Tag Archive for: pediatric mental health

A Holistic Approach to Overcome PANDAS and PANS Part 4

Part 4: Treatment: From Acute Intervention to Long-Term Resilience

By Cristina McMullen, Bioenergetic Practitioner, Longevity Health Center 

When a child is in acute crisis, intervention must be decisive. In PANDAS cases, antibiotics are often the first step — a medical practice rooted in the discovery of penicillin by Alexander Fleming.

Some children improve dramatically within 48 hours. Others experience partial improvement, followed by relapse.

Anti-Inflammatory and Immune-Modulating Therapies

NSAIDs may reduce inflammation. Short steroid bursts may suppress immune overactivation.

In more severe cases, IVIG or plasmapheresis may be considered to modulate antibody activity.

These treatments can be powerful. But they are not without cost or risk. And they may not address underlying terrain issues contributing to immune dysregulation.

The Antibiotic Resistance Reality

It is worth remembering that even Alexander Fleming warned about antibiotic misuse leading to resistance.

Today, biofilms and resistant bacterial forms complicate chronic infections. The National Institutes of Health estimates that a large proportion of chronic infections involve biofilm communities that are significantly more resistant to treatment.

This may help explain recurring flares despite appropriate antibiotic therapy.

A Functional Medicine Lens

At Longevity Health Center, we believe stabilization is only the beginning.

Long-term healing involves restoring immune balance.

That often includes:

  • Supporting gut integrity
  • Rebuilding microbiome diversity
  • Identifying food sensitivities
    Reducing environmental toxin burden
  • Optimizing nutrient status
  • Strengthening sleep and nervous system regulation

We don’t approach this as a quick fix. We approach it as rebuilding resilience.

Prevention and Immune Training

Modern research increasingly supports the idea that immune systems require appropriate microbial exposure early in life to develop tolerance.

At the same time, overuse of antibiotics, environmental chemicals, chronic stress, and dietary shifts may contribute to rising autoimmune conditions.

The goal isn’t fear.

It’s balance.

Public health organizations such as the Centers for Disease Control and Prevention and the World Health Organization continue to monitor infectious and immune trends globally. As our understanding evolves, so must our strategies for prevention and resilience.

The Bigger Picture

PANDAS and PANS sit at the crossroads of infection, immunology, neurology, and psychiatry.

They challenge traditional silos of medicine.

But they also offer a powerful reminder:

The brain is not separate from the immune system.
 Behavior is not separate from inflammation.
 And healing often requires looking at the whole child.

At Longevity Health Center, we walk alongside families navigating this complexity — carefully, compassionately, and collaboratively.

Because when the immune system is supported, and inflammation is addressed at its roots, many children find their way back to themselves.

A Holistic Approach to Overcome PANDAS and PANS Part 3

Part 3: Diagnosis & The Ongoing Debate

By Cristina McMullen, Bioenergetic Practitioner, Longevity Health Center

 

If you’ve been navigating PANDAS or PANS with your child, you’ve probably already noticed something frustrating: Not everyone agrees on what it is, or how to diagnose it.

Some clinicians believe these conditions are often missed. Others are more cautious and feel the criteria can sometimes be applied too broadly. And in the middle of that debate are families watching very real, very sudden changes in their children.

You might hear phrases like “correlation doesn’t equal causation.” But when a child changes overnight—developing OCD, anxiety, tics, or severe behavioral regression—parents are often left trying to make sense of a pattern that feels very real in front of them.

That gap between lived experience and evolving science is part of what makes this condition so complex.

How PANDAS and PANS Are Diagnosed

One of the most important things to understand is this:

PANDAS and PANS are clinical diagnoses. They are not confirmed by a single lab test.

Instead, they are identified based on a child’s symptom presentation, timing, and medical history.

