If you’re a parent, chances are high you’re familiar with strep infections. Strep bacteria enter the nasopharynx (throat and nose area) and cause a bacterial infection. This usually manifests in symptoms like sore throat or sinusitis.

Unfortunately, a sore throat isn’t the only complication that can result from strep bacteria. Research has long connected strep infections to conditions from meningitis to endocarditis. 

More recently, Group A streptococci infections in children have correlated with severe neurological and mental health symptoms. This is a condition known as PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.

PANDAS is also related to a similar condition called PANS, or Pediatric Autoimmune Neuropsychiatric Disorders. However, PANDAS can occur only following a strep infection, whereas PANS requires no strep infection. 

Both PANS and PANDAS can lead to the unexpected and rapid development of OCD (obsessive-compulsive disorder) symptoms and other neurological disturbances. 

What causes PANDAS? This question stumped scientists for years. But recent research has given us greater insight into how strep gets into the brain and what happens when it does.

What happens when strep goes to the brain?

We know that a strep infection generally starts in the nose and throat area. Pathogens enter the bloodstream, a condition known as bacteremia. This triggers the activation of the body’s immune response. The immune system begins to produce antibodies like neutrophil cytokine proteins to fight these pathogens.

Normally, this process is a good thing. It’s our body’s way of fighting off infection. However, strep bacteria are tricky. The molecules in the bacteria’s cell wall are similar to those found in certain human cell membranes. Because of these similarities, if strep gets into the brain, the body’s own immune system can start attacking brain tissue.

Typically, this doesn’t happen. The blood vessels of the brain form an extremely tight blood-brain barrier. This protects the brain and the central nervous system from the autoantibodies released into the blood. 

However, recent research suggests a new answer. Certain bacterial antibodies can move into the brain from the olfactory (or smell) receptors in the nasal cavity to the brain’s olfactory bulb.

Can a throat infection spread to your brain? A throat infection cannot technically “spread” to the brain. However, strep antibodies can enter the brain and cause neurological symptoms.

Generally, PANDAS develops in children between 3 and 12 years old. It usually occurs after an infection of Group A Streptococcus, or GAS. This includes certain strains of strep bacteria, such as Streptococcus pyogenes. However, Group B Streptococcus can also cause PANDAS and other neurological conditions.

What are the symptoms when strep affects the brain?

One of the typical hallmarks of PANDAS is the quick onset of intense symptoms like OCD. These usually develop within a few days or, in some cases, weeks. 

Beyond sudden OCD symptoms, you may see symptoms like:

  • Eating disorder, restricted eating, body dysmorphia
  • General anxiety, separation anxiety, irrational fears
  • Emotional lability (AKA sudden mood swings), depression, suicidal thoughts
  • Aggression or irritability
  • Behavioral regression, baby talk, loss of ability to draw
  • Drop in academic performance, decreased attention span
  • Night terrors, insomnia
  • Bedwetting, change in urinary frequency or urgency
  • Sensitivity to light, sounds, smells, tastes, and textures
  • Brief hallucinations
  • Dysgraphia (deterioration of handwriting)
  • Clumsiness
  • Physical or vocal tics
  • Sydenham chorea (involuntary muscle movements)

Can strep cause neurological problems? Yes, PANDAS can cause severe neurological issues if left untreated. 

Can you die from strep in the brain? Typically, you cannot die from strep in the brain, but untreated symptoms can dramatically disrupt a patient’s daily life.

Can strep cause seizures? Strep cannot cause seizures. PANDAS can cause tics and involuntary muscle movements.

Diagnosing PANDAS

Case reports often show similarities between PANDAS and other neurological and behavioral conditions. Because of these similarities, the condition is often misdiagnosed. The critical marker is the presence of strep bacteria. Your pediatrician may find this through tests such as:

  • Throat cultures
  • Stool samples
  • Nasal cavity samples
  • Blood tests

Unfortunately, not all PANDAS patients test for the presence of strep bacteria. This is one reason a PANDAS diagnosis can be somewhat controversial.

Another important factor is to note that at least 2 of the 7 major symptoms of PANDAS have occurred sudden onset. Your pediatrician will likely ask about some of the symptoms listed above, such as:

  • Anxiety
  • Emotional lability/depression
  • Oppositional/aggressive behaviors
  • Emotional or behavioral regression
  • Deterioration in learning abilities or school performance
  • Sensory and motor abnormalities
  • Other somatic signs and symptoms, like changes in sleep or urination habits

Lastly, your pediatrician will need to rule out other neurological conditions with similar symptoms. Such immune-related and autoimmune disorders include rheumatic fever, Sydenham’s chorea, and scarlet fever.

What is the treatment for PANDAS?

Since a strep infection causes PANDAS, starting treatment with antibiotics and antimicrobials is important. Penicillin and medications such as ceftriaxone can be used to treat the strep infection. However, herbal and antibiotics may be a better treatment option. Conventional antibiotics can damage the gut microbiome and end up making symptoms worse. 

Immunomodulatory treatments can also be used to support the immune system and reduce inflammation that triggers symptoms. These may include peptide therapy, dietary changes such as the GAPS diet, and supplements like vitamin D, probiotics, and cilantro.

My child had strep in the brain. Symptoms persist; what do I do now?

PANDAS can have significant psychological effects. In this case, a combination of treatment options can often help with long-term treatment. For instance, cognitive behavioral therapy (CBT) might help with some of the anxiety and OCD symptoms that come with PANDAS. 

One clinical trial found that OCD symptoms caused by PANS and PANDAS decreased by 49% in all participants when treated with CBT. The trial was small, including only 8 patients, but all patients maintained improvements over time.

Other additional PANDAS treatments may include:

  • Plasma exchange, or plasmapheresis
  • Corticosteroid therapy
  • Intravenous immunoglobulin (IVIG)
  • Anti-inflammatories, antihistamines, antifungals, antibacterials
  • Additional supplementation such as fermented cod liver oil

Individualized Treatment Plans For Whole Body Healing

PANDAS is a rare and complex condition. Not all doctors are familiar with PANDAS or its treatment options. If your child is suffering from PANDAS or PANS, or you suspect they are, we’re here to help. 

The M Center believes in holistic health solutions personalized for every patient’s needs.

Book a consultation with us today, and let us discover how we can best serve you.

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