Chronic Strep and PANDAS Link Explained
PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. It refers to a condition in which a child’s immune system, after being triggered by a common strep infection like strep throat, mistakenly attacks healthy brain tissue—particularly in areas that regulate behavior, emotions, and movement. The result can be a sudden and dramatic onset of symptoms such as obsessive-compulsive behaviors, tics, anxiety, emotional volatility, and regression in skills or academic performance.
Unfortunately, many children suffering from PANDAS are misdiagnosed or dismissed entirely. In conventional medicine, the focus often stays downstream—on treating surface-level symptoms like anxiety or attention issues—without questioning what may have triggered such rapid changes in the first place. Pediatric patients are frequently labeled with psychiatric diagnoses and placed on medications without any exploration into recent infections or immune dysfunction. This disconnect leaves families feeling helpless and children without the care they truly need.
At Restorative Medicine Center, Dr. Teresa Birkmeier-Fredal takes a different approach. Rather than simply managing symptoms, she focuses on identifying and treating the root causes—what she calls the “Root Cause Triad”: microbes, toxins, and chronic stress response. In the case of PANDAS, chronic or recurrent strep infections are often the microbial trigger that sets off a cascade of immune dysregulation. Dr. Birkmeier-Fredal’s integrative strategy uses both conventional and naturopathic tools to calm the immune system, treat underlying infections, and restore neurological balance.
What Is PANDAS?
PANDAS—short for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections—is a condition in which a child’s immune system reacts abnormally to a strep infection. Rather than resolving once the infection is cleared, the immune system begins to target the brain, particularly areas like the basal ganglia that are involved in regulating movement, emotion, and behavior.
This autoimmune reaction can lead to a sudden and often terrifying onset of neuropsychiatric symptoms that seem to appear out of nowhere.
Hallmark Symptoms of PANDAS
Children with PANDAS typically experience:
- Obsessive-compulsive behaviors (OCD): such as repeated handwashing, checking, or intrusive thoughts
- Tics: involuntary movements or vocalizations, including blinking, throat clearing, or jerking motions
- Behavioral regression: loss of previously acquired skills or sudden shifts in personality
- Mood swings and irritability: intense emotional outbursts or sudden episodes of rage
- Separation anxiety or generalized anxiety: extreme fear of being away from caregivers, school refusal, or persistent worry
- Sleep disturbances, bedwetting, and sensory sensitivities may also be present
These symptoms often develop rapidly following a strep infection and may fluctuate or worsen with future illnesses.
How PANDAS Differs from PANS
While PANDAS is specifically triggered by streptococcal infections, PANS—Pediatric Acute-onset Neuropsychiatric Syndrome—is a broader diagnosis. PANS includes similar neuropsychiatric symptoms but can be triggered by a variety of infectious agents (such as Lyme or mycoplasma), environmental toxins, metabolic disturbances, or even psychological stressors.
In both conditions, the underlying mechanism is the same: an overactive immune response mistakenly targeting the brain. The key difference lies in the trigger—PANDAS is strep-specific, whereas PANS encompasses a wider range of immune provocateurs.
Understanding Group A Streptococcus
Group A Streptococcus is a common bacterium responsible for illnesses such as strep throat, scarlet fever, and impetigo. While these infections are often considered mild and easily treated, for some children, a seemingly routine strep infection can set off a much more serious chain reaction within the immune system.
Acute vs. Chronic Strep Infections
An acute strep infection typically causes visible symptoms like sore throat, fever, or swollen glands. It’s treated with antibiotics and symptoms usually resolve within days. However, chronic or recurrent strep infections can behave differently. The child may have minimal or no classic symptoms, but the bacteria continue to linger in the tonsils, nasal passages, or sinuses—repeatedly activating the immune system over time.
These “silent” infections may not be picked up with a standard rapid strep test or culture, leading to false reassurance and delayed treatment.
The Problem with Chronic Strep
In children susceptible to PANDAS, chronic strep exposure keeps the immune system in a state of constant alert. This persistent immune activation can result in the production of antibodies that cross-react with brain tissue, inflaming neurological pathways and disrupting behavior, mood, and cognition.
