PANS/PANDAS — Pediatric Neuro-Inflammatory Treatment

Your child was fine. Then suddenly—overnight or within days—they're not.

Maybe they developed severe OCD (hand-washing, checking locks obsessively, contamination fears). Or debilitating anxiety. Tics. Rage episodes. Refusal to eat. Separation anxiety. Handwriting that suddenly looks like a kindergartener's. Sleep disruption. Bedwetting that came out of nowhere.

Pediatricians say "it's behavioral" or "it's anxiety—try therapy." Psychiatrists prescribe SSRIs. Nothing helps. You feel like you're losing your child.

Here's what most doctors miss: PANS/PANDAS is not a psychiatric disorder. It's an autoimmune/neuroimmune condition triggered by infection.

At Rooted Health Clinic, we specialize in PANS/PANDAS using functional medicine and integrative approaches. We start anti-inflammatory and immune-modulating treatment immediately while testing for the triggering infection.

This is complex medicine. But we've seen kids recover—from completely non-functional to back at school, thriving. It takes time, but recovery is possible.

What is PANS/PANDAS?

PANDAS = Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections Triggered specifically by strep throat (Group A Strep).

PANS = Pediatric Acute-onset Neuropsychiatric Syndrome Same symptoms, but triggered by infections other than strep (mycoplasma, Lyme, Epstein-Barr, influenza, mold, etc.) or by non-infectious immune triggers.

What happens: An infection triggers an immune response. Antibodies mistakenly attack the basal ganglia (the part of the brain that controls movement, behavior, and emotions). Result: sudden, severe neuropsychiatric symptoms.

Key characteristics:

• Sudden onset — symptoms appear overnight or within 24-72 hours

• Dramatic change — your child is not themselves

• Multiple symptoms at once — usually a cluster of symptoms

• Often triggered by illness — recent strep, ear infection, cold, flu, or stealth infection

Symptoms of PANS/PANDAS

Primary symptom (always present):

• Sudden, severe OCD — intrusive thoughts, compulsions (hand-washing, checking, counting, contamination fears)

Plus at least two of the following:

• Severe anxiety (separation anxiety, generalized anxiety, panic attacks)

• Rage episodes, aggression, irritability

• Emotional instability (laughing then crying within minutes)

• Regression (baby talk, clinginess)

• Brain fog, difficulty concentrating, memory problems

• Decline in school performance, handwriting deterioration• Tics (motor or vocal), jerky movements

• Sensory issues (sounds, textures, lights suddenly intolerable)

• Sleep disturbances, nightmares, night terrors

• Urinary frequency, bedwetting (if previously toilet-trained)

• Food restriction, fear of eating, sudden pickiness

• Dilated pupils, dark circles under eyes

Timeline: Symptoms appear suddenly (within hours to days) and are severe from the start—not a gradual worsening.

Our Approach: Treat Inflammation & Infection Together

PANS/PANDAS requires both immune modulation AND identification/treatment of the triggering infection. We start treatment immediately while testing runs.

Step 1: Start Anti-Inflammatory & Immune-Modulating Treatment Immediately

Reduce Brain Inflammation The immune attack on the basal ganglia causes inflammation. We reduce it with:

• Omega-3 fatty acids (high-dose fish oil for anti-inflammatory effects)

• Curcumin (potent anti-inflammatory)

• Vitamin D (immune modulation, often deficient)

• Probiotics (gut-brain-immune connection)

Low-Dose Naltrexone (LDN) LDN modulates the immune system, reduces neuroinflammation, and improves symptoms in many PANS/PANDAS kids. We start at a very low dose and increase gradually based on response. Well-tolerated and safe for children.

Gut Healing — Critical for Immune Function 70% of the immune system lives in the gut. Leaky gut and dysbiosis worsen autoimmune responses. We start immediately with:

• Elimination diet (remove gluten, dairy, sugar—common triggers for inflammation)

• Probiotics + prebiotics (restore healthy gut bacteria)

• Gut-healing nutrients (L-glutamine, zinc, collagen)

• Anti-inflammatory foods (vegetables, healthy fats, no processed foods)

Many parents see behavioral improvement within 1-2 weeks just from removing inflammatory foods.

Steroids (If Severe) For severe, acute flares, a short course of oral steroids (prednisone or prednisolone) can calm the immune response quickly. We prescribe when symptoms are debilitating and other interventions haven't helped fast enough.

IVIG (Intravenous Immunoglobulin) IVIG resets the immune system. It's expensive and insurance rarely covers it for PANS/PANDAS, but it can be life-changing for severe cases. We discuss it if first-line treatments don't produce enough improvement.

Antimicrobials (While Testing) If recent strep or ongoing infection is suspected, we start antibiotics immediately. The specific antibiotic is chosen based on the suspected pathogen and clinical presentation. For chronic infections (Lyme, mycoplasma), we use longer-term antimicrobial protocols.Step 2: Test for Triggering Infections (Concurrent with Treatment)

We test to identify what triggered the immune response. Common culprits:

Streptococcus:

• ASO titer, anti-DNase B — shows recent or ongoing strep infection

• Throat culture — active strep

Mycoplasma pneumoniae:

• IgG/IgM antibodies — very common PANS trigger

Lyme Disease & Co-infections:

• Lyme Western blot, Lyme panel

• Bartonella, Babesia testing if Lyme suspected

Viral Infections:

• Epstein-Barr Virus (EBV) — VCA IgG/IgM, EBNA, Early Antigen

• HHV-6, CMV, Coxsackie — other viral triggers

Mold Toxins:

• Urine mycotoxin panel — if mold exposure suspected

Inflammatory Markers:

• C-Reactive Protein (CRP), ESR — measures systemic inflammation

• ANA (anti-nuclear antibody) — rules out other autoimmune conditions

• Anti-basal ganglia antibodies — research test, not always available

Immune Function:

• Immunoglobulins (IgG, IgA, IgM, IgE) — check for immune deficiencies

• Vitamin D, zinc, magnesium — critical for immune function

Testing helps us target treatment (e.g., specific antibiotics for strep vs. Lyme, antifungals for mold, antivirals for EBV). But we don't wait for results to start anti-inflammatory protocols.

