A Serious Young Man

Michael is a high school student with PANDAS who I have been treating for the last several months.  He developed the condition at the age of 8 after a bout of strep throat that was treated with antibiotics.  The strep kept on reoccurring and Michael began exhibiting odd behaviors. He would wiggle or shake his body and make stepping patterns with his feet or tapping patterns with his fingers.  Then he started with various tics that presented like slurping and sniffing.  

He then became irritable with bouts of outright aggression, punching or kicking his parents.  He would fly off the handle, becoming rageful and defiant.  This alternated with periods of depression when he spoke of wanting to die and many irrational fears.

There were also many signs of age regression like bed wetting, playing with baby toys and wanting to nurse again.   School became quite difficult as his lapses into infantile behaviors, compulsions and tics interfered with any productive activities. 

All of these were typical of PANDAS, or " Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections."  Although it can manifest from infancy through adolescence, it is most typically presents in children aged 6 to 12, with ages 8 to 10, as in Michael's case, being the most common.  

The basic indications of PANDAS are the development of obsessive compulsive behaviors and/or tics that suddenly appear following a strep infection such as strep throat.   Just as important in terms of diagnostic criteria is that the symptoms appear suddenly - “overnight and out of the blue”.   They include tics - motor or vocal, obsessions, and/or compulsions.  Moodiness, irritability, and anxiety are also typical.   There is a tendency toward anxiety attacks and a strong fear of being separated from loved ones (separation anxiety).

Apparently, the condition is produced by a misdirected immune response triggered by a strep infection that causes inflammation within the basal ganglia.  This is the part of the brain responsible for speech, involuntary movement (tics) and emotion. This inflammation causes an abrupt onset of neurologic and psychiatric symptoms including OCD, tics, anxiety, emotional lability, urinary frequency and sleep disturbances.

It is thought that the reason for these aberrant immune reactions has to do with what is called 'molecular mimicry'.  Strep bacteria have developed a capacity to survive in the human body by camouflaging themselves with molecules on their cell wall nearly identical to molecules found in the heart, joints, skin, and brain tissues.  

While this allows the bacteria to evade detection for a long period, eventually they are recognized as foreign to the body and the immune system reacts to them by producing antibodies. Because of the molecular mimicry, the immune system reacts not only to the strep molecules, but also to the human host molecules that were mimicked.  This is the autoimmune response whereby the body attacks its own tissues.   In PANDAS, the immune system response is chiefly directed toward the brain.

As with most parents of children with the condition, Michael's were caught off guard and mystified as to what was happening with their son.  He once had been an extremely sensitive shy child who needed a lot of holding and attention and his new behaviors were inexplicable.  His pediatrician treated episodes of strep with antibiotics, but not being familiar with the syndrome did not recognize the overall pattern of symptoms.

While the antibiotics were effective for each bout of strep and Michael did manage to get thru a few years of early elementary school despite being frequently absent, his condition took a turn for the worse after being vaccinated at the age of 10. He had been up until that time fully vaccinated and had received his first flu vaccination the year before onset.   

Similar to the debate about autism, the role of vaccinations as a cause for PANDAS - or the similar, more broadly defined 'Pediatric Acute-onset Neuropsychiatric Syndrome' (PANS), is controversial.  That said, the emergence of PANDAS/PANS in the late 1990's correlates with the rise in number of vaccines that began in the 1980's and tripled over the next two decades.

In Michael's case, after this particular vaccination, his irritability, anger and aggressiveness spiked.  He began to refuse to go to school.  The OCD worsened and he developed more classic tics such as head nodding and shoulder shrugging.  Michael himself no longer felt he could understand the math or write and would run away if asked to do schoolwork.

It took several years for the parents to come across an article on PANDAS and realize that this was what was happening to their son.  By this time, he was being homeschooled.   Free of the stress of having to attend school as well as with better nutrition, there was some mild improvement in his symptoms.  

They also began to seek out medical professionals knowledgeable about the condition. Michael was put on antibiotics on an ongoing basis that only marginally helped.  Other treatments like the ADHD drugs and antidepressants seemed to aggravate him.  Intravenous immunoglobulin therapy or IVIG also seemed to make things worse.

 Eventually, Michael's mother found that the nutritional supplement n-acetyl-l-cysteine (NAC), which is an amino acid derivative that enhances glutathione production and detoxification, improved his mental clarity and mood.  In addition, on the advise of another neurologist, the IVIG was restarted on a regular basis. This time it proved to be quite effective in reducing many of his symptoms.

 By the time we began homeopathic treatment the improvements of the IVIG treatment had reached a plateau.  He still manifested various types of tics, as well as some anxiety and OCD behavior.  In addition, his parents were concerned that Michael was seemingly dependent on monthly IVIG infusions and were hopeful of achieving a full remission so that they could be stopped.

As with any condition, the determinate factor in successful homeopathic treatment in PANDAS/PANS is the recognition of what is unusual or characteristic about the person and the symptoms in the context of the syndrome itself. Put another way, we must ask what is unique about the way this individual child is presenting compared with other PANS/PANDAS children?

What stood out for Michael was a tremendous rigidity in his thinking, a strong desire for routine and an aversion to change, along with a need to follow the rules.  It troubles him to get into trouble at home or school.  He is also quite fastidious with a dislike for informality.

 These characteristics match Cuprum metallicum - that is, the homeopathic remedy prepared from copper.  Cuprum dates back to the earliest period of homeopathy and has a strong affinity for neurological disorders such as epilepsy with the signature symptoms of spasms, cramps and tics.  On a mental level, Cuprum patients can present as very serious, rule bound and 'ritualistic' - the homeopathic term for compulsive with this usual reserve periodically giving way to spasms of anger.

Although it is still early, Michael's response to the remedy has already been quite positive.  Within a week his tics, compulsive behaviors and concentration were noticeably improved.  He also reported that his anxiety and need for routine had diminished.   With ongoing homeopathic treatment, the action of the remedy will likely deepen bringing about further improvements with the ultimate goal of full remission.