Tics/Stims PANS/PANDAS
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Hello, my child often has facial tics, eyes and mouth and verbal tics none of which are bothersome. However last Thursday he had an intense fare up of a head/neck jerky and shaking or bobbing tic or stim that he has not had in a while.
It came on very suddenly and seemingly situational when I dropped him off at a neighbor friends home for the evening dinner packed so I could attend a training/workshop. He gets along with the boy his age but they generally play at my home because he really does not like the boys strict mom. He really did not want to go to their house, none the less drop him off I did. Thirty minutes later the mother texts me and says his head is bouncing and shaking and is he okay? Sure enough when I picked him up his head was jerky and bouncing around quite severely, perhaps the worst I’ve seen. This continued at school the next day, continued through his after school ski program, through cub scouts sledding Saturday, again Sunday and Monday.
I asked him if he is shaking his head on purpose and he said yes. I asked why and he said because it feels uncomfortable not to which led me to think perhaps this is self soothing stimming in reaction to stress or anxiety onset.
Yet, by Monday I had teachers emailing and calling me because they were worried about him. His ASD specialist suggested while these things can come and go and can be triggered by stress and anxiety, she recommended we rule anything medical out. He does have an appointment with his PCP this morning. However, I feel his PCP is not very knowledgeable about these pediatric conditions, ASD etc, I’m likely more knowledgeable about a lot of it. I am brining in description of PANS and PANDAS for the PCP to consider. Gonna have him look at the throat and or run a culture to see if there is anything or rule it out. Then of course I know there is the antibody titters test. I also read that strep can also hang out in “hidden” areas not the throat such as the nasal or sinuses?
My child did complain of a sore neck Sunday night, likely because of all the bobbing, but Monday nigh he complained his throat hurt when he swallowed. He does have a little cold and nasal congestion and likely post nasal drip. Monday Jan 8th he had a slight fever and a cough, then Wed Jan 16th he had a tummy bug, then Thur Jan 24th is when the tics or stims started.
While I feel this was situationally triggers, I feel there could also potentially be a PANDAS or PANS connection. While we did discus PANDAS quite a bit in module 15, we didn’t talk a whole lot about PANS. My understanding is that other infections beyond strep can cause a PANS reaction? Are there specific types of infections that can result in PANS?
I should add to that as fast and suddenly as his tics came on they decreased a lot yesterday/Tuesday I noticed end of day when I picked him up and his principle also confirmed very decreased yesterday. So it kinda brings me back to situational, stress, anxiety trigger. With PANS/PANDAS can tics come on suddenly and last intensely for 4.5 days then decrease a lot?
Lisa,
Trying to get caught up on missed posts.Whatever became of this situation with your son?
PANS for the most part has the same outward symptoms that PANDAS does. Perhaps not as intense, but that’s not always the case. Typically for both the symptoms don’t go away suddenly after a few days. There definitely seems to be an anxiety componet with your son.
Dr. Woeller
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