Even after the infection appears to be gone, the immune system can remain stuck in attack mode, creating a cycle of worsening symptoms with each new exposure or illness.
The Autoimmune Mechanism: How Strep Triggers Brain Inflammation
Molecular Mimicry and Immune Confusion
One of the most perplexing aspects of PANDAS is how a simple infection in the throat can lead to serious psychiatric and neurological symptoms. The answer lies in a concept known as molecular mimicry, a type of immune system mistake where the body’s defenses begin to confuse its own tissues with foreign invaders.
When Group A Streptococcus infects the body, the immune system creates antibodies to fight off the bacteria. However, some of the bacterial proteins closely resemble proteins found in the basal ganglia—a critical area of the brain involved in regulating movement, emotion, and behavior. Because of this similarity, the immune system can accidentally start attacking the child’s own brain, thinking it's still fighting off the infection.
This cross-reactivity is what underpins the neuropsychiatric symptoms of PANDAS, such as tics, OCD, and emotional dysregulation.
Brain on Fire: Inflammation and Dysfunction
The immune attack on the basal ganglia causes neuroinflammation, disrupting the way neurons communicate. This inflammation can happen quickly and dramatically, which is why parents often report that their child changed “overnight” after an illness. In more insidious cases, low-level, chronic exposure to strep keeps the immune system in a simmering state of inflammation, with symptoms that wax and wane over time.
The Role of the Blood-Brain Barrier
Under normal conditions, the blood-brain barrier serves as a protective shield, preventing harmful substances and immune cells from entering the brain. But during infections or periods of immune stress, this barrier can become “leaky,” allowing immune molecules—including misdirected antibodies—to enter the brain and exacerbate inflammation.
Research continues to uncover just how critical these immune mechanisms are in PANDAS and related conditions. At Restorative Medicine Center, Dr. Birkmeier-Fredal integrates both clinical insight and cutting-edge science to uncover the underlying immune dysfunction—not just to name it, but to reverse it.
The Overlap with Other Infections
Beyond Strep: What Can Trigger PANS?
PANS shares many symptoms with PANDAS but is not limited to streptococcal infections. Its onset can be triggered by:
- Lyme disease and co-infections like Bartonella and Babesia
- Mycoplasma pneumoniae
- Mold exposure and other environmental biotoxins
- Viruses (including Epstein-Barr virus, COVID-19, and others)
- Metabolic or autoimmune disturbances
- Psychological stressors that overwhelm an already taxed immune system
In many of these cases, the immune system reacts with the same type of inflammatory brain response seen in PANDAS, even when strep is not the instigating factor.
Why Differentiating Matters
Understanding whether a child is experiencing isolated PANDAS or a broader form of immune dysregulation (PANS) is essential for effective treatment. Mislabeling a case as just PANDAS can lead to a narrow treatment approach focused only on strep, while ignoring co-infections, toxins, or chronic stress responses that may also be contributing.
At Restorative Medicine Center, Dr. Birkmeier-Fredal uses a comprehensive diagnostic framework—the Root Cause Triad—to evaluate all potential drivers of immune dysfunction: microbes, toxins, and chronic stress. This approach ensures that no piece of the puzzle is missed, and that treatment is tailored to address the complete root cause picture—not just one trigger in isolation.
There Is Hope
If your child has been struggling with sudden behavioral changes, tics, or emotional instability, and no one can seem to explain why—you are not alone. PANDAS is real. It is not a mystery diagnosis or an abstract theory. It’s a treatable, immune-mediated condition that arises when the body’s defenses go awry.
The good news is that when we stop chasing symptoms and start investigating the underlying causes—when we dig deeper instead of masking—healing becomes possible. At Restorative Medicine Center, we specialize in doing just that.
By addressing the root causes of immune dysregulation, Dr. Teresa Birkmeier-Fredal has helped many children and families find clarity, validation, and a path toward recovery.
Ready for Answers?
If your child’s symptoms sound like PANDAS—or if you’re just tired of going from specialist to specialist without progress—it’s time for a more comprehensive approach.
📞 Call Restorative Medicine Center at 248.289.6349
📍 Visit us at 705 Barclay Cir #115, Rochester Hills, MI