Controversy Over Causes

While this syndrome has been recognized for decades, the link between the symptoms and an infection has been the subject of intense controversy, with some researchers and clinicians claiming insufficient evidence, and denying children treatment to fight the sometimes elusive infection.

But the medical community has coalesced around a clearer description of the symptoms, their causes, and how they should be treated. This should make it easier for parents to get care for severely affected children.

Dr. Swedo, who heads the pediatrics and developmental neuroscience branch

of the National Institutes of Mental Health, first identified PANDAS in 1998, and has been in the vanguard of research and advocacy ever since. The larger category, PANS, was added in 2010 to account for cases that could not be linked definitively to strep infections.

There is now broad acceptance that PANDAS is, like rheumatic fever, a misdirected immune response to the strep bacteria, which mimics human heart or brain tissue. The immune system attacks the heart (in the case of rheumatic faver) or brain (in the case of PANDAS), causing this array of mental health symptoms.