Few experiences are more frightening for a parent than watching their child change seemingly overnight. A previously thriving child may suddenly develop intense anxiety, obsessive-compulsive behaviors, rage episodes, tics, school refusal, sensory sensitivities, or cognitive regression. Families are often left feeling confused, dismissed, and desperate for answers.
PANS and PANDAS are frequently misunderstood and misdiagnosed because their symptoms look psychiatric on the surface. Children are often labeled with anxiety disorders, OCD, ADHD, mood disorders, or behavioral conditions without recognition that the symptoms may be driven by immune dysfunction affecting the brain.
This is why working with a PANS/PANDAS treatment specialist matters. These conditions are not simply behavioral problems to be managed—they are immune-mediated illnesses that require thoughtful medical evaluation and treatment.
At Restorative Medicine Center in Michigan, Dr. Teresa Birkmeier-Fredal approaches PANS and PANDAS through a root cause, immune-focused lens. Rather than asking how to control symptoms, we focus on understanding why the immune system is inflamed and attacking the brain, and how to calm that process safely and effectively.
What Are PANS and PANDAS?
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome)
PANS is defined by the sudden onset of severe neuropsychiatric symptoms, most commonly obsessive-compulsive behaviors or severe anxiety, accompanied by additional cognitive, emotional, and behavioral changes.
These may include:
- Emotional lability or sudden mood swings
- Rage episodes or aggression
- Cognitive decline, brain fog, or regression
- Sleep disturbances
- Sensory sensitivities
- Restrictive eating or food aversions
Unlike PANDAS, PANS is not limited to a single infectious trigger. Multiple immune stressors can initiate the inflammatory response, which is why many children with PANS do not fit neatly into traditional diagnostic boxes.
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)
PANDAS is a subset of PANS in which streptococcal infections trigger an autoimmune response targeting the brain. In these cases, antibodies produced to fight strep mistakenly cross-react with brain tissue, leading to neuroinflammation.
Key features of PANDAS include:
- Abrupt onset of OCD and/or tics
- Temporal association with strep infection
- Episodic symptom flares
- Neurologic and behavioral changes
The hallmark is not just the presence of strep, but the immune system’s abnormal reaction to it.
Why PANS/PANDAS Are Often Missed or Mismanaged
One of the greatest challenges families face is that PANS and PANDAS often go unrecognized. Behavioral symptoms are frequently misattributed to anxiety disorders, OCD, oppositional behavior, or trauma—without considering an immune or infectious trigger.
Many children are placed on SSRIs, stimulants, antipsychotics, or behavioral therapy alone. While these interventions may provide temporary symptom relief, they do not address the underlying immune inflammation driving the condition.
Standard laboratory testing can also be misleading. A negative strep test or “normal” labs do not rule out immune dysfunction or chronic infection. As a result, families are often told to “wait and see,” even as symptoms escalate.
Early recognition and proper treatment matter. The longer immune-mediated neuroinflammation persists, the more entrenched symptoms can become. Timely, root cause–focused care can significantly improve outcomes and reduce long-term impact on a child’s development and well-being.
Infectious Triggers Commonly Involved in PANS/PANDAS
Streptococcal Infections
Strep infections are the classic trigger in PANDAS. These may include:
- Strep throat
- Sinus or skin infections
- Recurrent or partially treated infections
In some cases, strep exposure is occult or recurrent, meaning the child may not present with classic symptoms of infection. Immune memory and molecular mimicry can still provoke neuroinflammation long after the initial exposure.
Lyme Disease and Vector-Borne Infections
Lyme disease and other vector-borne infections are increasingly recognized as major contributors to PANS and PANDAS—especially in states like Michigan, where tick exposure is common.
Organisms such as:
- Borrelia
- Bartonella
- Babesia
can disrupt immune regulation, promote chronic inflammation, and directly impact neurologic function. These infections are frequently overlooked in children with neuropsychiatric symptoms, leading to incomplete treatment and ongoing immune activation.
Other Infectious Triggers
PANS and PANDAS may also be triggered or perpetuated by:
- Mycoplasma pneumoniae
- Viral infections
- Chronic sinus infections
- Gastrointestinal infections or dysbiosis
In many children, multiple infections coexist, creating a cumulative immune burden that overwhelms the system and fuels ongoing brain inflammation.
The Role of the Root Cause Triad in PANS/PANDAS
PANS and PANDAS do not develop from a single trigger acting in isolation. In nearly every case, immune dysfunction arises from the interaction of persistent infections, inflammatory toxins, and nervous system dysregulation—what we refer to as the Root Cause Triad.
Microbes: Persistent Infections Driving Immune Activation
Chronic or recurrent infections are a primary driver of immune activation in children with PANS/PANDAS. These infections continually stimulate the immune system, increasing the risk of immune misfiring and brain inflammation.
