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PANS patients develop worsening or new onset of post-COVID psychiatric symptoms

PANDAS/PANS in the COVID-19 Age: Autoimmunity and Epstein–Barr Virus Reactivation as Trigger Agents?
PANS patients develop post-COVID psychiatric symptoms

This review article describes the impact of both the COVID-19 pandemic and infection on children with Pediatric Acute-Onset Neuropsychiatric Disorders (PANS). The authors examine whether PANS patients developed post-COVID psychiatric and/or neurologic symptoms. 1

Additionally, they explore whether the reactivation of the Epstein-Barr virus could be a possible trigger for PANS in patients post-COVID.

Studies report post-COVID psychiatric symptoms

One study found, 71% of children with PANS/PANDAS “showed an increase in symptoms during the lockdown.” And, 1 in 3 patients had an onset of new symptoms. “Interestingly, 29% of the children showed the onset of new symptoms such as irritability, fears and generalized anxiety.”

Another study reported an increase in PANS/PANDAS patients of neurologic and psychiatric symptoms post-COVID. “The most commonly exacerbated symptom after confirmed COVID-19 infection was mood lability (58%), followed by OCD, tics and sensory symptoms.”

“COVID-19 infection can not only result in an exacerbation of the condition of children already affected by PANS but can also eventually trigger new-onset PANS.”

The authors present 5 cases of adolescents with PANDAS who experienced an increase post-COVID in their psychiatric symptoms. “Three cases showed a reactivation of [Epstein-Barr virus] EBV, as well as increased inflammatory markers. In the other two cases, EBV was not reactivated, but the inflammatory panel was altered.”

They hypothesize, “the pathogenic mechanisms of silent viruses, such as the Epstein–Barr virus, are related to neuroinflammation, immune responses and reactivation” as potential trigger agents for PANS.

“COVID-19 resulted in the exacerbation of obsessions, tics, anxiety and mood symptoms and decreased wellbeing.”

“Intravenous immunoglobulin (IVIG) has shown clinical efficacy in critically ill patients with COVID-19,” the authors state. “This treatment is also prescribed to PANDAS patients, suggesting, again, a potential relationship between the underlying immune profiles of PANS and COVID-19 patients.”

They suggest, “The temporal association between the emergence of new cases of PANS and infection with SARS-Cov-2 may suggest a causative trigger role of COVID-19 in the development of central nervous system autoimmunity.”

How can the Cunningham Panel™ help you in identifying and treating patients with infection-induced autoimmune encephalopathies?

  1. Pallanti S, Di Ponzio M. PANDAS/PANS in the COVID-19 Age: Autoimmunity and Epstein–Barr Virus Reactivation as Trigger Agents? Children. 2023; 10(4):648.