THE STREP STORY, PART 1

For the past few weeks we’ve been talking all about the immune system — how it works and what happens when things go awry. If your child has PANS/PANDAS, their immune system is one of your primary concerns. In fact, the “A” in these diseases stands for “autoimmune”, which is what happens when the immune system gets confused and attacks the body’s own tissues.

PANS/PANDAS are autoimmune conditions where your child’s immune system mistakenly attacks the part of their brain called the basal ganglia. We’ll dive into the specifics of that in a minute. But first, let’s talk about what triggers this immune confusion.

THE GROUP A STREP STORY

In the case of PANDAS, it all starts with strep. Group A strep is one of the most common bacteria in humans, and if not treated, one of the most dangerous. Group A strep is not an uncommon bacteria. It’s passed through the cough or sneeze of an infected person. If you breathe in the droplets or touch contaminated surfaces and then touch your face, you can become infected as well.

Traditionally, strep has been associated with such illnesses as Rheumatic fever, scarlet fever, carditis, arthritis, skin abnormalities and Sydenham chorea — a disorder characterized by jerky, involuntary movements of the hands, arms, shoulder, face, legs, and trunk.

Strep throat is the most common trigger for PANDAS. But strep infections can occur in other parts of the body as well, including the oropharynx (the part of the throat behind the mouth), tonsils, and anus. So a negative throat culture doesn’t mean that strep isn’t present somewhere else.

I mentioned that group A strep is one of the most dangerous bacteria in humans. This is in part due to its stealthy nature. In order to survive in its human host, strep developed the ability to surround itself with molecules that are nearly identical to the tissues of the heart, skin, joints, and brain.

Because of this clever disguise, it takes the immune system a while to recognize strep as a “non self” antigen. Eventually the immune system recognizes strep for the harmful invader it is and mounts an attack.

But because the strep bacteria has surrounded itself with molecules that are so similar to specific tissues in the body, the immune system creates antibodies not only to the strep, but also to the body tissues strep mimics.

And that’s where the real problems start. Once the immune system creates antibodies that are targeted towards its own tissues, it perceives those tissues as the enemy and starts attacking them.

An autoimmune response happens when antibodies are targeted to a specific body tissue. So autoimmunity isn’t a general attack on the body. It’s always targeted toward a specific area.

IN THE CASE OF GROUP A STREP, THERE ARE SEVERAL POSSIBILITIES:

Carditis — the immune system attacks the heart.

Arthritis — the immune system attacks the joints.

Sydenham chorea — the immune system attacks the brain.

PANDAS — a “toned down” version of Sydenham chorea.

HOW STREP LEADS TO PANDAS

In PANDAS, the cross-reactive antibodies created in response to the strep bacteria go on to attack an area of the brain called the basal ganglia.

The basal ganglia are a group of nuclei (cluster of neurons) located at the base of the brain and linked to the thalamus. The basal ganglia are associated with movement disorders, such as Huntington’s and Parkinson’s disease.

In addition to voluntary movement control, the basal ganglia are also associated with procedural learning, eye movements, along with cognitive and emotional functions.

The basal Ganglia are also the site of 2 dopamine receptors.

Since cells communicate through chemicals, they have ports called receptors that receive these communications. Dopamine receptors receive dopamine, a neurotransmitter associated with attention, movement, and the pleasure/reward centers of the brain.

THE TWO DOPAMINE RECEPTORS IN THE BASAL GANGLIA ARE:

The D1 receptor — a direct pathway in the basal ganglia which facilitates movement

The D2 receptor — an indirect pathway which inhibits movement

When the cross-reactive antibodies associated with strep attack the dopamine receptors in the basal ganglia of the brain, it causes a fluctuation in dopamine. This results in the OCD, tics, and other neuropsychiatric symptoms that are associated with PANDAS.

ADDITIONAL PROBLEMS ASSOCIATED WITH STREP

Unfortunately, the autoimmune effects of strep aren’t the only issues that result from a strep infection. Like I mentioned, group A strep is an extremely dangerous bacteria.

OTHER DOWNSTREAM EFFECTS OF STREP:

Strep increases the enzyme glutathione peroxidase, which decreases glutathione in the body. We need glutathione to detoxify.

Strep decreases tyrosine which, in turn, decreases dopamine.

Strep increases glutamate in the brain. Glutamate is an excitatory neurotransmitter that can cause seizures.

Strep increases neuraminidase which facilitates viral spread.

Strep increases NADase which is the enzyme that decreases NAD. A decrease in NAD causes decreases in tryptophan, which in turn depletes serotonin — a mood stabilizer.

Strep increases TNF alpha. Tumor necrosis factor alpha (TNF alpha) is pro-inflammatory cytokine involved in systemic inflammation. TNF alpha plays a major role in Tourette’s Syndrome, OCD, stims, repetitive speech issues, Rheumatoid Arthritis, and leaky gut (permeability in the small intestine).

IT’S NOT JUST STREP

Children with PANDAS have compromised immunity. So they are susceptible to a variety of infectious organisms.

In my practice, I have found that the majority of the PANDAS children I treat have additional infections, including Lyme and mycoplasma, as well as viral and fungal infections.

Likewise, toxicity in the form of pesticides, chemicals, and heavy metals also play a significant role in adding to the inflammatory burden.

ONCE THE IMMUNE SYSTEM IS COMPROMISED, PANS AND PANDAS CHILDREN MAY BECOME SENSITIVE TO ADDITIONAL ENVIRONMENTAL OR INFECTIOUS TRIGGERS:

😳 Exposure to common bacteria or viruses

😳 Pollen

😳 Mold

😳 Candida

😳 Inflammatory foods

😳 Pesticides

😳 Chemicals

Children with PANS/PANDAS need more than just a treatment for strep. Unfortunately, once these conditions have taken hold, there are additional problems to deal with.

That’s why it’s so important to find a practitioner who specializes in working with PANS/PANDAS and utilizing all the available therapies and detoxification protocols. If you need help with your child, please reach out. That’s why I’m here.

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