The Neuroimmune Connection: Understanding PANDAS/PANS
This topic was recently explored in greater depth by the Global Autoimmune Institute, where I was quoted as a clinician specializing in supporting families affected by PANDAS/PANS. You can read the full article here: https://www.autoimmuneinstitute.org/articles/pandas-pans-and-autoimmunity/
The Neuroimmune Connection
Autoimmune activity doesn’t stop at the blood–brain barrier. Once viewed as separate systems, the brain and immune system are now understood to be interconnected. Autoimmune and inflammatory processes can affect behavior, mood, cognition, and functioning—especially when triggered by infection.
This growing awareness helps explain infection-triggered behavioral changes, brain fog, sudden OCD symptoms, and neuropsychiatric shifts seen in PANDAS and PANS. Understanding this connection is essential for families seeking answers.
What Are PANDAS and PANS?
For many families, the onset of severe neuropsychiatric symptoms in a child or teen is frightening and confusing—and it is often difficult for parents to determine if the changes occurred from an infection.
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) refers to an onset of OCD, anxiety, food restriction, cognitive changes and tics, to name a few syptoms, following a Group A strep infection.
PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) is a broader diagnosis that includes symptoms triggered by a range of infections, environmental factors, or other causes.
Both conditions are based on a connection between infection, immune dysfunction, and brain-based symptoms.
What Symptoms Are Seen in PANDAS/PANS?
Children may experience an onset of:
Obsessive-compulsive symptoms
Severe food restriction
Extreme anxiety
Mood swings and depression
Irritability or rage episodes
Behavioral regression
Decline in school performance
Motor or sensory changes, including tics
Sleep disturbances or bedwetting
These symptoms often appear rapidly—sometimes overnight—leaving families overwhelmed and unsure where to turn.
What Causes These Changes?
Research suggests that, in vulnerable individuals, an immune response to infection may mistakenly target areas of the brain involved in emotion, movement, and behavior—particularly the basal ganglia.
Autoantibodies may cross the blood–brain barrier and interfere with normal brain signaling. This autoimmune process may help explain the neuropsychiatric symptoms seen in PANDAS/PANS.
Risk factors can include:
Family history of autoimmune disease
Underlying neurodevelopmental vulnerabilities
Animal studies support this autoimmune model, showing behavioral changes when affected antibodies are introduced.
How Are PANDAS/PANS Diagnosed?
Diagnosis can be challenging because symptoms overlap with conditions like OCD, depression, ADHD, anxiety, eating disorders and more.
A thorough evaluation may include:
Detailed medical history
Review of symptom onset and triggers
Bloodwork specific to identifying PANDAS/PANS
Assessment for underlying infections or inflammatory triggers
Because specialists often take different approaches, families frequently experience confusion, delays in diagnosis, or misdiagnosis—experiences that are often traumatic for families dealing with PANDAS/PANS.
Treatment Approaches
Diagnostic protocols and treatment were published in 2017 in The Journal of Adolescent Psychopharmacology, recommending a three-prong approach to treatment: https://www.pandasppn.org/jcap/
1. Antimicrobial Treatment
Antibiotics and other medications may be used to treat suspected infections like strep, Lyme disease and coinfections, mycoplasma and various other illnesses.
2. Psychological and Behavioral Interventions
CBT, ERP, medication, and naturopathic therapies may help children manage symptoms of OCD, anxiety, depression, or irritability after a level of medical stabilization is in place. Support and guidance for parents and families is also highly recommended and can be provided by therapists and mental health clinicians until a level of medical stability is achieved and the child or teen can participate in therapies for anxiety, OCD, depression and other issues.
3. Immunomodulatory Treatments
Providers may consider anti-inflammatory or immune-modulating therapies.
The Role of Therapy
After medical stabilization, therapy plays an important role in the three-prong approach of helping children and families navigate emotional and behavioral symptoms.
As I shared in the Global Autoimmune Institute article:
“I teach parents self-regulation skills and DBT skills to help them through the ups and downs of medical treatment and the challenges the PANDAS or PANS child or teen may experience.”
I also discussed the emotional toll on parents and the importance of validation and support during diagnosis, flares and regressions:
“One of the first things I do is help parents understand that the symptoms are not their child’s fault—and not theirs either. That reframing alone can lower the shame and panic that often show up in the early stages.”
Therapy can help:
Reduce anxiety and OCD symptoms
Support emotional regulation
Improve family communication
Help children cope with distressing symptoms
Strengthen resilience during flare-ups
Why Families Often Struggle
Unfortunately, many parents spend months—or years—searching for answers before finding a provider who understands PANDAS/PANS. Too often, families experience minimizing or dismissive responses, adding trauma and self-doubt to an already overwhelming situation.
A team-based approach can be helpful, possibly involving the following providers:
Primary care
Immunology
Psychology and psychiatry
Neurology
Rheumatology
Developmental pediatrics
OT / PT as needed
Coordinated care can reduce confusion, validate families’ experiences, and improve outcomes.
Hope Through Research, Advocacy, and Awareness
Although much remains unknown, research is expanding rapidly. Families and clinicians are pushing the field forward through advocacy, collaboration, and increased awareness.
With continued research, advancements in diagnostic tools, and greater clinician education, there is growing hope for earlier diagnosis, better treatments, and deeper understanding of the neuroimmune mechanisms at play.
Support for Your PANDAS/PANS Family is Available
There is a path forward—even if things feel chaotic right now. With the right support, your child and your family can find more stability, understanding, and relief.
Julie Cox, LCSW is a licensed therapist with 25 years of experience supporting clients in Yorktown Heights, New York. She specializes in PANDAS/PANS and trauma and uses evidence-based approaches like CBT (Cognitive Behavioral Therapy), DBT (Dialectical Behavior Therapy) and EMDR (Eye Movement Desensitization and Reprocessing), to help families navigate the challenges of PANDAS/PANS and assist clients in resolving trauma. Julie Cox, LCSW is committed to providing compassionate, trauma-informed, expert care across New York State.