PANDAS is typically considered when there is:

  • A sudden onset or dramatic worsening of OCD and/or tics
  • A temporal association with a streptococcal infection
  • Supporting clinical history suggesting immune involvement

Labs such as ASO and Anti-DNase B titers may be ordered to evaluate for recent strep exposure, but they are not diagnostic on their own. Antibody levels can vary depending on timing, prior immune response, and whether the infection was recent or partially treated. Negative results can still be misleading because not all children will show elevated or rising levels, even when infection appears to be a trigger.

This means diagnosis cannot rely on labs alone—it requires careful clinical evaluation of symptom timing and pattern.

PANS is diagnosed when there is:

  • A sudden onset of OCD or restrictive eating
  • Along with at least two additional neuropsychiatric or behavioral symptoms (such as anxiety, irritability, regression, sleep disruption, or urinary symptoms)
  • No requirement for a known infectious trigger

Because there is no single identifiable cause, PANS is also a clinical syndrome defined by symptom pattern, not a laboratory marker.

Where Testing Fits In

Laboratory testing can still be helpful, but primarily as supporting information, not confirmation of diagnosis.

Testing may be used to explore:

  • Evidence of recent or past infections
  • Immune system activation
  • Inflammatory or metabolic contributors that may be worsening symptoms

However, no lab test currently available can definitively confirm or rule out PANDAS or PANS. These results must always be interpreted in the context of the full clinical picture.

What About the Cunningham Panel and Other Advanced Testing?

You may also hear about the Cunningham Panel, a specialized test developed to evaluate certain antibodies and immune signaling patterns that may be associated with neuropsychiatric symptoms.

It measures markers such as:

  • Anti-dopamine receptor antibodies (D1 & D2)
  • Anti-lysoganglioside antibodies
  • Anti-tubulin antibodies
  • CaMKII activation (a signaling marker related to immune activity in the brain)

The intention is to explore whether immune dysregulation may be contributing to symptoms.

However, there are several important considerations for families:

The Cunningham Panel is not a diagnostic test for PANDAS or PANS, and its clinical reliability remains debated.

It is also:

  • Expensive, often costing close to one thousand dollars
  • May not be covered by insurance
  • Variable in its results, which can shift depending on whether a child is in a symptom flare or relatively stable at the time of testing

Because of this, results may look very different at different points in a child’s journey.

Some clinicians still use the panel as a supportive tool in complex cases, while others do not rely on it due to inconsistency and lack of broad clinical consensus.

A More Accessible Option: Neural Zoomer

Another test some integrative providers may consider is the Neural Zoomer, a broader panel that evaluates immune reactivity to a wide range of brain and nervous system proteins.

This test looks at antibodies associated with:

  • Neuroinflammation
  • Brain and nerve tissue reactivity
  • Neurotransmitter receptors (such as dopamine and GABA)
  • Blood–brain barrier integrity
  • Infection-related immune responses

Because it casts a wider net, it may help identify patterns of immune activation affecting the nervous system that standard labs do not capture.

In many cases, it is:

  • Somewhat more affordable than the Cunningham Panel (though still typically out-of-pocket)
  • More commonly used in integrative and functional medicine settings
  • Available as a simple blood test

However, it’s important to understand:

  • Like the Cunningham Panel, it is not diagnostic for PANDAS or PANS
  • Pediatric reference ranges are limited, so results require thoughtful interpretation
  • It reflects immune reactivity, not necessarily causation or active disease

The Bigger Picture

Both of these tests can offer insight into immune patterns—but neither provides a definitive answer.

They may help answer questions like:

  • Is there evidence of immune activity affecting the brain?
  • Are there patterns that suggest inflammation or barrier disruption?

But they cannot answer:

  • Is this definitively PANDAS or PANS?

That diagnosis still comes back to clinical history, symptom pattern, and timing.

In many cases, families gain more clarity by focusing first on patterns and response to treatment, rather than relying heavily on advanced testing alone.

Is PANDAS/PANS Underdiagnosed or Overdiagnosed?

The honest answer is that both perspectives exist.

Some children with sudden neuropsychiatric changes may go years without anyone considering an immune or post-infectious component. Others may receive a PANDAS/PANS label without a clearly supported trigger.

