Introduction
The term PANDAS stands for paediatric autoimmune neuropsychiatric disorders associated with streptococcus. The syndrome involves sudden and often major changes in personality, behaviour, and movement in children following an infection involving Streptococcus pyogenes (streptococcal-A infection).
Strep infections can be mild, causing nothing more than a minor skin infection or sore throat. On the other hand, they can cause severe strep throat, scarlet fever, and other complications. Strep is found inside the throat and on the surface of the skin. It is contracted when an infected person coughs or sneezes and a non-infected person breathe in the droplets or touch contaminated surfaces, and then touch the face.
Most people with a strep infection make a full recovery. However, some children develop sudden physical and psychiatric symptoms a few weeks after infection. Once they start, these symptoms tend to rapidly get worse.
Signs & symptoms
Usually, symptoms of PANDAS develop about four to six weeks after a strep infection. They start all of a sudden and get worse within two to three days. They include physical, and psychological manifestations. These symptoms can interfere with schooling and quickly become debilitating. Other childhood psychiatric illnesses develop gradually but PANDAS shows a quick pathology.
Psychological symptoms may include:
obsessive, compulsive, and repetitive behaviours
separation anxiety, fear, and panic attacks
unstoppable screaming, irritability, and frequent mood changes
emotional and developmental regression
visual or auditory hallucinations
depression and suicidal thoughts
Physical symptoms may include:
tics and unusual movements
sensitivities to light, sound, and touch
deterioration of small motor skills or poor handwriting
hyperactivity or inability to focus
memory problems
trouble sleeping
refusing to eat, which can lead to weight loss
joint pain
frequent urination and bedwetting
near catatonic state
Children with PANDAS don’t always have all of these symptoms, but they generally have a mix of several physical and psychiatric symptoms.
Causes
The exact cause of PANDAS is unknown.
Some experts consider it as an auto immune response to Streptococcus infection
Pathophysiology
The exact pathophysiology of PANDAS is still unknown, but the current hypothesis is that a group A β-hemolytic streptococcal (GABHS) infection results in an autoimmune-mediated process involving antineuronal antibodies.
Medical history
Physical and psychiatric evaluation
Throat culture
Blood tests for infection
Treatments
Treatment of PANDAS is multidimensional. It involves addressing both the physical and psychiatric symptoms. It is important to make sure the strep infection is completely gone.
Treating the strep infection
Strep infections are treated with antibiotics. Most strep infections are successfully treated with a single course of antibiotics. Some of the antibiotics used in this condition include:
amoxicillin
azithromycin
cephalosporin
penicillin
Treating psychological symptoms
Psychiatric symptoms may start to improve with antibiotics, but they’ll likely still need to be addressed separately. OCD and other psychiatric symptoms are generally treated with cognitive behavioural therapy.
OCD also usually responds well to selective serotonin reuptake inhibitors, a type of antidepressant. Some common ones include:
fluoxetine
fluvoxamine
sertraline
paroxetine
These medications will be prescribed in small doses to start. They can be slowly increased if necessary.
Other treatments like corticosteroids, such as prednisone are used in some cases.
In unresponsive cases, a blood plasma exchange to remove the faulty antibodies from their blood is sometimes recommended.
Intravenous immunoglobulin therapy uses healthy donor blood plasma products to help boost the child’s immune system.
No long-term studies of children with PANDAS have been done yet as the disease is identified only in 1998. Some children show excellent prognosis once antibiotics are started. Most of them recover without significant long-term symptoms. For others, it can become an ongoing problem requiring periodic use of antibiotics to control infections that may cause flare-ups.
Complications
Inability to function at school or public places
Poor family and social life.
Permanent cognitive damage.
Disease & Ayurveda
There is no exact correlated disease in Ayurveda to PANDAS. As it is an infectious disease that affects both physically and mentally, multidimensional approach is needed in the treatment. As there are mostly psychological or psychosomatic signs and symptoms are included with chronic degenerative changes in the body over time, it is considered as Vaata-Pitta predominant unmaada with a Vaata imbalance affecting the body. In the case it is considered as an external infestation, it is correlated to the condition of Krimi also.
Nidana
Suklartava dushti (Genetic or hereditary)
Aagantuja (environmental/infectious)
Purvaaroopa
Not mentioned
Samprapti
Due to causative factors, the doshas get aggravated and when they affect the child’s body and mind simultaneously many signs & symptoms of the disease manifest.
Lakshana
Emotionally unstable
Fearful
Forgetful
Less body mass index
Convulsive actions
Weakness of muscles and body
Aggression
Memory problems
Sleep problems
Sensitive to light, sound or touch
Etc.
Divisions
Not mentioned
Prognosis
Kricchrasadhya or Yaapya
Chikithsa
Ayurveda treatment for PANDAS highly vary individually as it solely depends upon the patient. Age, strength, history, body constitution, mental etc. should be considered while treating the condition. As in many other psychiatric and psychosomatic conditions & Krimi, removing obstructions in channels, cleaning the bowels and entire body will relieve the infection and cure the disease in most of the cases. Follow up will be needed for proper strengthening of the weakened system.
Samana
Aamapachanam
Agnideepanam
Rasayanam
Brumhanam
Sodhana
Vamanam
Virechanam
Nasyam
Asthapanavasti
Snehavasti
Snehana-abhyanga, siropichu, sirovasti, talam
Swedana
Commonly used medicines
Mridweekadi kashayam
Kallyanakaghrutam
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
No home remedies are proven scientifically to cure PANDAS. But relaxation techniques, meditation, yoga and pranayama can help the person to Improve the quality of life.
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, ghee
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from extreme hot & cold climates.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule. Avoid keeping awake late night.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle.
Yoga
Regular stretching and mild cardio exercises are advised. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/books/NBK333433/
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
Through Ayurvedaforall Dr. Nair offers online consultation to patients worldwide and has served hundreds of patients over the last 20 years. In addition to his Ayurvedic practice, he is the chief editor of ayurveda-amai.org, the online portal of Ayurveda Medical Association of India, and the state committee member of Ayurveda Medical Association of India.
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