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PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)

pandas_car_magnet_brain2_1A child may be diagnosed with PANDAS (now also known as PANS) when OCD or tic disorders appear suddenly following a strep infection or if symptoms of OCD or tic disorders suddenly become worse following a strep infection. Other symptoms associated with PANDAS/PANS include ADHD, anxiety, mood changes, sleep disturbances, incontinence, changes in muscle movements (e.g. handwriting) and joint pain. This disorder is thought to be caused by an autoimmune reaction to the infection, where the child’s antibodies produced by the infection interfere with neuronal (brain) cells. Recently, PANDAS was renamed PANS (Pediatric Acute-onset Neuropsychiatric Syndrome). It has now been recognized that this disorder can sometimes have other infectious triggers besides strep as well as having non-infectious triggers, as long as the acute onset of OCD or tic disorders criteria is met.

The standard allopathic treatment for PANDAS/PANS is antibiotics, which is often effective in the short-term but is ineffective and harmful in the long-term. Homeopathic treatment has been proven to be effective for this disorder. Parents should note that homeopathic treatment does not interfere with antibiotic treatment and that homeopathy can be used safely and effectively in combination with other treatments for PANDAS.

The Homeopathic Treatment of PANDAS/PANS: Cured Case Excerpts

Excerpt from PANDAS: A Carsinosin case by Karen Cohen published in

Prescription Carcinosinum 200C



A positive change was noted 48 hours after taking the remedy. “It is as if a cloud lifted and the feeling of lightness has been sustained for all of these weeks”. Her room is still her sanctuary but she is fine with changes in the home such as a change in the position of furniture. Going to sleep is much easier. She does have to read certain books in a very specific order before going to sleep. The end of school was a triumph, with Adelle having great success as the lead in the school play. Her stomach gets sensitive about twice a week, down from complaints daily. She has not had any headaches since taking the remedy. If she scratches the molluscum, many more will appear in the same area. Her feet no longer feel “too dry.”

Adelle got a flu virus with a high fever of 104 degrees. She lost her appetite for four days and felt sick and dizzy. After the illness she got a rash over all of her body that lasted for three days. This is the first time in three years that she had and illness and did not manifest a change in behavior suggestive of PANDAS. Normally she has had a PANDA reaction after each cold or small illness.

Plan: wait



Adelle seems happier, less sensitive and less moody and is not exhibiting obsessive symptoms of tics such as eye blinking.

Adelle is able to sleep better and falls asleep more easily. She still tends to want to stay up late. She decided to try and sleep at a friend’s house but called in the evening and asked her parents to pick her up. However, she is planning to go on a camping trip with her class at school and is looking forward to it.

She is still having lots of stomach aches and does not feel well right after having her lunch at school. She has not had a headache since taking the remedy (four months). The Molluscum are almost completely gone. On the first day of a return to school Adelle woke with a cold and sore throat. She felt this way for four days but only missed two days of school. With the cold there was no return of PANDAS symptoms. This is the first time in three years that she had and illness and did not manifest a change in behavior. Her mood remained calm and consistent and she is rarely chewing her fingers or nails.

Adelle is a bit more flexible in general and is more accepting of change. She still does not have friends come into her room and is protective o the space because she built a sort of structure in the middle of the room and “I have my stuff organized in a special way.”

She actually began to change a few things and hung something new on the wall. Her feet are more comfortable in shoes and she rarely has to wet the feet to overcome the feeling of dryness.

Plan: wait



Wonderful improvement. No PANDA reactions seen since the remedy. No longer has stomachaches or headaches. All of the Moluscum are gone. Adelle goes to sleep easily and has friends sleep over in her room. She is still resistant to socks and has some sensitivity to fabrics. Transitions, changes and new environments are taken in stride. The atmosphere in the house is much easier and Adelle is very communicative and not at all moody. No illnesses, no symptoms of PANDAS.

Homeopathy for PANDAS Case Study by Angelike Lemke published in

Philip (7 years old) is a neurotypical boy who is a high achiever in school. His mother says, “He began having nervous tics and fears as well as obsessions a few years ago. Antibiotics helped to some degree but did not hold for very long. PANDAS is interfering with his life and stopping him from living the kind of life a boy should.” He is obsessed with hand washing, and tics include a clicking sound made in the throat, eye blinking, and twisting his neck to the side. He does his best to control the tics at school, but they emerge when he comes home. His mother describes his emotions thus: “Overwhelmed, rejected, not worth being heard what his feelings are, and this provokes a rage, like you don’t want to lose control but you can’t help yourself. He pushes me (his mother) away and says ‘don’t talk to me.’ His breathing feels high up; his heart feels closed up. He is hard on himself and has high expectations of himself.”

