A Functional & Integrative Approach to PANDAS & PANS
When we consider restoring the brain to optimal function, we need to make various dietary and lifestyle modifications to dampen inflammation within the brain. Factors that will decrease the autoimmunity in the brain include managing the immune response, lowering inflammation, and rehabilitating the brain. At the core, it truly comes down to fostering an anti-inflammatory lifestyle for children struggling with PANDAS and PANS.
Diet
Diets high in inflammatory foods will contribute to PANDAS/PANS symptoms. The most common inflammatory foods are gluten, grains, dairy, eggs, soy, corn, refined sugars, food additives, and individual food sensitivities. Additionally, certain foods can cross-react with various brain structures in PANDAS/PANS children. Continuing to consume these inflammatory and cross reactive foods can perpetuate a leaky gut and leaky blood brain barrier and therefore the progression of PANDAS/PANS symptoms. Removing these inflammatory foods can be difficult for these patients as their neurological symptoms are often triggered when certain foods are taken away. One thing is certain, a PANDAS/PANS child will never improve when allowed to consume an inflammatory diet!
Oftentimes, a low carbohydrate or ketogenic diet can be life-changing for these children because of their anti-inflammatory effect on the brain. Ketogenic diets are perfectly safe for children. Done correctly, ketogenic diets are nutrient-dense and abundant in all micronutrients and macronutrients. In addition to a diet high in quality fats, consuming a diverse variety of vegetables is important. This not only offers important nutrients, but also offers important fibers and nutrients to flourish the microbiome.
Supplements
Supplements can play an important role in modulating the immune response and dampening inflammation within the body. Some common recommendations are turmeric/curcumin, resveratrol, green tea extract ECGC, glutathione, molecular hydrogen, and Vitamin D.
Beyond these nutrients and compounds, understanding and eliminating factors that triggered the autoimmunity within the brain are often an important step in healing. For example, if the autoimmunity is triggered by toxic mold and mycotoxins, removing the child from that environment and walking them through specific detoxification is crucial. Additionally, the elimination of any triggering pathogen is paramount and can be addressed through certain herbal remedies.
Brain Rehabilitation
It is important to understand that the basal ganglia is injured in PANDAS/PANS patents. This injured portion needs activation so that healthy neurons can go around the damaged neurons and regain function in the basal ganglia. Thankfully, through neuroplasticity, the brain has the ability to change. Since PANDAS/PANS are autoimmunity against the basal ganglia, we need to look at activating this specific portion of the brain. To do this, focusing on exercise, coordinated movement, and specific sensory activities is key. Coordinated movements such as dance and martial art help children coordinate how their muscles turn on and off and work together. Additionally, sensory games that involve focus and concentration activate the basal ganglia. Games such as Red Light Green Light or Simon Says help to activate the frontal lobe as well.
Immunoglobulin Therapy
Immunoglobulins can be administered intravenously or subcutaneously. Intravenous immunoglobulin (IVIG) is the intravenous administration of immunoglobulins, primarily IgG. Immunoglobulin therapy is made from thousands of human donors. There are some risks involved with using immunoglobulins from many human donors including exposure to hidden infections, differing IgG potencies with each administration, and a 10-15% failure rate.
Many clinicians and parents feel that IVIG therapy was life changing for PANDAS/PANS patients. The research shows some positive evidence for IVIG. One study looked at the effectiveness of IVIG in 12 PANDAS patients. These patients received a course of IVIG therapy along with other medications for intervention based on the individual’s presentation. The study provides evidence that IVIG may be useful in the management of children with moderate to severe symptoms. Furthermore, we have had success within our clinic using immunoglobulin therapy.
Additional therapies often used for PANDAS/PANS patients are Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), antibiotics, NSAIDs, plasmapheresis, steroids, herbal remedies, homeopathy, and tonsillectomies. While some of these therapies have been used with varying levels of success, we believe in identifying and correcting the root causes of these autoimmune conditions.
Sources
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340809/
https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736%2898%2912297-3.pdf
http://pandasnetwork.org/treatment/