Dr. Kumar’s Take:
This large Stanford study looked at how well oral steroids work for kids with PANS or PANDAS. It found that corticosteroids helped shorten flares, especially when given early. Kids who took steroids had faster improvement and more durable relief. While not a cure, this approach may offer families a tool to get their child back to baseline faster, especially if used at the right time and for long enough. A well-designed clinical trial is still needed, but the results are promising.
Key Takeaways:
✔ Steroids shortened flare duration by nearly 5 weeks.
✔ Early treatment worked better than delayed use.
✔ Longer steroid courses led to more lasting symptom relief.
✔ Most children responded positively, though side effects were common.
Actionable tip:
If your child is having a severe PANS flare and infections have been treated or ruled out, ask your doctor whether a short course of corticosteroids is appropriate. Early use may help reduce the length and intensity of symptoms.
Brief Summary:
This observational study from the Stanford PANS Clinic analyzed 85 flares in 98 children with PANS or PANDAS. Some flares were treated with short or long courses of oral corticosteroids, while others were not. The study found that corticosteroids shortened the average flare duration and led to quicker improvement in symptoms. Children treated earlier in the flare had better outcomes. Although some experienced side effects, most were temporary.
Study Design:
- Type: Retrospective observational study
- Setting: Stanford PANS Clinic
- Participants: 98 children with a single or relapsing/remitting episode of PANS or PANDAS
- Data: 403 flares total; 85 treated with 102 oral corticosteroid courses
- Time Frame: September 2012 to January 2016
- Analysis: Multilevel random-effects modeling with multiple covariates controlled
Results:
- Shorter flares: Flares treated with corticosteroids lasted 6.4 weeks on average versus 11.4 weeks without (p < 0.001)
- Early steroids worked better: Each day of delay led to longer flare duration
- More lasting relief: Longer steroid courses increased the duration of symptom improvement (p = 0.014)
- Positive responses: 79% of flares treated with steroids showed improvement
- Side effects: 44% of steroid courses had side effects, mostly mild or short-lived; 3 courses were stopped early due to severity
- Relapse rates: High relapse rates suggest steroids may need to be part of a broader treatment plan
How Corticosteroids Might Help in PANS
PANS and PANDAS are believed to involve inflammation in the brain, especially in the basal ganglia. Steroids reduce inflammation and suppress overactive immune responses. In this study, they seemed to help calm symptoms faster, possibly by quieting microglial activity and reducing blood-brain barrier permeability.
Related Studies and Research
Tonsillectomy as a Treatment for PANDAS – Reviews the potential role of tonsil removal in reducing symptoms.
Azithromycin for PANS-Related OCD – Evaluates the role of azithromycin in treating obsessive-compulsive symptoms.
IVIG for PANDAS: Pediatric OCD Trial – Reviews IVIG’s effectiveness in a randomized trial.
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 PANS?
PANS stands for Pediatric Acute-Onset Neuropsychiatric Syndrome. It involves sudden onset OCD or eating restrictions plus other severe symptoms like anxiety, mood swings, or tics.
Is this the same as PANDAS?
PANDAS is a subtype of PANS triggered by a strep infection. Both involve similar immune-related brain inflammation and symptoms.
Are steroids safe for kids with PANS?
Short courses of steroids were mostly safe in this study, though nearly half of the patients had temporary side effects. Long-term use may lead to weight gain and Cushingoid features.
When is the best time to start steroids?
Earlier is better. The sooner steroids were started during a flare, the shorter the flare lasted. Delays reduced their effectiveness.
Are steroids a cure for PANS?
No. Many children relapse after treatment. Steroids can help manage flares, but long-term management often requires more comprehensive care.
Conclusion
This Stanford study provides strong observational evidence that oral corticosteroids may be a useful tool in managing PANS and PANDAS. While not a cure, they appear to reduce flare duration and improve symptoms, especially when started early and used for a longer course. The findings support the need for a randomized, placebo-controlled trial to formally evaluate their effectiveness.
Families should work closely with experienced clinicians and weigh the benefits and risks of steroid use. In many cases, a carefully supervised steroid burst may offer much-needed relief in the midst of a PANS flare.