This is part of why diagnosis can feel so confusing—it relies heavily on clinical judgment rather than a single definitive test.

Our Approach: Looking at the Whole Picture

At Longevity Health Center, we take a step back from one-size-fits-all answers.

Instead, we focus on patterns:

  • When did symptoms begin, and how quickly did they change?
  • What infections, immune stressors, or environmental triggers came before onset?
  • What does the child’s immune and health history show over time?
  • How do symptoms shift with treatment or stress?

Because in complex neuroimmune conditions, no single lab test or checklist tells the full story.

Careful observation, clinical pattern recognition, and individualized evaluation are essential.

Encouragement for Parents

If you’re in the middle of this journey, it’s okay to feel uncertain.

Science is still evolving. The opinions can be conflicting. And yet—your observations about your child matter.

You are often the first to notice the pattern. And in conditions where timing and subtle changes are important, that insight can be one of the most valuable pieces of the clinical picture.

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A Holistic Approach to Overcome PANDAS and PANS Part 2

How Infections and Inflammation Reach the Brain

By Cristina McMullen, Bioenergetic Practitioner, Longevity Health Center 

 

In Part 1, we explored how an autoimmune response can target the brain in children with PANDAS and PANS.

Now let’s go deeper.

Because understanding how inflammation reaches the brain helps explain why some children spiral into chronic symptoms — and why others recover.

When Inflammation Doesn’t Turn Off

In a healthy immune response, inflammation is temporary.

A pathogen enters. The immune system responds.
The invader is eliminated. The immune system quiets.

But in autoimmune states, that final step fails.

Macrophages and other immune cells continue releasing inflammatory cytokines. Antibodies remain active. The immune system stays on high alert.

This prolonged immune activation doesn’t just circulate in the bloodstream — it affects barriers designed to protect vital organs.

One of the most important of those barriers is the blood–brain barrier (BBB).

The Blood–Brain Barrier: The Brain’s Security System

The blood–brain barrier is a tightly woven network of capillaries that separates circulating blood from brain tissue.

Under normal circumstances, it prevents bacteria, viruses, large proteins, and circulating antibodies from entering the brain.

But during systemic inflammation, those tight junctions can loosen.

Cytokines increase vascular permeability. Capillaries expand. The barrier becomes more permeable than it should be.

This is where autoimmune conditions become neurological conditions.

When neuroactive antibodies cross into brain tissue, they don’t behave passively. They bind. They signal. They alter neurotransmitter activity.

In PANDAS and PANS, the region most consistently implicated is the basal ganglia.

The Basal Ganglia: Where Movement, Emotion, and Habit Intersect

The basal ganglia are not a single structure but a network of nuclei located deep within the brain. They include:

The caudate nucleus

The putamen

The globus pallidus

The substantia nigra

The subthalamic nucleus

Each region contributes to coordination between movement, cognition, motivation, and emotion.

The caudate nucleus, for example, plays a role in inhibitory control and procedural learning. The putamen influences movement patterns and habit formation. The substantia nigra helps regulate dopamine — a neurotransmitter central to reward and motor control.

When inflammation affects this network, the results can be profound:

Repetitive motor movements

Intrusive thoughts

Compulsive behaviors

Emotional volatility

Impulsivity

Sensory dysregulation

Imaging studies during acute PANDAS episodes have demonstrated enlargement of the caudate and putamen. In some documented PANS cases associated with Lyme neuroborreliosis, MRI findings have even shown infarction within basal ganglia structures.

These are not subtle findings.

They underscore an important reality: this is not “bad behavior.” This is inflamed neural circuitry.

Beyond Strep: Other Triggers of PANS

While PANDAS is specifically associated with Group A Streptococcus, PANS expands the list of potential triggers.

Let’s walk through some of the most commonly investigated.

Epstein–Barr Virus (EBV)

EBV is incredibly common. Many children are exposed to it early in life.

