Strep infection and PANS/PANDAS
Recently, the news has been full of children falling ill with strep (short for streptococcal) infection. Parental concern has increased pressure on GP surgeries and hospital A and E departments. Usually, if a child’s immune system is working well, this common infection is overcome in a short space of time without complications. However, problems can arise if the immune system is not working well and cannot silence the strep infection. Unfortunately, many scientists have warned that the social distancing of the last two years could weaken immune function and leave people more vulnerable to previously common bugs.
Strep can trigger a condition called PANDAS
One of the chronic complications of strep infection that I see frequently in the clinic is a condition known as PANDAS. This is an acronym for Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection. PANDAS is an autoimmune condition where strep infection triggers the immune system to attack certain tissues in the brain, thereby disrupting normal neurological activity. Although it causes psychiatric-like symptoms, this is most definitely not a mental illness, but a physically driven condition. As such it needs a physical handling. Although the name suggest otherwise, adolescents and adults as well as children can suffer from PANDAS. When other infections than strep are involved, the condition is known as PANS - Paediatric Acute-onset Neuropsychiatric Syndrome. Although advertised as an acute onset condition, I have seen both sudden and gradual onset of this condition in clinical practice.
What are the symptoms of PANS/PANDAS?
This condition generates antibodies to dopamine receptors in the brain. An antibody is a protein used by the immune system to identify and neutralise foreign invaders in the body such as bacteria and viruses. Dopamine receptor antibodies types 1 and 2 (DR1and DR2) stimulate dopamine receptors in brain cells in the area of the brain known as the basal ganglia. Receptors are specialised structures on the surface of a cell that bind to other substances and create an immune response. In PANS/PANDAS this is a stimulation, not a tissue destruction effect. If that stimulation has a central nervous system effect, it can drive the following symptoms:
Anxiety
OCD
Profound insomnia
Abrupt changes in behaviour
If the activation affects the body, it can cause:
Tics
Tourette’s syndrome
Uncontrolled movements
How do you test for PANS/PANDAS?
Run the Cunningham Panel which tests for DR1, DR2, anti-lysoganglioside and anti-tubulin antibodies. Researchers expect to identify more antibody types in the future that could stimulate dopamine receptors and cause profound behavioural changes. No matter what is causing the overstimulation in the brain, there is an additional marker in the Cunningham Panel called calcium/calmodulin kinase 2 (CaMK2) which will still show the system is being driven too hard even if the specific antibody has not yet been identified. The CaMK2 marker also shows how severe the problem is.
Scientific research shows the Cunningham Panel to be highly accurate and sensitive (Shimasaki et al., 2020, Journal of Neuroimmunology). A previous paper, (Bejerot, 2017, Journal of Neuroimmunology) suggested poor sensitivity and accuracy. However, the authors of this study used the wrong tubes for blood samples. The paper Hesselmark and Bejerot, 2017, Journal of Neuroimmunology, is a correction to their first paper, admitting their error.
It is a pity that the condition of PANS/PANDAS is so poorly studied by physicians in the UK. Indeed, the first Bejerot paper which used in the wrong test tubes in their study, and therefore produced an invalid result, is often used as an excuse not to explore this condition as a potential cause of symptoms. This condemns the sufferer to a false diagnosis of mental illness and a potential lifetime of harmful psychiatric drugs which nothing to address the real causes and can make symptoms considerably worse.
It is important to realise that strep or other infections need no longer be present for antibodies to cause overstimulation of brain cells. This is because immune cells have a memory. Very often the triggering incident may be a childhood throat infection, the symptoms of which have long gone, however, strep antibodies are still testing high.
I always think it is prudent to test for current active infections as well as doing a Cunningham Panel. This is so I can see if a virus or bacterial infection currently needs to be addressed as well as calming down the autoimmune flares. In either case, we need an immune roadmap to help navigate the way out of a PANS/PANDAS condition.
Foods as well as infections can trigger flares
Recent research ( Vojdani and Turnpaugh, Biomarkers in Neuropsychiatry, 2020) show that foods can also vigorously cross-react against DR1, DR2 and anti-lysoganglioside antibodies. This means that when a patient eats a food that is recognised by an antibody to a dopamine receptor or to lysoganglioside, it will then trigger the unwanted central nervous system symptoms listed above. The significance of this is that the diet of a PANS/PANDAS suffer should be carefully monitored for foods that can trigger or worsen flares and increase both mental and physical symptoms. IgG (1-4) ProImmune M food testing can be used. It is worthwhile knowing that mint has demonstrated high cross-reactivity to both DR1 and DR2 antibodies. Milk products also react strongly with DR2 antibodies. Therefore, it is very true that cases fail to the degree that they cannot stick to a required diet.
If you would like more information about PANS/PANDAS, the Cunningham panel or ProImmune M IgG (1-4) food allergy testing, please visit the Academy of Nutritional Medicine website at www. aonm.org. If you suspect that you or a loved one may have PANS/PANDAS and would like to investigate this, please contact the Good Health Clinic on goodhealthclinic@outlook.comto request a free 30 minute Enquiry Call or book an initial appointment.
With best wishes for the New Year and your very good health in 2023,