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Health alert: Unexplained tics in children could be PANDAS

PANDAS, Pediatric Autoimmune  Neuropsychiatric Disorder, is a rare condition which can occur in children after a Strep infection.  It often goes undetected for weeks or months because its symptoms appear to be psychological not physiological.  Specifically, children suffering from PANDAS can develop abrupt symptoms of severe motor tics, anxiety (particularly separation anxiety), obsessions and/or compulsions and urinary frequency.  These symptoms appear “out of the blue” and usually reach full scale intensity within 24-48 hours.

Transient Motor tics, spasmodic motor movements, are common for children to experience.  They have been reported to occur in as many as 50% of children who otherwise experience no other psychiatric condition.  Many of us have seen children who blink frequently or lick their lips.  However, the tics in PANDAS are generally much more severe and involve larger body parts such as the shoulders and neck.   If they occur for more than a few weeks, children will get sore muscles.  As well, their peers become aware and usually comment on their oddity.

Pediatricians have mixed beliefs on whether PANDAS is a real medical disorder.  Because it is a rare condition, there is little research and what is available has few numbers of children and often isn’t replicated. Therefore, many pediatrians don’t consider a diagnosis of PANDAS when evaluation children who display these symptoms.  However, a simple strep test can confirm its diagnosis.

Because PANDAS is a rare condition, some people consider me an expert as I’ve seen 5 cases in my practice, 3 in the last year!  Recently, I got a call from a mother of a child I had seen once the year before.  Jake was 9 years old.  He is a very bright child who had experienced some significant anxiety symptoms when he was 8.  At that time, his symptoms quickly resolved after a single psychotherapy session.  However, Jake’s mother sounded extremely concerned in her voice message.  She said Jake (not his real name) had begun evidencing severe tics and anxiety.  His tics included large movements of his neck and shoulders.

Something about her symptom description and tone led me to return her call immediately.  I asked if Jake had been ill at all recently.  In a surprised tone, she said that yes, he had complained of a headache and fatigue a few days before, but no other symptoms.  Jake had not complained of a sore throat.  Taking a deep breath and asking the mother to “trust me” and not do any research on the internet, I asked her to have Jake tested for strep that day.  To the surprise of all involved, the strep test was positive. After six hours on antibiotics, Jake’s symptoms had lessened and within 24 hours, the tics were almost gone.  When I saw Jake and his mother two days later, Jake demonstrated a couple mild tics which his parents related had been occurring for several weeks.  Jake showed some eye blinking that was barely noticeable, the kind frequently seen in children.

Jake’s mom urged me to write this article.  She related that after Jake had been on medicine for a day, she researched PANDAS on the internet.  Most children and parents experienced weeks and months of frustration attempting to treat their child’s symptoms.  Often families had consulted with pediatricians, neurologists, psychiatrists, psychologists and other health professionals without any resolutions to their child’s symptoms.  Many went through months of fear, emotional distress and turmoil.

I certainly can’t say with certainty whether PANDAS should or should not be considered a medical disorder.  However, a simple Strep test and antibiotic treatment ended Jake’s symptoms within a few days.  A couple of sessions of behavioral therapy decreased the remaining tics.  What could have been a long, painful experience was simply and inexpensively treated.  If your child suddenly develops large muscle tics, anxiety, and/or obsessive or compulsive behavior, you may want to consider getting a strep test.

(Written by Wendy Blumenthal, Ph.D., PDr. Blumenthal has been practicing in Sandy Springs for over 20 years.  She has a small psychotherapy practice specializing in child, adolescent and family therapy.  Within the field of child psychology, she further specializes in pediatric medical psychology, working with children who experience acute or chronic medical conditions.  She also does psychoeducational evaluations and  works with children who have ADHD, learning problems or high functioning autism.)

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