Testing typically includes:

VCA IgM (indicating recent infection)

VCA IgG (which persists long term)

EBNA antibodies (which appear later)

Early Antigen (EA) antibodies (which may suggest active infection)

Interpreting EBV labs can be complex. Some antibodies remain positive for life, making it difficult to distinguish past from current activity.

Mycoplasma pneumoniae

Mycoplasma is unique among bacteria because it lacks a cell wall. That makes it harder to detect and treat.

Testing may involve:

IgM and IgG antibody levels

PCR assays that detect bacterial DNA

Because Mycoplasma can be small and elusive, false negatives are possible.

Lyme Disease and Coinfections

Lyme disease, caused by Borrelia burgdorferi, is typically evaluated using ELISA followed by Western Blot testing.

However, both tests have limitations. False negatives are common, especially early in infection. PCR testing may detect bacterial DNA, but even that depends on where the sample is drawn.

When neurological symptoms overlap with immune dysregulation, Lyme and coinfections often enter the differential diagnosis.

Environmental Factors: Metals and Mold

Heavy metals such as lead, mercury, aluminum, and arsenic can be measured through blood, urine, or hair analysis.

Mold exposure may be evaluated through antibody testing or organic acid testing. However, mold mycotoxin testing can yield false negatives if the body is not actively excreting toxins at the time of testing.

These environmental contributors don’t directly “cause” PANS in most cases. But they may increase inflammatory burden, lower immune resilience, and contribute to chronic immune activation.

Why False Negatives Are So Common

One of the most frustrating aspects of PANDAS and PANS is that testing is imperfect.

Strep titers (ASO and Anti-DNase B) don’t always rise significantly. In fact, studies have shown that only about half of confirmed strep infections produce a significant increase in ASO titers.

Timing matters. Age matters. Individual immune response variability matters.

This diagnostic uncertainty is part of why controversy persists.

 

A Holistic Approach to Overcome PANDAS and PANS Part 1

When OCD Isn’t Just OCD 

 

By Cristina McMullen, Bioenergetic Practitioner, CTN, Longevity Health Center 

There are moments in parenting that divide life into “before” and “after.” For some families, that moment isn’t a diagnosis of autism. It isn’t a traumatic event. It isn’t a long, slow decline.

It’s a Tuesday. Your child goes to school happy. They come home withdrawn.
 Within days, they’re washing their hands obsessively. Refusing food. Crying uncontrollably. Developing tics. Panicking at bedtime. Saying thoughts are “stuck” in their head.

And you think: This cannot just be anxiety. For a subset of children, it isn’t.

A Disorder First Recognized in the 1990s

In the 1990s, researchers at the National Institute of Mental Health began studying a puzzling phenomenon. Led by Dr. Susan Swedo, they noticed a pattern: some children developed sudden-onset obsessive-compulsive behaviors and motor tics shortly after a strep infection. Not gradually. Suddenly.

The researchers proposed a new condition: PANDAS — Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.

The idea was bold. It suggested that in certain children, a common bacterial infection could trigger an autoimmune reaction that affected the brain.

Over time, clinicians realized that strep wasn’t the only trigger. Other infections, viral, bacterial, even inflammatory environmental stressors, appeared capable of producing the same abrupt neuropsychiatric changes.

That broader diagnosis became known as: PANS — Pediatric Acute-Onset Neuropsychiatric Syndrome.

What Makes PANDAS and PANS Different?

Children struggle with OCD and anxiety for many reasons. So what distinguishes PANDAS or PANS?

It’s not simply the presence of obsessive thoughts or tics. It’s the abruptness and severity of onset.

Parents often describe it as:

  • “A light switch flipped.”
  • “He disappeared overnight.”
  • “She was a different child within days.”

Along with OCD and/or tics, children may experience:

  • Severe separation anxiety
  • Emotional lability
  • Aggression or irritability
  • Regression (baby talk, bedwetting)
  • Decline in handwriting
  • Sleep disturbances
  • Restrictive eating
  • Sensory hypersensitivity

These symptoms don’t creep in slowly. They erupt. And that timing is the first major clue.

