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ENCEPHALITIS

 

PANDAS is NOT currently classified as encephalitis. However, PANDAS can cause an Encephalitic-like Sudden Onset in acute case..

Dr. Russell C. Dale, Institute of Child Health, University College London, and colleagues have written up groundbreaking work on the nature a form basal ganglia autoimmune encephalitis caused by a virus, Von Economo’s, and its similarities to PANDAS symptoms.

COMMENTARIES ON THE BASAL GANGLIA:


PANDAS/PANS IS DIFFERENT THAN TYPICAL ENCEPHALITIS

“Typical Encephalitis” is different than PANDAS. It is an inflammation caused by a viral or bacterial infection that is present in the brain and physical deterioration is often rapid and severe and it is easily detected via an MRI. This dangerous elevation of symptoms does not seem to occur in PANDAS/PANS.

In THE LANCET Neurology article (2011) Autoantibodies associated with diseases of the CNS: new developments and future challenges, neurologists link PANDAS and possible encephalopathy. Specifically look at the chart on page 2 where PANDAS is listed.

Some PANDAS/PANS provider will refer to PANDAS/PANS as a form of encephalitis. Perhaps in the future, the classification of PANDAS and PANS may change.


AUTOIMMUNE ENCEPHALTIS

The following paper by Dr. Finn Somnier, Neurologist, discusses sporadic cases similar to encephalitis. As he states, “More recent discoveries appear to point towards a variety of different aetiologies of EL-like disorders and within a context of autoimmune encephalitis”. In this paper, he includes PANDAS.

Autoimmune encephalitis-History & current knowledge (2012)   Posted with permission of Finn E. Somnier, M.D., D. Sc. (Med.). (A neurologist “must have”. PDF may load slow as it is 40 pages.) refer to pages 32+ for PANDAS.


NEURO-INFLAMMATION AND PSYCHIATRIC ILLNESS

Knowing that autoimmune disorders can create a host of neuropsychiatric symptoms is not new. The paper Neuroinflammation and Psychiatric Illness by Dr. Souhel  Najjar, et al. discusses neuropsychiatric disorders associated with autoimmunity, including a section devoted to PANDAS. It also discusses the possible role of cytokines, CNS glutamate dysregulation, increased oxidative stress, and Blood Brain Barrier (BBB) dysfunction in what is categorized as psychiatric illneses.


BASAL GANGLIA AND MRI

It is difficult to prove inflammation because NERVES do not show up in an MRI.

The studies have shown some changes in the Virchow Robin Spaces and a Swedo study did show increase volume of basal ganglia. With the brain, we cannot take tissue out and look at under a microscope for inflammation. We must use our own brains to think logically instead.”

One of the Swedo studies the above doctor is referring to is Swedo, et al (2000) – MRI Assessment of Children with OCD or TICS Associated with Streptococcal Infections.

Since PANDAS involves the basal ganglia it is likely minimal inflammation, if any, will be detected.  It is worthwhile to rule out obvious issues.

However,  similarly, many illnesses, like Alzheimers, Parkinson’s and Huntingtons, which involves microscopic nerves of the brain, do not show any brain damage under MRI but only with specialized PET scans once the illness is severely advanced.

Neurologist, Harry Chugani (see below), Univ of Michigan, is researching techniques to monitor inflammation to the BG but the tests are preliminary and not available unless part of a study. Research funds to advance his work are being sought as of 2012.

As parents, when we face doctors who will not help us with treatment, it can be helpful to use the words, “an encephalopathic-like episode” has occurred in your child.

 

ENCEPHALITIS CAN BE CAUSED BY:

  • Viral
  • Bacterial
  • Autoimmune response to a bacteria or virus (as in the rare illness ADEM, Acute Disseminated Encephalomyelitis. In ADEM, the white matter of the brain is injured and inflamed).

WHY PANDAS/PANS PERPLEXES THE MEDICAL COMMUNITY

PANDAS/PANS is different than what doctors have had experience with before.

Some children respond rapidly to 10 days of antibiotics. Most children require a longer course of antibiotics. Why this is – is not yet clear – though doctors have observed this to be true. PANDAS’ sudden attacks then slow, relapsing-remitting course is NOT how inflammatory brain illnesses are currently thought about by the medical community.

The topic of encephalitis is brought up only to explain that there is precedent for strange and varied psychological behaviors stemming from brain inflammation, especially where the basal ganglia are involved and that a bacterial irritation with ensuing autoimmune responses can be the culprit.

In PANDAS, initially, the episode is a negative autoimmune response in the basal ganglia to the strep bacteria. It is in the basal ganglia area only. It is not in the white or gray matter itself. There is no infection in the brain. **

* * NOTE: Very rarely, it has happened that in a few PANDAS, an MRI has picked up white or gray matter inflammation and the children are in those cases in need of and will receive immediate treatment for encephalitis.

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