A Hopeful Approach: LDN for Pediatric Neuropsychiatric Syndrome (PANS)- Functional Integrative Medicine Quincy Columbia Springfield
- John Kim
- Sep 19
- 4 min read
For any parent, watching a child suddenly develop severe and distressing symptoms is a deeply frightening experience. When this abrupt change involves obsessive-compulsive behaviors, extreme food restriction, anxiety, and aggression, it may be a sign of Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). This complex condition can turn a family’s life upside down, leaving parents searching for answers and effective treatments.
Navigating a PANS diagnosis can feel overwhelming, but understanding the condition and the available treatments is the first step toward finding relief. While standard therapies are often the starting point, emerging options like low-dose naltrexone (LDN) offer a new layer of hope. This article will guide you through what PANS is, how it's typically treated, and how LDN may offer a supportive role in managing its symptoms.
What Is Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)?
PANS is identified by the sudden, dramatic onset of obsessive-compulsive disorder (OCD) or severe eating restrictions in children. The change often happens overnight. Alongside these core symptoms, a child must also display at least two other neuropsychiatric symptoms, which can include:
Severe anxiety, especially separation anxiety
Mood swings, irritability, or aggression
Behavioral regression (acting much younger than their age)
Sudden decline in school performance or cognitive abilities
Sensory sensitivities or motor abnormalities, like tics
Sleep problems and urinary issues
PANS is often triggered by an infection. The body’s immune system, in its effort to fight off a pathogen like strep throat, influenza, or Lyme disease, mistakenly attacks the brain. This autoimmune response leads to inflammation, particularly in the basal ganglia—a part of the brain that helps regulate behavior, emotion, and movement.
A well-known subset of PANS is PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections), which is specifically linked to strep infections. PANS is a broader term that includes PANDAS and cases triggered by other infections or inflammatory processes.
How Is PANS Usually Treated?
Managing PANS requires a comprehensive and multi-faceted approach, often involving a team of specialists. The primary goals are to address the root cause of the inflammation, manage the psychiatric symptoms, and support the child’s overall health.
A typical treatment plan is often layered and may include:
Treating the Infection: If an active infection is identified, antibiotics are used to eradicate the trigger. Sometimes, prophylactic (preventative) antibiotics are prescribed to prevent future infections and subsequent flares.
Managing Psychiatric Symptoms: Cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) can help manage the OCD, anxiety, and mood-related symptoms. It's important to start with low doses, as children with PANS can be very sensitive to medications.
Reducing Inflammation: This is a cornerstone of PANS treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids are often used to calm the neuroinflammation. For more severe cases, immunomodulatory therapies like intravenous immunoglobulin (IVIG) or therapeutic plasma exchange (TPE) may be recommended to help reset the immune system.
While these treatments can be very effective, some children continue to struggle with persistent or relapsing symptoms. This is where exploring supportive, adjunctive therapies like low-dose naltrexone can be a valuable next step.
Understanding Low-Dose Naltrexone (LDN)
Naltrexone is a medication that, at standard doses of 50-100 mg, is approved to treat opioid and alcohol use disorders. However, when used at a much lower dose—typically between 0.5 mg and 4.5 mg—it works very differently in the body. This is known as low-dose naltrexone, or LDN.
LDN offers a dual-action mechanism that makes it a promising option for inflammatory and autoimmune conditions:
It Boosts Endorphins: LDN temporarily blocks opioid receptors in the brain. The body responds by increasing its production of endorphins, our natural pain-relievers and mood-elevators.
It Calms Inflammation: More importantly for PANS, LDN helps regulate the immune system by calming overactive immune cells in the brain called microglia. By inhibiting these cells, LDN reduces the production of inflammatory chemicals that contribute to the symptoms of PANS.
Because of its anti-inflammatory and immune-modulating effects, LDN is used to help manage symptoms in conditions like fibromyalgia, Crohn's disease, and multiple sclerosis. Its favorable safety profile makes it an appealing option to explore in pediatric cases.
How LDN May Help Children with PANS
The core issue in PANS is neuroinflammation. LDN’s ability to reduce inflammation in the brain makes it a logical and supportive therapy to consider, especially for children who haven't found complete relief with standard treatments.
Clinical observations from specialized pediatric clinics suggest that LDN can be a helpful addition to a PANS treatment plan. It may help by:
Reducing Persistent Inflammation: LDN targets the underlying inflammation that drives PANS symptoms, potentially helping to reduce the severity and frequency of flares.
Stabilizing Mood and Behavior: By boosting endorphins and calming the brain's immune response, LDN may help improve mood swings, irritability, and anxiety.
Improving Overall Well-Being: Parents have reported improvements in their child's energy, sleep, and overall function after starting LDN.
It is important to approach LDN methodically. Treatment usually begins with a very low dose, such as 0.5 mg, and is slowly increased over time to find the optimal dose for the child while minimizing side effects. While the evidence is still emerging and primarily based on clinical experience rather than large-scale trials, LDN offers a low-risk, potentially high-reward option for families navigating the challenges of PANS.
A Path Forward with Integrative Care
Finding the right combination of therapies for PANS requires a personalized and holistic approach. Low-dose naltrexone represents a hopeful, science-backed tool that aligns with an integrative care philosophy—one that focuses on addressing the root cause of illness while supporting the body's innate ability to heal. While more research is needed, LDN is emerging as a valuable adjunctive therapy that can help many children with PANS reclaim their health and happiness.
If you are exploring integrative treatment options for your child, it is essential to work with a knowledgeable provider. Dr. Yoon Hang Kim offers a virtual integrative and functional medicine practice serving patients in Iowa, Illinois, Missouri, Texas, Georgia, and Florida. By focusing on root-cause analysis and personalized health solutions, Dr. Kim is dedicated to helping patients on their journey toward wellness. To learn more or to schedule a consultation, please visit www.directintegrativecare.com.
References
Comments