This case was a strong presentation of Ignatia, which was prescribed in 1M potency to be taken once a week. Streptococcus pyogenes 1M was given intercurrently once a week. With close follow-up, Philip’s case resolved within 3 months, to the point where he no longer had tics or emotional lability and his self-confidence was restored.

While some patients respond to less frequent dosing, in cases of suppression I give the remedy more often and in high potencies. I will also teach the parents to redose the remedies if they see symptoms of a PANDAS flare such as a temper tantrum or an increase in tics. I look for amelioration of symptoms within the first week of treatment; however, the long-term process of healing on the deepest levels can take many months and diligent follow-up. Sometimes healing is a bumpy road; when remedies are dosed, tics can get worse, and intense emotional “confessions” may surface. This is fine as long as the parents understand the process.

In the long run, pharmaceutical treatment of Streptococcus or chronic immune deficiency can lead to the suppression or penetration of Streptococcus deep into the neurological system. Eventually, upon encountering a pathogen, these children begin to manifest temper tantrums and tics instead of typical colds and flus. Homeopathic treatment helps reestablish a healthy response to these infections, harmonize the immune system, and release suppression.

Homeopathic Treatment of PANS Case Studies by Jamie Oskin published in

PANS Case Study 1 Excerpt

I prescribed Arsenicum album 30C, 3 pellets sublinqually QD.

At Jeb’s first monthly follow-up visit, he reported a significant reduction in both tics and OCD symptoms. For example, he no longer cared if another person touched his food at school and would happily eat it without fear of contagion. He had no new episodes of asthma or skin eruptions, and he no longer had to get up from dinner to reheat his food several times during a meal to make sure it was hot.

Over the course of the next several months, we went up in potency periodically as his symptoms plateaued or there were slight regressions in improvement. His symptoms are markedly reduced and continue to improve. He and his parents are very happy with the marked and speedy improvement because it has been a struggle for the prior 4 years. Jeb loves acting and he was very excited to tell me that he had been selected to be in 2 theater productions, which were now much easier to participate in because his tics were greatly reduced (Organon §9).

PANS Case Study 2 Excerpt

I prescribed Staphisagria 30C, 3 pellets sublingually QD. I kept all other medications and supplements the same, so as to only change 1 variable in the case at a time.

Ben had a tendency to get frequent infections since early childhood, which likely predisposed him to the PANDAS autoimmune process. Since he is susceptible to tics, they may have been exacerbated by other factors, such as the methyphenidate, since tics are a known side effect of stimulant ADHD medications. Thus, the tics may be multifactorial. Regardless of the cause, the symptoms indicating Staphisagria predated the later, more progressed, expression of the disease. Staphisagria matched the most characteristic symptoms, in this case Ben’s suppressed anger and his sensitivity to insult and reprimand, which are triggering modalities of the chief complaints,‡19 ie, the anger outbursts and tics.

Within 3 months of being on Staphisagria, Ben reported that his anger was much improved. He still had a predisposition to become angry, but he was more able to control his anger without it bothering him as much. For example, he was not yelling back or hitting his brother as much when teased. He no longer needed to run to the car to scream after getting out of school for the day. He reported that his tics were, “Way less! I almost never have them.” His neck pain from the tics was also gone.

We ran strep titers prior to his 3-month follow-up appointment. Ben’s mother was happy because although his strep titers were still elevated, they were reduced. It is impossible to attribute the decreased strep titers to the homœopathic treatment because it is possible that they would have declined gradually over time on their own, since he was being treated with long-term antibiotics (thereby reducing the risk of relapse with a new strep infection). Despite this, it is a good sign that his immune system is settling down, and it follows the timeline of the improvement in his tics since starting homœopathy. His parents are happy that within 3 months of starting homœopathic treatment, they have seen a marked reduction in behavior outbursts and tics. Because his OCD symptoms have not improved significantly from the first prescription, Ben may require subsequent homœopathic prescriptions after the initial main problems (aggravation from vexation and anger, tics) are no longer problematic. Long-standing chronic diseases often require a sequence of prescriptions over the course of an extended period of time to cure the case (Organon §162 to 184). Over time, we plan to slowly and carefully wean him from his allopathic medications as he continues to improve with homœopathic treatment.

