Chronic Lyme disease and PANDAS/PANS have a number of things in common, among which is the fact that both conditions are controversial and looked at skeptically by mainstream medicine. Physicians doing biomedical work in the pediatric population see a large number of individuals with neurobehavioral disorder, and these two conditions are frequently considered as possible causes in these patients.

PANDAS/PANS is classically described as the fairly sudden onset of OCD behavior or motor tics following a strep infection. In practice, however additional features are often present, including anxiety/separation anxiety, inattention and loss of cognitive function such as math skills. Furthermore, the ‘triggering’ organism may not only be strep. Other possible agents include mycoplasma and viruses.

Similarly, the classic picture of Lyme disease is fatigue, arthritis, cognitive dysfunction, and headache preceded by a characteristic rash. In practice, things are often different, especially in the pediatric population. Here one often sees neuropsychiatric manifestations such as mood disorders, irritability, poor school work, distractibility, light and sound sensitivity and insomnia.

One can see the potential for overlap in the two conditions. There are, for example, reports of Lyme disease causing Tourette’s. Mood disturbances from Lyme disease could certainly present with anxiety similar to that seen in PANDAS/PANS. Both conditions may present with oppositional/defiant behavior or cognitive impairment.

In both conditions, laboratory testing can be helpful but is often not definitive. A positive strep test or strep titer can indicate strep exposure, but doesn’t prove neurological injury in PANS. A positive Lyme titer might also only indicate exposure and not active disease. 

Conversely, both conditions may seem to occur without positive lab tests, in that an individual with normal test results may have typical symptoms and respond to treatment.

Treating these conditions can be quite complex and both require a comprehensive approach that addresses not only the infecting agents, but also the need to balance and support the immune system, address metabolic deficiencies and sensitivities and provide psychological and behavioral therapies. Psychotropic medications  may be needed.

It is also quite possible that the two conditions can coexist in the same individual, and in fact, we have seen this in numerous patients. Additionally, it has been hypothesized that Lyme disease might be one of the infections that could trigger PANS. Fortunately, treatment regimens can be designed to address both conditions simultaneously.