Dr. Kumar’s Take:
This was the largest randomized controlled trial to date testing intravenous immunoglobulin (IVIG) for children with PANDAS and moderate to severe OCD. During the double-blind phase, IVIG showed better results compared to placebo, though this difference was not statistically significant. But after the study, pateints who had received the placebo were then given IVIG and saw a 50% improvement at 12 weeks and 62% improvement at 24 weeks. The study was safe, well-designed, and gives us another tool in our fight against PANDAS.
Key Takeaways:
✔ IVIG was safe and well tolerated in children with PANDAS.
✔ In the double-blind phase, IVIG did not significantly outperform placebo.
✔ In the open-label phase, most kids improved by over 50 percent on OCD scores.
✔ More research is needed to identify which kids benefit most.
Actionable Tip:
If your child has sudden OCD symptoms following a strep infection, ask your doctor about PANDAS. Keep a symptom diary and track response to any treatments. Immune-based therapies may help, but first line therapy should still be antibiotics.
What Is This Study About?
This 6-week randomized, placebo-controlled trial studied 35 children with PANDAS—an autoimmune brain disorder triggered by strep that can cause OCD, tics, anxiety, and behavior changes. Researchers tested whether IVIG could reduce OCD symptoms and improve functioning.
Children received either IVIG or placebo for two days, followed by monitoring at 6, 12, and 24 weeks. Those who did not respond in the double-blind phase were offered IVIG openly in the next phase.
Study Design:
- Participants: 35 children (ages not specified) diagnosed with PANDAS and moderate to severe OCD
- Design: Double-blind, randomized, placebo-controlled trial
- Treatment: IVIG 1 g/kg/day for 2 days vs placebo
- Follow-up: 6, 12, and 24 weeks
- Main Measures:
- Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS)
- Clinical Global Impressions–Improvement (CGI-I)
- Responder Definition: ≥30% drop in CY-BOCS and a rating of “much” or “very much improved” on CGI-I
Results:
- Double-Blind Phase:
- IVIG group improved OCD scores by 24%
- Placebo group improved by 12%
- 35% of IVIG group responded vs 22% in placebo
- The difference was not statistically significant
- Open-Label Phase:
- Children who received IVIG after placebo improved by 55% at 12 weeks
- Improvements reached 62% by 24 weeks
- The majority of children benefited by the end
How IVIG May Help in PANDAS
PANDAS is believed to occur when the immune system mistakenly attacks parts of the brain after a strep infection. IVIG provides healthy antibodies that may calm this response. It works by:
- Neutralizing harmful autoantibodies
- Modulating immune cells
- Possibly repairing immune balance in the brain
The study didn’t prove that IVIG works for all children with PANDAS, but the open-label results suggest that some children respond well—especially if standard OCD treatments don’t help.
Related Studies and Research
This trial builds on smaller studies showing potential benefit from IVIG, steroids, and plasma exchange in PANDAS. It’s part of a growing effort to understand autoimmune contributions to mental health.
Related Studies and Research
Tonsillectomy as a Treatment for PANDAS – Reviews the potential role of tonsil removal in reducing symptoms.
PANS Treatment: Large Survey Study – Examines treatment trends and outcomes in a large community-based sample.
PANDAS OCD Treatment Overview – Summarizes current treatment strategies for PANDAS-related OCD.
Podcast: Could Your Child’s Behavior Changes Be Cured with an Antibiotic? – A deep dive into the link between strep infections and dramatic neuropsychiatric symptoms.
Frequently Asked Questions
What is IVIG?
IVIG is a blood product made from pooled antibodies from healthy donors. It’s used to treat autoimmune and inflammatory conditions by modulating the immune system.
How long does IVIG take to work for PANDAS?
In this study, most children showed significant improvement within 6 to 12 weeks after treatment.
Is IVIG safe for kids?
Yes. The study found IVIG to be safe and well tolerated. No serious side effects were reported.
Should my child with PANDAS get IVIG?
IVIG is considered a second-line treatment. It’s best reserved for moderate to severe cases that don’t respond to behavioral therapy or antibiotics. Always work with a PANDAS-experienced clinician.
Conclusion
IVIG shows promise for treating some children with PANDAS, especially those with severe OCD symptoms after strep infections. While this study did not find a statistically significant benefit in the double-blind phase, most children improved in the open-label phase. The therapy is safe and may help those who don’t respond to first-line treatments.