198. PANS and PANDAS (pt 2 of 2)

In this second part of a 2-part series from last week’s show, host Dr. Lia talks with Dr. Erica Greenberg about some of the surprising research looking at the association between autoimmune and inflammatory conditions and higher rates of OCD. Dr. Greenberg discusses the neuroscience around OCD from genetic to environmental factors, and the puzzling overlap of symptoms in disorders like Tourette's and OCD. She stresses the crucial need for interdisciplinary research to shed further light on these intricate associations.

You’ll get insights into why certain treatments are recommended with caution and why controversy still remains around PANDAS and the desperate need for collaboration and comprehensive research to truly understand these complex conditions. You’ll also hear about the role of stress-induced inflammatory responses and how they render some individuals more susceptible to immune-related dysfunctions, shedding light on the significant impact of environmental factors like lead exposure on basal ganglia circuitry. Dr. Lia’s conversation with Dr. Greenberg reveals the interconnected nature of disorders such as OCD, Tourette syndrome, and other neuropsychiatric ailments, underscoring the necessity for further research.

Conversations like these illuminate the path forward, emphasizing that the key to understanding and treating these conditions lies in collaborative research efforts across various disciplines.

[01:46 -12:40] Understanding PANDAS and PANS Origins and Symptoms

• PANDAS is specifically linked to post-infectious streptococcal etiology.
• PANDAS involves the sudden onset of tics and/or OCD.
• PANS shares a similar characteristic of sudden, rapid onset of a complex of symptoms.
• Importance of understanding the specific triggers and symptoms associated with both PANDAS and PANS.

[12:41 - 23:32] Understanding the Clinical Outcomes of PANS/PANDAS Treatment

• Sudden onset of symptoms such as tics, OCD, and separation anxiety is notable in these conditions.
• Some children experience complete recovery back to baseline after antibiotic treatment within a week.
• There is ongoing research into the different potential clinical courses following a PANS/PANDAS diagnosis.
• Emphasis on the importance of recognizing and understanding the diverse range of clinical outcomes.

[23:33 - 35:37] Genetic and Environmental Influences on OCD and Tourette Syndrome

• Studies show significant associations between OCD, Tourette syndrome, and increased rates of throat infections.
• Research indicates higher odds ratios of developing OCD and Tourette in youth with infection histories.
• A dose-response relationship exists between strep infections and OCD/Tourette symptom severity.
• Studies find higher rates of autoimmune disorders in individuals with OCD and Tourette and their family members.

[35:38 - 48:00] Key Information and Challenges Surrounding PANS and PANDAS

• Need for more thoughtful, nuanced, safe, appropriate information for parents.
• There's evidence that PANS and PANDAS have a more negative impact on families compared to typical OCD
• OCD and Tourette syndrome develop slowly, while PANS and PANDAS show abrupt changes.
• Families face significant trauma, especially when providers dismiss their concerns.

[48:01 - 55:17] Closing segment Takeaways

Links to resources mentioned on the show

Erica Greenberg, MD PANDA AND PANS Presentation Swipe Files