall behind developmentally and academically. Other common symptoms include involuntary movements, tics, and eating disorders. While the case definition of PANS limits the diagnosis to symptoms that have a sudden onset,10 most of my patients symptoms have come on gradually.
In my medical practice , I see many children and teens. I have been surprised by how many suffer from PANS. While they all have Lyme disease, it appears that Bartonella and Mycoplasma may be the worst offenders in triggering PANS.
Pans Effects Children & Adolescentscausing Debilitating Symptoms
Lyme disease has been identified as one of the many infections capable of triggering a condition termed, pediatric acute-onset neuropsychiatric syndrome . The disorder, which effects children and adolescents, can cause debilitating symptoms, including OCD, eating disorders, anxiety, mood swings, and attention deficit disorder. PANS and Lyme disease also share similarities. Differentiating the two medical conditions can be challenging, as symptoms of PANS and Lyme disease can overlap. Getting a correct diagnosis is important since treatments for each may be different and treatment delays can make symptoms worse.
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What Causes Pans And Pandas
Researchers believe that PANS is caused by the bodys immune reaction to an actual infection. PANDAS is specifically associated with a streptococcal infection, such as strep throat. In some cases, the onset of PANS is the first sign of an underlying infection.
You might not associate your childs abrupt behavioral and emotional changes with an illness because they can carry infections without developing symptoms. It may sound odd that your child can have an infection without symptoms, but bacteria, such as strep, can hide and live inside your body without triggering an immune response.
For example, the same type of strep that gives rise to PANDAS also causes pharyngitis. The bacteria can thrive in the pharynx without causing signs of disease until sudden complications like an abscess or rheumatic fever arise.
What Symptoms Define Pans And Pandas
Youll understand why everyone uses the acronym when you learn what PANS and PANDAS means. PANS is pediatric acute-onset neuropsychiatric syndrome. PANDAS stands for pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection.
PANS is a neuropsychiatric disorder that occurs after the age of 3 and before puberty. The condition is diagnosed when:
- Obsessive-compulsive disorder or a tic disorder suddenly appears following a strep infection
- Symptoms of preexisting OCD or tic disorder worsen following a strep infection
Children with PANS and PANDAS develop psychological and behavioral problems such as:
- Changes in motor abilities like handwriting
The symptoms of PANDAS develop dramatically and suddenly, often appearing overnight.
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