The Immune System Protector, and Sometimes Instigator

To understand PANDAS and PANS, we have to appreciate how sophisticated the immune system really is.

Your child is exposed to microbes every day, through air, food, surfaces, and social contact. The fact that they don’t constantly fall ill is a testament to the immune system’s layered defenses.

First Line of Defense: Physical and Chemical Barriers

Before a pathogen ever enters the bloodstream, it must pass through protective barriers:

  • Skin with its slightly acidic pH
  • Mucosal linings in the nose, throat, and gastrointestinal tract
  • Stomach acid capable of destroying many microbes

These surfaces are not sterile. In fact, they’re populated with trillions of beneficial bacteria. These microbes compete for space and nutrients, preventing harmful organisms from gaining a foothold.

When this system is balanced, it works like a well-oiled machine.

Second Line of Defense: Innate Immunity

If a pathogen breaches those barriers, the innate immune system activates.

Macrophages, specialized white blood cells, identify invaders by recognizing specific molecular signatures known as pathogen-associated molecular patterns (PAMPs). These signatures have remained remarkably consistent throughout evolutionary history.

When a macrophage binds to a pathogen, it engulfs it. Literally.

The cell membrane expands around the microbe, pulls it inside, and digests it using enzymes contained in lysosomes.

Macrophages also release signaling molecules called cytokines. These chemical messengers:

  • Recruit additional immune cells
  • Increase blood flow
  • Trigger inflammation

Inflammation isn’t inherently bad. In fact, it’s essential for healing.

But what happens when inflammation doesn’t turn off?

Third Line of Defense: Adaptive Immunity

The adaptive immune system is highly specific.

T cells activate B cells to produce antibodies, proteins designed to recognize one precise target, called an antigen.

Once the pathogen is cleared, antibody production typically slows, and the immune response resolves.

But in autoimmune conditions, that shutdown mechanism malfunctions.

When the Immune System Gets Confused

In PANDAS and PANS, researchers believe a process called molecular mimicry may occur.

Certain pathogens, particularly Group A Streptococcus, carry surface molecules that resemble molecules found in human tissue. In attempting to eliminate the infection, the immune system produces antibodies.

Unfortunately, those antibodies may also recognize and bind to similar-looking structures in the child’s own body.

Instead of distinguishing “self” from “non-self,” the immune system becomes confused.

The result? An autoimmune attack.

The Autoantibodies Involved

Studies of children during acute PANDAS/PANS episodes have identified elevated antibodies against:

  • Lysoganglioside (a component concentrated in nerve cell membranes)
  • Tubulin (a structural protein highly concentrated in brain cells)
  • Dopamine D1 receptors
  • Dopamine D2 receptors

These targets are not random. Dopamine receptors play a central role in movement, reward processing, motivation, cognition, and behavior. When antibodies interfere with dopamine signaling, symptoms like tics, compulsions, and emotional instability can emerge.

Additionally, these autoantibodies may activate an enzyme called CaMKII (calcium calmodulin-dependent protein kinase II). Increased CaMKII activity can alter dopamine transmission, potentially amplifying neurological symptoms.

This is not a behavioral problem. It is neuroinflammation.

Crossing the Blood–Brain Barrier

Under normal circumstances, the brain is protected by the blood–brain barrier (BBB) — a tightly regulated network of capillaries that prevents large molecules, bacteria, and antibodies from entering brain tissue.

However, during systemic inflammation, those capillaries can become more permeable.

When the BBB opens even slightly, circulating antibodies and inflammatory cytokines may gain access to the brain. This is where symptoms intensify.

Why the Basal Ganglia Matter

Research indicates that the basal ganglia are particularly affected in PANDAS and PANS.

The basal ganglia are a group of subcortical structures located at the base of the forebrain. They are deeply involved in:

  • Voluntary motor control
  • Habit formation
  • Emotional regulation
  • Procedural learning
  • Cognitive processing

Key regions include the caudate nucleus, putamen, globus pallidus, substantia nigra, and subthalamic nucleus.

