One moment you have a healthy, happy-go-lucky, carefree child. Then suddenly, seemingly overnight, your child wakes up a different person. They are moody, anxious, aggressive and compulsively obsessing about seemingly trivial things or has developed restrictive eating.
Is this a real-life Dr. Jekyll and Mr. Hyde situation, or is there something medically wrong with your child?
When a sudden, inexplicable change occurs in your child’s health, a proper diagnosis and treatment can make all the difference. This is particularly true in the case of autoimmune disorders known as PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) or a subset of PANS that is associated with strep and known as PANDAS. (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections).
The National Institute of Mental Healthbrought意识和识别锅/熊猫在90s, and today scientists estimate as many as 1 in 200 children may have PANS/PANDAS.
但是一些专家对这个数字甚至条件的存在进行了竞争。由于提供者可能不会意识到孩子行为会发生变化存在生物学原因，因为某些父母可能是诊断和适当治疗孩子的更艰难的旅程。
儿童的感染后自身免疫性脑病（CPAE) at the University of Arizona Steele Children’s ResearchCenter, developed in partnership with Banner-University Medicine, is trying to change that. They are one of several recognized institutions across the country that integrates basic science and clinical research, clinical care and teaching to address a spectrum of neuropsychiatric disorders (such as PANS/PANDAS) that are often misdiagnosed, underdiagnosed or undiagnosed in children.
Georgette Mehalik，CPAE中心的儿科护士从业人员是初级保健心理健康专家，负责监督来自全国各地的潘斯和熊猫患者的后续护理。
Mehalik帮助您阐明了锅/熊猫，如果您担心您的孩子，为什么会发生它们以及下一步。
什么是锅/熊猫？
PANS is a clinical diagnosis given to children (ages 3 to puberty) who very suddenly begin exhibiting obsessive compulsive disorder (OCD) or severely avoidant/restrictive food intake disorder and associated symptoms. It’s called “acute onset” because the changes occur within 2 to 3 days. The cause of PANS is unknown but believed to be triggered by infections.
PANDAS is a subset of PANS but symptoms are triggered by a streptococcus infection, likestrep throat. Children at risk are those who have recently had a common childhood infection.
Mehalik said to meet diagnostic criteria for PANS/PANDAS, children must exhibit OCD or food avoidance along with two or more of these neuropsychiatricsymptoms:
- Anxiety (often social/separation)
- Emotional changes or Depression
- 易怒，侵略或对立行为
- Behavioral or developmental regression (i.e., baby talk)
- Deterioration in school performance, ADHD like symptoms, memory and cognitive changes
- 感觉或电机变化
- Somatic signs and symptoms often sleep disturbances, urinary accidents and more frequency.
梅哈里克说：“由于这些疾病的情节性质，有时父母可能会错过第一个迹象，或者认为奇怪的症状只是因为他们的孩子感觉不舒服。”“但是，大多数父母经常回想起症状的开始，或者他们'失去孩子'的那一天。通常是在一夜或感染后的几天内。”
为什么会发生锅/熊猫？
确切的原因仍在研究中，但共识是潘斯/熊猫是由自身免疫性反应引起的。
Mehalik说：“众所周知，链球菌细菌可以通过模仿人类细胞隐藏，从而导致免疫系统对其与其自身细胞非常相似的细胞产生抗体。”“由于免疫反应，血脑屏障可能会受到破坏。鼻子上方有一个很小，很薄的区域（头骨的最薄部分），可以使抗体进入大脑并破坏基底神经节，杏仁核和下丘脑的功能。这些领域控制着情绪，情感，行为，认知和感觉。”
How is it diagnosed?
这个时候没有一个单独的测试to confirm whether your child has PANS/PANDAS, and because it is a newly recognized condition, not all doctors are knowledgeable or experienced in treating these conditions. But, the University of Arizona Banner Team is working hard to help educate primary providers on this condition. Mehalik is educating professionals in the Southwest region to make sure that children are recognized and treated quickly. If the diagnosis is recognized early, treatment with antibiotics and/or anti-inflammatory medication may be the only treatment needed.
由于通常不认识到锅/熊猫的诊断，因此对孩子的完全护理可能需要采用多学科的方法，并进行仔细的病史和身体检查。您孩子的医生和专家将需要排除其他可能导致症状的疾病。他们可能会订购链球菌测试，尿液检查和血液检查，以查看感染或其他完全导致症状的东西。行为健康专家可能还需要看到您的孩子作为评估的一部分。
Diagnosis can be difficult because not every child has every symptom and there is not a test to do to confirm the diagnosis. PANS/PANDAS can be confused with the onset of other mental health conditions and this makes a team evaluation with medical and psychiatric professionals important if there is a question regarding the diagnosis. When a child completes this comprehensive evaluation and meets the criteria a clinical diagnosis of PANS/PANDAS can be made.
Mehalik also suggests that parents seek help immediately from their child’s physician when symptoms are first noted and keep a detailed log of the changes they are seeing in their child.
How is PANS/PANDAS treated?
有一种三管齐下的治疗方法：
- 用抗生素治疗原始感染
- 调节和修改孩子的免疫系统
- 心理疗法和咨询以帮助强迫症和其他症状。
Mehalik说：“首先，我们将要确保我们处理已确定的或怀疑的感染。”“但是我们也想平息过度反应的免疫系统，有时可能需要一段时间才能在最初的耀斑之后进行一段时间。”
梅哈里克说：“最初的爆发后，症状会随着时间的流逝而减弱。”“在开始详细说明这些症状，以及它们如何影响您的孩子的生活时，请保留详细说明这些症状的日记很有帮助。”
您的孩子可能还需要在学校提供支持。与他们的老师和学校行政部门谈谈您的孩子的诊断以及任何特殊考虑或更改，以帮助您的孩子容纳您的孩子。
我的孩子会变得更好吗？
好消息是，大多数儿童，如果得到认可和治疗，最终会完全康复并可以停止治疗，但是，有些儿童会出现持续的神经精神症状，或者在随后感染后出现恶化的症状。对于那些对治疗反应不佳的孩子，治疗是为了康复和支持儿童和家庭的支持。
“To help your child stay healthy, make sure they arewashingtheir hands, changing their toothbrushes often, avoiding others who are sick and taking common sense precautions to prevent illness.” Mehalik said.
What should I do if I think my child has PANS/PANDAS?
早期干预和治疗对于缩短疾病的进程，复发以及您的孩子可能遇到的功能障碍至关重要。如果您的孩子的行为在生病的几天内突然发生了变化，并且正在经历强迫症或食物限制的新症状以及其他神经精神症状，请不要等待，请参阅您的PCPto be evaluated.
For additional resources, visit thePANDAS Network, the熊猫医生网络或联系CPAE中心for further questions or concerns.