Step 3: Long-Term Management & Prevention

Prophylactic Antibiotics Many PANS/PANDAS kids need long-term low-dose antibiotics to prevent strep reinfection and flares. We prescribe when appropriate based on your child's history.

Gut Maintenance Keep the gut healthy long-term: probiotics, anti-inflammatory diet, avoid triggers (gluten, dairy, sugar). Gut health = immune health.

Immune Support Daily vitamin D, zinc, omega-3s, probiotics. Strong immune system = fewer infections = fewer flares.

Monitor for Flares PANS/PANDAS can flare with new infections. We teach parents to recognize early signs and intervene quickly (increase LDN, restart antibiotics, add steroids if needed).

Therapy & Support Cognitive-behavioral therapy (CBT) for OCD, exposure-response prevention (ERP), and family therapy help manage symptoms and rebuild function. We coordinate with therapists.

What to Expect

First Visit (60-90 minutes)

We'll review your child's full history: onset timeline, symptoms, recent illnesses, exposure history. We'll order testing and start anti-inflammatory/gut-healing protocols immediately. You'll leave with a clear plan.Follow-Up Care

We see your child regularly (every 2-4 weeks initially) to monitor progress and adjust treatment. Recovery is a process—usually 3-6 months to see significant improvement, sometimes 6-12 months for full recovery. But many kids start improving within weeks.

Realistic Expectations

• Some kids respond quickly (weeks) — especially if caught early

• Some kids take months — chronic infections, severe cases

• Relapses can happen — with new infections

• Recovery is possible — we've seen kids go from non-functional to thriving

PANS/PANDAS is treatable. It takes persistence, but kids can get their lives back.

Membership Model

We don't accept insurance because insurance doesn't pay for the time PANS/PANDAS families need. Our Direct Primary Care membership gives you:

• Unlimited office visits — as often as needed

• Text/email access to Dr. Altman — questions don't wait for appointments

• Wholesale supplements — significant savings

• Affordable labs — through LabCorp direct billing

Pediatric Membership: $185/month

Testing, IVIG, and specialty treatments are additional, but you'll never be surprised—we discuss costs upfront.

Success Stories

"We got our daughter back." "She went from happy 8-year-old to unrecognizable in 48 hours. Severe OCD, panic attacks, wouldn't eat. Pediatrician said 'anxiety.' Dr. Altman tested for strep and mycoplasma—both positive. He started antibiotics, LDN, gut healing, and steroids. Within 2 weeks she was 50% better. By 3 months she was back to school full-time. We're 6 months in now and she's 95% herself. This man saved our family." — M.R., Temple, TX

"Finally, someone who knew what this was." "We saw 5 doctors. Nobody had heard of PANS. Dr. Altman diagnosed it in the first visit. He started treatment immediately and we saw improvement within a week. It's been a long road but our son is thriving now. We're forever grateful." — J.K., Salado, TX

"The only doctor who would treat him." "Psychiatrists wanted to put him on antipsychotics. Pediatricians said there's nothing wrong. Dr. Altman said 'This is PANS' and started treatment. LDN and antibiotics changed everything. He's back in school, back to being himself. Thank you, Dr. Altman." — L.S., Killeen, TX

FAQ

How quickly will my child improve? Some kids improve within 1-2 weeks (especially with steroids). Others take 2-3 months. Severe or chronic cases can take 6-12 months. Every child is different.Does my child need IVIG? Not always. Many kids respond well to antibiotics, LDN, and anti-inflammatory protocols. IVIG is reserved for severe cases or kids who don't respond to first-line treatments.

Will my child need antibiotics forever? Some kids need prophylactic antibiotics long-term (6-12 months or more) to prevent flares. Others can stop once infections are cleared and the immune system stabilizes. We personalize based on response.

Can PANS/PANDAS be cured? Some kids fully recover and never have another flare. Others have periodic flares with infections but recover quickly with treatment. Long-term gut health and immune support reduce flare risk.

What if testing comes back negative? Negative tests don't rule out PANS/PANDAS. Infections can be stealth (hiding in tissues), or antibody levels may have already dropped. We treat based on clinical presentation, not just labs.

Do SSRIs help? Sometimes, but they don't treat the root cause. We address the immune/infection component first. SSRIs can be added if OCD symptoms persist after immune treatment.

Can you treat my child remotely? Yes, we offer telemedicine for Texas residents. Many PANS/PANDAS families prefer remote visits.

Does insurance cover this? We don't accept insurance. You can use HSA/FSA funds for membership and services. IVIG is rarely covered by insurance for PANS/PANDAS, but we help families navigate options.

Ready to Get Your Child Back?

PANS/PANDAS is terrifying. But it's treatable. You don't have to navigate this alone.

Schedule Your Consultation Call or text: 254-780-0023 Email: hello@elitefamilycare.sprucecare.com

Location: Rooted Health Clinic 1401 N Stagecoach Rd Salado, TX 76571

We serve families in Salado, Temple, Killeen, Belton, Georgetown, Waco, and surrounding Central Texas communities.

This is specialized medicine. This is how kids recover.