Imaging studies have shown that during acute PANDAS episodes, parts of the basal ganglia — particularly the caudate and putamen — may appear enlarged. Inflammatory changes in this region correlate with symptom severity.

When these structures are disrupted, the brain can become “stuck” in repetitive loops — motor loops (tics) or cognitive loops (obsessions and compulsions).

The child isn’t choosing the behavior. Their circuitry is inflamed.

Why Doesn’t This Happen to Every Child?

This is the most important question. Strep is common. Viral infections are common. Most children recover without developing autoimmune neuropsychiatric symptoms.

So what makes certain children vulnerable? Research is ongoing, but likely contributors include:

  • Genetic predisposition
  • Immune regulatory differences
  • Microbiome imbalance
  • Prior inflammatory burden
  • Environmental exposures
  • Blood–brain barrier integrity

PANDAS and PANS don’t arise from one factor alone. They emerge from a convergence of vulnerability and trigger.

The Emotional Toll on Families

Parents navigating PANDAS or PANS often describe a unique type of grief.

Their child is still there,  but not fully accessible.

The suddenness is destabilizing. Teachers may question parenting. Pediatricians may default to psychiatric explanations. Friends may not understand. And yet the parent knows something inflammatory happened.

At Longevity Health Center, we validate that experience. We recognize the immune-brain connection. And we believe no child should be dismissed as “just behavioral” without deeper exploration.

What Comes Next

In Part 2, we’ll go deeper into how infections beyond strep, including viruses, Mycoplasma, Lyme disease, mold exposure, and even heavy metals, may trigger or perpetuate PANS symptoms.

We’ll also explore how diagnostic testing works, why false negatives are common, and why the controversy persists.

Because understanding the mechanism is the first step toward meaningful healing.

 

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Understanding PANS, PANDAS, and Lyme Disease

Podcast Spotlight: Cristina McMullen on Integrative Lyme Solutions 

Longevity Health Center’s Bioenergetic Practitioner Cristina McMullen recently sat down with Dr. Michael Karlfeldt, host of the Integrative Lyme Solutions podcast, for an in-depth discussion on pediatric neuroimmune conditions and integrative healing.

In this compelling conversation, Cristina dives deep into PANS (Pediatric Autoimmune Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections), shedding light on how these often-misunderstood conditions intersect with Lyme disease and chronic infections.

Understanding the Root of Complex Pediatric Symptoms

Children with PANS or PANDAS can experience sudden and dramatic changes in behavior, mood, cognition, and physical health. Cristina explains why these symptoms are frequently misdiagnosed or overlooked and how infections such as Lyme, strep, and other immune triggers can play a central role in driving neuroinflammation.

Drawing from her own professional journey, she shares the realities of diagnosing and treating these complex conditions, especially when conventional approaches fall short. Her insights offer both clarity and validation for families navigating confusing and often overwhelming healthcare paths.

What You’ll Learn in This Episode

This jam-packed episode offers practical, actionable information, including:

  • Key symptoms and red flags of PANS and PANDAS
  • The role of infections, including Lyme disease, in triggering neuropsychiatric symptoms
  • How immune dysfunction and inflammation impact the developing brain
  • The use of bioenergetic testing to uncover hidden stressors
  • Integrative treatment strategies, including herbal and natural remedies
  • Why individualized care is essential for meaningful recovery

Cristina emphasizes a whole-child approach that looks beyond symptoms to address underlying immune and infectious drivers, offering a roadmap rooted in both science and compassion.

A Message of Hope for Families

Perhaps most importantly, this episode delivers something every parent and caregiver needs: hope. Cristina shares why recovery is possible and how the right combination of testing, treatment, and support can help children regain their health and quality of life.

If you’re a parent, practitioner, or advocate seeking deeper understanding of PANS, PANDAS, and their connection to Lyme disease, this episode is a must-listen.

Tune in on Apple Podcasts     Listen on Spotify      

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