Can Preventing Strep Help Kids with PANDAS? A Closer Look at Prophylactic Antibiotics

Dr. Kumar’s Take:

This study from the National Institute of Mental Health (NIMH) explored whether giving antibiotics could prevent strep-triggered neuropsychiatric flares in children with PANDAS. While the approach was well-structured and targeted, the overall results showed only modest benefit. However, for children with a strong pattern of symptom worsening after strep infections, this research supports considering prophylactic antibiotics as part of a carefully monitored plan.

Key Takeaways:

✔ Study included 37 children with PANDAS over a one-year period.
✔ Participants received either penicillin or azithromycin to prevent strep infections.
✔ Antibiotics slightly reduced strep infections, but did not significantly reduce neuropsychiatric flares.
✔ Strict monthly monitoring and symptom scoring were used to track changes.
✔ If a child developed a strep infection during the study, their study antibiotic was paused and treated with another class of antibiotic.

Read more

Do Steroids Help Kids with PANS Recover Faster? A Closer Look

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.

Read more

What Really Works for PANS or PANDAS? A Review of 698 Cases

Dr. Kumar’s Take:

This large community-based survey gives us one of the clearest pictures yet of what works, and what doesn’t, for treating PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) or PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus). The key insight? Aggressive early treatment of infections and inflammation works better than just psych meds. Long courses of broad-spectrum antibiotics, IVIG in immune-deficient patients, and even common NSAIDs like ibuprofen made a measurable impact. SSRIs and psych meds were hit-or-miss, often poorly tolerated. If your child is struggling with sudden-onset OCD or tics, make sure infections and inflammation are fully addressed. Don’t stop at psychiatric meds alone.

Read more

Can Tonsillectomy Help Kids with PANDAS? A Look at the Evidence

Dr. Kumar’s Take:

This study adds to the small but growing body of research on tonsillectomy as a possible treatment for PANDAS, especially when antibiotics fail. While it’s a small retrospective case series, the findings are promising: 9 out of 10 kids experienced symptom relief after tonsillectomy, and 4 had complete resolution. For families struggling with recurrent strep infections and persistent OCD or tics, this could offer an additional option to consider.

Read more

Plasma Apheresis Shows Promise for Severe PANDAS Cases

Dr. Kumar’s Take:

This case series from Georgetown University offers strong clinical evidence that therapeutic plasma apheresis (TPA) can bring life-changing improvements for children suffering from severe PANDAS. Most had already failed standard therapies, yet showed an average 65% improvement at 6 months and 78% improvement at long-term follow-up. TPA seems especially helpful when symptoms are extreme—such as aggression, suicidality, or dangerous food refusal. It’s not a first-line treatment, but it can be a critical option when all else fails.

Read more

Can NSAIDs Help Kids with PANDAS Feel Better Faster?

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.

Read more

Can Azithromycin Help Kids With Sudden OCD? A Closer Look at PANDAS and PANS

Dr. Kumar’s Take:

This small pilot study suggests that azithromycin, a common antibiotic, may reduce OCD symptoms in children with PANDAS or PANS, especially if tics are also present. While results were mixed across different rating scales, but many children improved noticeably within just 4 weeks.

Key Takeaways:

✔ Azithromycin led to a stronger drop in OCD symptoms on one key clinical scale.
✔ More kids in the azithromycin group met the “treatment responder” criteria.
✔ Children with tics showed even more improvement.
✔ No major side effects, but possible heart rhythm issues mean caution is needed.

Read more

Do Surgeries or Medications Help Kids with PANDAS OCD? Here's What the Research Shows

Dr. Kumar’s Take:

This systematic review looked at whether medical treatments like antibiotics, IVIG, and steroids—or surgical options like tonsil and adenoid removal—help improve OCD symptoms in kids with PANDAS or PANS.

While both surgery and medication showed benefits, one treament didn’t stand out over the others. This highlights the urgent need for larger, high-quality studies with clear protocols. Until then, treatments should be individualized and often involve a combination of approaches.

Read more

IVIG for PANDAS: Can Immunotherapy Help Kids with Sudden OCD?

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.

Read more

PANDAS Triggered by Strep and Rapid Recovery with Antibiotics

Dr. Kumar’s Take on PANDAS

This study shows that PANDAS can appear suddenly in children after a mild group A strep infection and that treating the infection quickly often leads to rapid symptom relief. The real opportunity is early recognition: a child with abrupt OCD, separation anxiety, tics, or behavioral shifts should trigger evaluation for PANDAS with throat testing and prompt antibiotic therapy.

Key Takeaways

✔ PANDAS episodes were prospectively linked to recent group A streptococcal infections in a primary care setting.
✔ Antibiotics at the first PANDAS flare led to symptom improvement usually within two weeks.
✔ Recurrences of PANDAS aligned with new strep infections and again responded to antibiotics.
✔ More prior strep exposures before onset predicted a relapsing PANDAS course.
✔ Strep triggers were often clinically mild, so PANDAS can be missed without active suspicion.

Read more