PANS Case Study 3 Excerpt

In addition to the symptoms repertorized, the cognitive delay, bed-wetting, restlessness, carphologia (picking), sensitivity to noise, and photophobia were well-matched to Belladonna. I began the case with Belladonna 6C, 3 pellets sublingually QD, on January 9, 2014. Due to acute illnesses, we had to quickly change the potency several times within the first month of treatment.

On February 6, 2014, Allison had her first follow-up appointment, having been on Belladonna 200C QD. Her symptoms were improved: Her mother reported a 50 to 70% improvement in violent behaviors, she had not run away from her teachers, and her tics were 75% reduced. Her mother also noticed that her OCD behaviors were starting to lessen because her morning routine was not as challenging. She also was not complaining of photophobia or sensitivity to noises. Additionally, her running was a little more coordinated and she was not falling as much.

Allison had several fits and starts with relapses, which is typical of PANS due to the episodic nature of the condition. However, she responded markedly to daily doses of increasing potencies of Belladonna following each relapse. Her teacher was also impressed and sent home 2 notes because Allison’s handwriting had dramatically improved within a short time-frame. This is remarkable because it has been documented that children with PANS can have sudden regression in handwriting and drawing skills as a result of the disorder.1 Additionally, her school behavior reports improved, from average scores of around 30% prior to starting homœopathic treatment, to above 90% after homœopathic treatment. Her mother noted that they were shocked that she had 10 straight days of school behavior reports above 90%. Allison’s language was improving, and she could play outside on a sunny day without needing to wear sunglasses like she used to, since her photophobia was much less intense.

This third case is much more severe and complex than the first 2 cases. Because of the episodic nature of PANS, this case is not yet “out of the woods” and will require long-term persistence for a good prognosis. Educating parents with informed consent about what to expect in a more severe and challenging case such as Allison’s, is crucial to the long-term prognosis. The case can become more difficult to manage when all providers are not on the same page, or if the parents, when feeling desperate, quickly change medications without consulting the homœopath. These cases require more patience and perseverance from the family and the doctor, in order to reduce the chance of relapse, and will likely require several years of treatment with several remedy and potency changes along the way. Thankfully, with accurate prescriptions, Allison has responded very markedly and rapidly to homœopathic treatment and has been able to successfully wean off several of her long-term medications that had not been producing significant improvement in her symptoms. Her parents have been very happy with her progress since starting homœopathy.

Case Excerpt of An Adolescent with PANDAS by  Dr. Judyth Reichenberg-Ullman and Dr. Robert Ullman

Jim received a dose of of Syphilinum 1M. Two months later he reported some improvement. “I have shortened some of the rituals quite a bit and feeling like I have to wash is not bothering me as much. I’m more cheerful. I’m sick of not touching some of the things I felt I couldn’t touch. Everyone else can touch things so why shouldn’t I? I still need to wash my hands, but only once to feel clean, and I can turn the water on and off myself. I’m not using as many wash cloths. If I touch something that isn’t clean, I get a tight feeling in my stomach or chest, but less than before.”

Jim was still avoiding many places in his home, but could go into the basement. He nearly eliminated his bedtime ritual and seemed happier and more cooperative. Before he argued for hours; now his attitude was more manageable. Jim antidoted the medicine by using an antibiotic cream, but responded quickly to a second dose. Jim’s tendency toward infection was improved and the aggravation of the OCD symptoms during the infection was not as significant.

After six more weeks, Jim was improving every day. He went to the beach and acted nearly normally. Now Jim was able to lift a variety of items out of the car and carried the beach towels. Capable of performing all of his own self-care tasks, Jim insisted that his mom to hand him a towel and open and close the shower door. Previously Jim went through hundreds of wash cloths a day; now one was sufficient. Other gains were being able to walk through the garage, to turn on the television and VCR himself, and to feel comfortable sitting on more pieces of furniture in the house. Unloading the dishwasher, serving himself food, and eating tacos with his hands, all impossible before were now within his repertoire. Jim could also sit in the back seat of the car, use a seatbelt and turn on the radio, all of which were not possible before.

When asked about his progress, Jim said, “I don’t think of everything as dirty as it was. It is easier. I am freer to move around. I am not as scared of places. I can stay there more and do things. I enjoy taking care of myself now. My anxiety has dropped a lot. Last week I had a cold, but it didn’t affect my anxiety that much. My bedroom still seems dirty, but I am thinking of going in there now.”

Jim continued to make progress. We gave him another dose of Syphilinum 1M after three months because of a partial relapse. Jim had been sleeping in his room now for nearly two months, put up new pictures on the wall, and was able to put his clothes in the closet himself. Jim could also fill the lawnmower with gasoline and to use a napkin, which he earlier considered dirty, and even used a towel normally.

