As we have discussed the significant and devastating symptoms involved with both PANDAS and PANS, it is crucial to understand the mechanism behind these diseases as well as providing parents clear insight in how to identify them.

Molecular Mimicry

As we consider how to help children with PANDAS and PANS, it is important to understand the idea of molecular mimicry. Molecular mimicry is a key concept at the root of these conditions.

Molecular mimicry stems from an individual having permeable, or “leaky” barriers. When the gut and brain barriers are permeable, various foods, toxins, and pathogens can cross them. When the body is exposed to these foreign invaders, it begins producing antibodies towards them. The body initiates an inflammatory response which typically leads to a state of chronic inflammation.  In PANDAS and PANS patients, the pathogen is often strep, a virus, biotoxins, or another common environmental organism. This is where we draw the distinction between PANDAS and PANS. PANDAS is initiated with a streptococcal infection while PANS encompasses brain autoimmunity brought on by other infections.

As a result of the infection, the immune system then starts producing antibodies against the foreign invader.  The body, seeing similar amino acid sequences between foreign invaders and its own tissue, then initiates an immune response against its own tissue.  Essentially, the body is attacking itself in a case of mistaken identity.  This process is called molecular mimicry. The autoimmune condition that manifests is determined by what tissue(s) are being attacked.  In PANDAS and PANS, the body has an immune response against various structures in the basal ganglia portion of the brain such as dopamine or GABA receptors. As the body attacks these structures, the result is the manifestation of PANDAS/PANS symptoms.  Unfortunately, when the gut and blood brain barrier remain leaky, overtime an individual can develop more autoimmunity as this process perpetuates.

Why do Some Children Succumb and Not Others? 

Oftentimes what differentiates whether or not a child will succumb to PANDAS and PANS comes down to the permeability of the blood brain barrier. For example, in a healthy individual, streptococcal bacteria are too large to pass through an intact blood brain barrier. When the blood brain barrier breaks down and becomes permeable, there is enough room for various infections to easily pass through to the brain.

There is a strong relationship between leaky gut and leaky brain. The inflammation breaks down the barriers, reduces antioxidant reserves, and depletes the body of glutathione. There is a loss of immune tolerance because of T-regulatory cell dysfunction and overactive microglial cells. Unfortunately, these children can then end up with immune related injury to the brain.

Why do Symptoms Vary from Child to Child?

It is important to understand that the basal ganglia has three main circuits or “loops” for processing information including the sensory, motor, and emotional loops. Since information is processed through these three unique pathways, we see different manifestations of PANDAS/PANS symptoms arise in different patients.

Brain Testing

While many practitioners will identify PANDAS and PANS based on symptoms alone, we prefer to glean as much objective evidence as possible to guide us. In the research, we see the Cunningham panel being the gold standard of testing for PANDAS and PANS. Since these conditions have been identified, other testing has become available and more affordable. When working with families, we often do specific brain testing and other blood work to help us understand what is contributing to the symptoms.

When considering the integrity of the brain, we must look at various structures and proteins within the brain. When we assess patient’s brains for immune reactivity, we look at tests evaluating blood brain barrier integrity, demyelination antigens, optical and autonomic nervous system disorders, peripheral neuropathy, neuromuscular disorders, various infections, and, of course, autoimmunity within the brain. We look at dozens of markers in these categories because the brain is arguably our most precious organ. Our highly-intricate brains are what set us apart as humans. We cannot underestimate or neglect any contributing factor to brain dysfunction!

There is Hope

There is nothing worse than watching a child suffer. If you are a parent of a child with severe neurological symptoms, we want you to know there is hope! Thankfully, there are many tools available to help these children. Many of these we will discuss in our next post. At Restorative, we have helped many families navigate these extremely difficult conditions. We would love to walk alongside of you and help restore your child’s brain!

Sources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063373/

https://pubmed.ncbi.nlm.nih.gov/25599184/

https://www.ncbi.nlm.nih.gov/books/NBK333433/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3923298/