Can PANS Occur in Adults?
PANS is defined as a pediatric condition and does not formally occur in adults, though the underlying pathophysiology of acute-onset neuropsychiatric symptoms triggered by infections or autoimmune processes can manifest at any age under different diagnostic frameworks.
Understanding PANS as a Pediatric-Specific Diagnosis
The diagnostic criteria for PANS explicitly limit the condition to children and adolescents. The condition is characterized by abrupt onset of obsessive-compulsive disorder and/or severely restricted food intake, accompanied by acute neuropsychiatric symptoms in youth 1. Research cohorts consistently describe PANS patients with mean ages of onset around 7-8 years, with study populations ranging from ages 3-14 years 2, 3, 4.
The 2024 American Academy of Pediatrics clinical report on PANS focuses exclusively on sudden-onset severe behavioral and neuropsychiatric symptoms in children, emphasizing this as a pediatric condition 5. The Swedish cohort study enrolled only children and adolescents aged 4-14 years when establishing PANS diagnostic criteria 2.
Why Adults Present Differently
When adults develop acute-onset neuropsychiatric symptoms following infections or due to autoimmune processes, they fall under different diagnostic categories:
- Autoimmune encephalitis (AE) is the appropriate framework for adults with acute neuropsychiatric symptoms potentially triggered by autoimmune mechanisms 5
- Adult-onset OCD following neurological insults (including post-infectious states) is recognized but not classified as PANS 1
- The broader concept of infection-triggered neuropsychiatric symptoms exists across the lifespan, but PANS terminology is reserved for pediatric cases 1
The Pathophysiologic Overlap
The underlying mechanisms theorized in PANS—infection-triggered autoimmunity affecting basal ganglia and frontostriatal circuitry—can occur at any age 1. Historical examples include obsessive-compulsive symptoms in adults following encephalitis lethargica after the influenza epidemic, and in conditions like Sydenham chorea affecting the basal ganglia 1. However, these adult presentations are not termed PANS.
Clinical Implications
If an adult presents with acute-onset obsessive-compulsive symptoms, severe anxiety, food restriction, and other neuropsychiatric changes following an infection:
- Evaluate for autoimmune encephalitis with appropriate antibody panels and neuroimaging 5
- Consider post-infectious neuropsychiatric syndromes under adult diagnostic frameworks 1
- Assess for other causes of acute psychiatric symptoms including CNS infections, toxic-metabolic derangements, and primary psychiatric disorders 1
- Do not use PANS terminology, as this diagnosis is reserved for pediatric populations 2, 3, 4, 5
Key Caveat
The male predominance seen in early-onset schizophrenia (2:1 ratio) tends to equalize with age, as the average age of onset in males is 5 years earlier than females 1. Similarly, if PANS-like pathophysiology exists across the lifespan, age-related and sex-related presentation patterns would differ from the pediatric syndrome, further supporting distinct diagnostic categorization for adults.