Jim still had some limitations. He would not open or close the front door by himself, and the garage door still seemed dirty sometimes. Otherwise he was much better. Jim still cleaned a bit excessively, but to nowhere near the same degree as before homeopathic treatment. His mom reported that life was now liveable for the first time in several years. Jim still tended to get a cold or flu every four to six weeks.

Jim’s progress leveled off over the next few months. We gave him two doses of Syphilinum 1M for minor relapses. “I feel pretty comfortable in the house. Certain places in my room are still uncomfortable. We are going to move, which is okay with me. Things don’t seem as dirty. I am not doing a lot of hand washing. I can touch doorknobs now. I went on a camping trip without any problems and I am appearing in a play at school.”

Two months later, after moving to a different state, Jim continued to progress. He had felt contaminated after moving items from his room, but upon arriving at the new house, the change did him a lot of good. We repeated the Syphilinum. Jim succeeded at making new friends at school, and his schoolwork was going well.

Over the next few months, Jim’s OCD symptoms were much reduced, but he continued to get minor illnesses. At the end of the school year, he suffered a month-long cold, at which time his OCD worsened. Jim wanted to see how long he could go without a dose of medicine, so he did not tell his mom. While he had the cold, he spent a little more time in the bathroom, wanted to change his clothes more frequently, and avoided clearing the table. If he had to clean the bathroom sink, he felt somewhat contaminated. After a repetition of the Syphilinum, all of these symptoms went away. Jim obtained a summer job as a grocery bagger, which did not cause him any problems.

Everything went well for Jim until the fall, when he was hit by an SUV that backed into him in the parking lot of the grocery store. He wasn’t badly hurt. A few doses of Arnica and some visits to the chiropractor were all that he needed Six weeks later, Jim’s schoolwork was going well, and he was getting As and Bs. Doorknobs and bathrooms were acceptable to him and nothing felt off limits or dirty. He was dusting and vacuuming now. Jim preferred not to clean the toilet, but would it if his mother nagged him. Jim needed one more dose of medicine for a slight relapse.

Jim’s response to Syphilinum was dramatic, though it took more than a year for him to become close to normal again. Because his immune system had been weakened by the disease, he caught colds and influenza easily, which then exacerbated his OCD symptoms. These exacerbations became less and less as his homeopathic treatment continued. Though he continued to have acute illnesses, Jim was able to recover from them more easily and with less obsessiveness. We can expect that over the next year of treatment, Jim’s immune system will strengthen, making colds and flu a rarer occurrence.

Homeopathy for PANDAS Trial Result by Alan Freestone

  • 75% of responders reported an improvement in their child’s symptoms, in some cases the PANDAS symptoms completely resolved after the first prescription!
  • Around 50% of the kids fell somewhere on the Autistic Spectrum. It is clear to me that this susceptibility to recurring Streptococcal infections is on the same continuum as ASDs (Autistic Spectrum Disorder)… there is a dysbiosis – an imbalance of microbes inside these kids’ bodies.
  • 100% of the responders would recommend my treatment to others, and many have decided to continue as my patients after the trial.

What worked:

The kids often responded very quickly to the indicated remedy. Unlike other conditions, PANDAS showed rapid improvement, sometimes after a single pill. In comparison, ASD can take several months before any improvement is noticed. Saying that, the susceptibility to PANDAS is something that needs longer term treatment

Best thing that ever happened to my child and family” was one comment I received, which is just fantastic!

What didn’t work:

I had hoped to report that simply giving the Streptococcal nosode (Streptococcalpyogenes) – a homeopathic remedy made from the streptococcal bacteria, that we would be able to moderate the PANDAS symptoms in the same way that antibiotics such as Augmentin sometimes can. This did work in some instances, however what often happened was that this remedy aggravated the symptoms. So unfortunately I can’t recommend parents self-prescribing this remedy as a replacement for the antibiotics.

Overall, a positive but difficult experience” was how another parent described the trial. Sometimes the treatment can be tough on both the child & the parents with temporary aggravations of the symptoms occurring. It can take several months and changes in prescription to put the child back on the road to health. After all, it took time for them to get sick, so it takes time for them to heal.


PANDAS can respond very well to homeopathic treatment. However, please be prepared for several months of treatment before substantial and long-lasting improvements take place.

Copyright Sonya McLeod, Registered Classical Homeopath, Little Mountain Homeopathy, 351 E. 39th Ave, Vancouver, BC, (604) 677-7742