Symptoms and Causes of PANS

Symptoms of Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) typically present quickly, often within 24 to 48 hours. PANS is defined by a sudden and severe onset of neuropsychiatric symptoms. A child may abruptly display the associated symptoms such as obsessive-compulsive behaviors, anxiety, mood instability, or food restriction almost overnight. While triggers vary, infections, immune dysfunction, and environmental exposures, such as mold, moisture damage, and other biotoxins, are capable of initiating symptoms. Functional medicine doctors specializing in PANS will perform a comprehensive medical evaluation, including functional lab testing, to determine the underlying causes.

Because symptoms can appear so suddenly, families and healthcare providers often struggle to identify the exact cause. Functional medicine doctors and mold specialists at The Center for Occupational and Environmental Medicine (COEM) can provide early identification and intervention. Delaying treatment has the potential to allow symptoms to persist and worsen. Provocation-neutralization allergy testing, along with targeted immune and environmental assessments, including for mold exposure and water-damaged environments, can aid in stabilizing symptoms and preventing long-term complications.

PANS is capable of triggering sudden behavioral changes in children. A child who was previously well-adjusted may suddenly develop extreme mood swings, heightened anxiety, obsessive-compulsive tendencies, or severe irritability. These behavioral shifts may also include aggression, panic attacks, emotional outbursts, and a range of other symptoms. The severity of these symptoms can lead to misdiagnosis, as they may resemble psychiatric conditions such as acute anxiety, depression, or even psychosis. Functional medicine doctors at COEM will assess the psychological symptoms alongside other contributing factors such as immune dysregulation, inflammation, and possible infections or environmental exposures, including mold and biotoxins, that disrupt neurological function.

PANS-related behavioral changes are often highly unpredictable. A child may suddenly develop new fears, struggle with routine activities, or experience sensory sensitivities that were never present before. Separation anxiety, intrusive thoughts, and attention difficulties can further interfere with daily life, causing distress for both the child and their family. Since immune system dysfunction is capable of influencing these behavioral shifts, functional lab testing can help identify underlying infections, mold exposure, or other biotoxins. Specialists in functional medicine and mold-related illness frequently take a comprehensive approach, evaluating gut health, inflammatory markers, and immune function to create individualized treatment plans. Addressing the various associated medical triggers provides a path toward long-term stability and recovery.

The long-term effects of PANS vary depending on a number of individual factors including the speed of diagnosis and treatment, as well as individual health factors. Some children experience episodic flare-ups, where symptoms appear intensely for a period and then subside, while others may struggle with ongoing challenges if underlying triggers remain unaddressed. Without treatment, PANS has the potential to adversely impact a child’s development, academic progress, and social relationships. Repeated episodes of severe anxiety, compulsions, or behavioral dysregulation can contribute to delays in emotional and cognitive development. Additionally, persistent immune dysfunction may lead to prolonged inflammation in the brain, increasing the risk of secondary complications such as autoimmune disorders. Functional medicine doctors and mold specialists at COEM can aid in early intervention, incorporating targeted immune support and environmental assessment for mold, moisture damage, and biotoxin exposure, which can reduce the risk of long-term complications.

For some children, symptoms diminish over time, especially when the underlying cause is identified and treated. However, if infections, immune dysfunction, or toxic exposures like mold and water-damaged buildings persist, symptoms can become chronic. Long-term concerns may include executive function deficits, lingering anxiety, or increased susceptibility to future immune-related neuropsychiatric conditions. Functional lab testing plays a critical role in detecting hidden infections, nutritional imbalances, and environmental toxins that may still be contributing to symptoms. Specialists in functional medicine may recommend nutritional therapy, immune modulation, IV therapy, and environmental detoxification strategies to promote long-term healing and minimize future symptom flare-ups.

PANS can occur as a result of immune system dysfunction, in which an abnormal immune response mistakenly targets the brain, resulting in sudden and severe neuropsychiatric symptoms. This immune response is often triggered by infections such as strep, mycoplasma pneumonia, Lyme disease, or viral illnesses. Environmental exposures such as mold, moisture damage, and biotoxins, can also contribute to immune activation. When the immune system becomes dysregulated, it may produce antibodies or inflammatory compounds that interfere with brain function, particularly in areas responsible for mood regulation, behavior, and cognition. This autoimmune-like reaction is the reason that PANS symptoms can emerge so rapidly. Functional medical doctors at COEM, including Dr. Stephen Elliott, MD, the only MedMAPS-certified physician Fellow in South Carolina, focus on identifying and addressing these immune triggers to help stabilize symptoms.

Other immune-related factors may exacerbate PANS symptoms, including chronic inflammation, gut dysbiosis, and exposure to mold or water-damaged environments. When the immune system remains in a prolonged state of activation, it can continue to produce inflammatory compounds that disrupt neurological function, even after an initial infection has resolved. Functional lab testing aids in pinpointing specific immune dysfunctions, allowing for a more targeted and effective treatment plan. Specialists in functional medicine and mold-related illnesses can aid in reducing systemic inflammation, supporting detoxification pathways, and optimizing gut health to help regulate immune responses. Additionally, provocation-neutralization allergy testing can help identify additional sensitivities that may be contributing to issues. Addressing these underlying immune system imbalances allows for a more comprehensive approach to treatment, going beyond symptom relief to prevent future flare-ups and long-term neurological complications.

Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) treatment is available at The Center for Occupational and Environmental Medicine (COEM). For more information, contact us or book an appointment online. We are conveniently located at 7510 North Forest Drive North Charleston, SC 29420. We serve patients from Charleston, Mt. Pleasant, Summerville, North Charleston SC, Ladson, SC, Hanahan SC, James Island SC, John’s Island SC, Daniel Island SC, and all of South Carolina, Nationally, and Internationally.