While antibiotics can be helpful, they are often insufficient on their own. Killing microbes without addressing immune regulation, toxin load, and stress physiology frequently leads to incomplete recovery or symptom flares. The immune system must be supported while infections are addressed, not pushed beyond its capacity.
Toxins and Biotoxins: Amplifying Neuroinflammation
Toxins significantly worsen symptoms in many children with PANS/PANDAS. Mold exposure is a common and underrecognized contributor, as are biotoxins produced by chronic infections themselves.
These toxins:
- Increase inflammatory signaling in the brain
- Impair detoxification pathways
- Lower a child’s tolerance for treatment
Stress Response and Nervous System Dysregulation
Children with PANS/PANDAS often become stuck in a chronic fight-or-flight state. The amygdala—the brain’s threat detection center—becomes hypervigilant, constantly signaling danger.
This state:
- Drives immune signaling errors
- Increases inflammatory output
- Worsens emotional and behavioral symptoms
How a PANS/PANDAS Treatment Specialist Approaches Diagnosis
PANS and PANDAS cannot be diagnosed with a single lab test. A true specialist relies on clinical pattern recognition, integrating symptom history, immune markers, and real-world response to treatment.
Symptom History and Timing as Critical Diagnostic Data
- Abrupt onset of symptoms rather than gradual progression
- Clear “before and after” changes parents can identify
- Episodic flares often linked to illness, infection, or immune stress
- Clustering of neuropsychiatric, cognitive, and physical symptoms
Parents are often the most accurate historians. The timing and pattern of symptom onset provide essential diagnostic clues.
Evaluating Immune Markers and Inflammatory Patterns
- Markers of immune activation and chronic inflammation
- Evidence of immune dysregulation rather than isolated abnormalities
- Looking for patterns over time rather than single data points
Labs are used to support clinical suspicion, not to confirm or exclude diagnosis in isolation.
Identifying Contributors Together, Not in Isolation
A comprehensive evaluation considers:
- Infectious burden (strep, Lyme, coinfections, chronic infections)
- Toxic and inflammatory load (including mold and microbial toxins)
- Neurologic and nervous system dysregulation
These factors often overlap and amplify one another, driving persistent symptoms.
Why Diagnosis Is Clinical—Not Based on a Single Lab Result
- Immune dysfunction can suppress antibody production
- False negatives are common in chronic immune illness
- “Normal” labs do not rule out immune-mediated neuroinflammation
Diagnosis is based on patterns, context, and response, not one test result.
Root Cause–Focused PANS/PANDAS Treatment Approach
Treatment must support the child’s immune system while carefully addressing the underlying drivers of inflammation. The goal is regulation, not overwhelm.
Treating Infections at a Tolerable Pace
- Individualized treatment rather than rigid protocols
- Adjusting pace based on symptom response
- Avoiding aggressive interventions that provoke flares
Progress is measured by tolerance and stability, not speed.
Reducing Inflammation While Supporting Immune Regulation
- Calming inappropriate immune activation
- Supporting regulatory immune pathways
- Avoiding long-term suppression without addressing triggers
The goal is balance, not shutdown.
Supporting Detoxification and Mitochondrial Function
- Enhancing the body’s ability to clear inflammatory byproducts
- Supporting cellular energy production
- Reducing symptom burden and treatment intolerance
Children with immune dysfunction often struggle with toxin clearance, which must be addressed for healing to occur.
Addressing Foundational Physiology
Healing cannot occur without addressing:
- Sleep quality and circadian rhythm
- Nutritional adequacy and hydration
- Stress physiology and nervous system regulation
A dysregulated nervous system perpetuates immune dysfunction, making these foundational elements essential—not optional.
Treating the Cause, Not Just the Behavior
PANS and PANDAS are immune-mediated neurologic conditions, not primary psychiatric disorders. While the symptoms may appear behavioral on the surface, they are driven by inflammation and immune dysregulation affecting the brain.
When these conditions are recognized early and treated thoughtfully, the long-term trajectory for a child can change dramatically. Instead of managing crises, families can move toward stability, resilience, and recovery.
Root cause care offers hope for children who have not responded to conventional approaches—and clarity for families who know something deeper is being missed.
Schedule a PANS/PANDAS Evaluation in Michigan
If your child is struggling with sudden behavioral or neuropsychiatric symptoms and you are searching for a PANS/PANDAS treatment specialist in Michigan, a deeper, immune-focused evaluation may be the missing step.
At Restorative Medicine Center, we focus on identifying and treating the underlying immune drivers of PANS and PANDAS so children can heal—not just cope.
Restorative Medicine Center
705 Barclay Circle, Suite 115
Rochester Hills, MI 48307
Phone: 248-289-6349
Fax: 248-289-6923