Management of PANDAS/PANS in a 7-Year-Old with OCD Symptoms
Your daughter's PANDAS/PANS condition requires more aggressive treatment beyond antibiotics alone, including consideration of immunomodulatory therapy, cognitive behavioral therapy, and possibly SSRI medication to address her persistent OCD symptoms.
Understanding PANDAS/PANS
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) and PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) are characterized by the sudden onset of OCD symptoms and/or tics following infections, particularly streptococcal infections 1. Your daughter's case fits this pattern with OCD symptoms appearing after a strep infection.
Current Treatment Assessment
The current treatment with cefdinir is showing inconsistent results:
- Antibiotics are appropriate for treating the underlying strep infection 2
- However, antibiotics alone may be insufficient for established neuropsychiatric symptoms 3
- The 21-day course of cefdinir should be completed as prescribed 4
Next Treatment Steps
1. Immunomodulatory Therapy
- Consider a longer or repeated course of corticosteroids since the short burst previously helped significantly 5
- For severe, persistent symptoms, more aggressive immunomodulatory treatments may be needed:
- Intravenous immunoglobulin (IVIG)
- Non-steroidal anti-inflammatory drugs (NSAIDs) during exacerbations 3
2. Psychiatric Treatment
Start cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) - this is the first-line psychological treatment for OCD 6
- Requires 10-20 structured sessions
- Should be adapted to your daughter's developmental level
- Family involvement is crucial for effectiveness
Consider SSRI medication if OCD symptoms remain severe despite other interventions 6
- Higher doses are typically needed for OCD than for depression
- Should be used in conjunction with CBT
3. Ongoing Monitoring and Prevention
- Regular strep testing during respiratory illnesses
- Prophylactic antibiotics may be considered if recurrent strep infections trigger symptoms 7
- Use standardized measures like the Children's Yale-Brown Obsessive-Compulsive Scale to track progress 6
Prognosis
This condition is not hopeless. While PANDAS/PANS can be challenging to treat, many children show significant improvement with appropriate treatment 5. The neuropsychiatric symptoms can resolve completely in some cases, especially with early and comprehensive intervention.
Important Considerations
- Timing is crucial - early intervention with appropriate treatment tends to yield better outcomes
- Multidisciplinary approach - coordination between pediatrician, psychiatrist, and possibly immunologist/rheumatologist is beneficial 5
- Watch for comorbidities - anxiety, depression, and other conditions may develop and require additional treatment 6
- School accommodations may be needed during symptomatic periods
Common Pitfalls to Avoid
- Relying solely on antibiotics when immunomodulatory therapy is needed
- Delaying psychiatric treatment while focusing only on the infectious component
- Insufficient duration of treatment - both medical and psychological interventions often need to be continued for extended periods
- Inadequate family involvement in therapy, which is essential for success in treating childhood OCD 6
Your daughter's symptoms are challenging but treatable with the right approach combining infectious disease management, immunomodulation, and psychiatric care.