Joshua Flowers
Introduction: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a pervasive problem lacking a consistent treatment protocol (Sigra et al, 2018). Since it was first described in the scientific literature (Swedo, Leonard, Garvey, Mittleman, Allen, Perlmutter, Lougee, Dow, Zamkoff, & Dubbert, 1998), numerous studies have elucidated details regarding the proposed pathophysiology, clinical characteristics, and underlying areas of neurological dysfunction (Orefici, Cardona, Cox, & Cunningham, 2016). In this paper, we will present a case in which a 16 year-old girl who presented with PANDAS and Sydenham chorea, as well as postconcussional syndrome, is treated with our multi-modal approach. Case presentation: The subject presented to the office with complaints of choreiform movements, “jumpy feeling legs”, difficulty with concentration/memory, GI symptoms, fatigue, and anxiety. Previous work ups for these complaints include MRI, blood tests, and stomach scan with no resulting diagnosis. Management and outcome: The patient underwent two intensive courses of treatment of two weeks duration. Treatment consisted of functional neurological rehabilitation, IV infusions, and functional medicine interventions. The patient experienced subjective improvements including less discomfort and decreased anxiety. Objective improvements were shown in neurological function through physical exam and diagnostic procedures. Discussion: Currently, there is no established “gold standard” for the treatment of PANDAS and related disorders. We present a novel paradigm of treatment for patients with PANDAS, and related disorders, in the form of a case study
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