Dr. Kumar’s Take:
This observational study found that children with PANDAS who took NSAIDs either before or early in a flare had shorter episodes of neuropsychiatric symptoms. These findings suggest a possible role for early anti-inflammatory treatment in managing this condition. While this was not a randomized trial, the results are compelling enough to justify further study.
Key Takeaways:
✔ NSAIDs taken early in a flare shortened symptom duration by about 2.6 weeks.
✔ Prophylactic NSAID use cut flare duration by around 4 weeks.
✔ Earlier treatment led to shorter flares, with each day of delay increasing the flare length slightly.
✔ No serious side effects were reported.
Actionable Tip:
If your child has PANDAS, keeping a journal of early flare signs and discussing a plan for NSAID use with your provider may help reduce the length and severity of symptoms. But remember, NSAIDS are only effective for reducing the symptoms of neuroinflammation. You still need to treat the causative infection, or the immune system will continue to create antibodies that attack the brain.
What This PANDAS Study Found
Researchers followed 95 children with PANS or PANDAS who experienced 390 total flares. They compared flares that were treated with NSAIDs to those that were not.
The main finding: flares that were treated with NSAIDs—especially early or as maintenance—tended to be shorter.
Study Design:
- Type: Observational study at a PANDAS specialty clinic
- Subjects: 95 children meeting strict PANS/PANDAS criteria
- Data: 390 flares tracked from onset to resolution
- Excluded: Flares that were ongoing, treated aggressively (like with IVIG), or given NSAIDs after 30 days
- Analysis: Used statistical models that adjusted for demographics and treatments
Results:
- No NSAIDs: Average flare duration was about 12.2 weeks
- Prophylactic NSAIDs: Flares were about 4 weeks shorter
- Early NSAID use (within 30 days): Flares were 2.6 weeks shorter
- Delaying NSAIDs: Every day of delay slightly lengthened the flare
- Side effects: None serious were reported
How NSAIDs Might Help in PANDAS
PANDAS is believed to be triggered by an abnormal immune response to infections like strep, causing inflammation in the brain. NSAIDs (like ibuprofen) reduce inflammation and might calm the immune response early in a flare.
By dampening this reaction, NSAIDs could reduce how long symptoms like OCD, tics, or eating issues last.
Related Studies and Research
PANDAS OCD Treatment Overview – Summarizes current treatment strategies for PANDAS-related OCD.
Tonsillectomy as a Treatment for PANDAS – Reviews the potential role of tonsil removal in reducing symptoms.
PANDAS Strep Antibiotic Recovery Study – Details how antibiotics affected symptom recurrence post-strep infection.
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
How soon should NSAIDs be started during a PANDAS flare?
Ideally, within the first 30 days of flare onset. Starting earlier may reduce the flare length even more.
What NSAIDs were used in the study?
The study did not specify brands, but commonly used NSAIDs include ibuprofen and naproxen. Always consult your doctor for dosing and safety.
Are there risks to using NSAIDs in children?
NSAIDs are generally safe short-term when dosed correctly, but long-term use may cause stomach or kidney issues. Your doctor can help assess the risks.
Can NSAIDs replace antibiotics or IVIG?
No. This study suggests NSAIDs may shorten flares, but they are not a cure. A full treatment plan for PANDAS may include antibiotics, immune therapy, or psychiatric support.
Conclusion
This study gives hope that early or preventive use of NSAIDs may help shorten painful, disruptive flares in children with PANDAS. While more research is needed, the findings support a simple, widely available intervention that could improve quality of life for families dealing with this condition.