Is there a link between Strep Throat and Symptoms of Autism?
We get asked this question a lot. Why? Because some people have read about the symptoms of PANS & PANDAS and think it is the same as autism. Why do they do this?
Simple because PANDAS has many similar symptoms as behaviours associated with autism. However in order to understand the link between STREP throat and these behaviours it is important that you know the history.
PANDAS is an acronym for paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections
PANDAS is the clinical cause of acute and sudden onset of obsessive compulsive disorder. In 1998 Dr Swedo (Chief of Paediatrics and Developmental Neuroscience for the National Institute of Mental Health) and colleagues coined the term to help diagnose 50 rare cases of sudden OCD following strep throat. It is believed that PANDAS is quite rare, however it is estimated to play a role in 1 in 10 new cases of OCD each year in the USA.
What is PANDAS then?
It is an autoimmune response to bacterial infection. Normally with any bacterial infection the body produces antibodies which help fight the bacteria from the body. However strep is unique as the proteins on the bacterium cell wall will resemble some proteins on human cells. The bodies reaction is to attack the healthy cell this can take place in joints, heart valves and certain parts of the brain. Specifically the ganglia.
Here is a quick video that helps you understand the role of the basal ganglia.
Why then is associated with autism you ask? Well the presentation of PANDAS specifically if given the list you make think it was explain the profile of a child or adult with autism
Motor or Sensory Abnormalities including but not restrictive to new sensory sensitives to light noise smell, taste and texture Dysgraphia, clumsiness, tics
Anxiety and anxiety attacks – similar to what we call in autism melt downs
Sudden regression in behaviours which present as temper tantrums, loss of age appropriate language, clingy behaviour though not specifically separation anxiety.
Problems at school – impulsivity, hyperactivity, changes to reasoning and processing of visuospatial environment.
Depression and/or irritability
Sleep issues including disturbance and insomnia
Urinary frequency and enuresis (bed wetting)
How is it different from autism?
Well typically it is dramatic and has been described as an overnight change. Many children with autism will present with different behaviours across a period of time.
Can PANDAS be treated?
The good news is absolutely. It can resolve on its own once STREP infection is treated with the correct antibiotics.
However in some cases the symptoms persist well beyond the initial recovery period after STREP. For that reason there are medical enquiries into treatment for inflammation. Other reported treatments include plasma exchange and immunoglobulin – however both have severe side effects.
CBT has been used in cases where OCD is severe to treat the symptoms and as with many behaviours CBT is used for it has success rates.
What do I do? - I think my child has PANDAS
Consultant your GP or Primary Care Physician immediately and ask them to consult for PANDAS. This may include taking throat culture to establish presence of STREP culture.