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  1. Could this be PANDAS?

    I second the investigating Lyme. So many of us with PANS/PANDAS also have Lyme, and it can cause these symptoms without PANS, too. And yes, PANDAS/PANS can absolutely affect adults! I'm 22, and my worst attack was at 19. I hate that "pediatric" is in the name at all. I have a feeling a lot of cases in teens and young adults are missed because everyone assumes it's a pediatric disease. I'm looking forward to the day when it's officially renamed Basal Ganglia Encephalitis, or when more doctors are willing to consider it a type of autoimmune encephalitis (my PANS neuro says it is). That being said, PANS/PANDAS is just one type of autoimmune disease that attacks the brain. There are plenty of other kinds of autoimmune encephalitis, so if you don't have classic "PANDAS" per say, it's entirely possible that you have some other neuro-immune disorder. I believe there's something called Hashimoto's Encephalopathy, but I don't know much about it. Have you looked into that? Over the last three years, usually my depression, anxiety, and cognitive problems have been the main issue, though I've also had movement symptoms and anorexia at times. When I'm in a flare, I feel like I'm in another world. I can still see and hear everything that's going on, but I feel detached from myself and reality. I'll have a constant sensation of being trapped inside my thoughts, yet completely outside of myself because I lose my personality. It's like life happens without me. I definitely think PANS presents differently in kids than in adults.
  2. Separating PANS from Lyme/Bart

    PANS and Lyme/co-infections can certainly happen all at once. It's also possible to still have PANS after an infection is gone. I find it’s sometimes impossible to separate them all (especially Bartonella), and until the infections are under control, you might not make a whole lot of headway with PANS. On the other hand, it’s my understanding that treating the infections can sometimes cause so much inflammation that it re-triggers autoimmunity. It happened to me. Check out this post I found on the subject, written by an LLMD: http://lymemd.blogspot.com/2017/08/autoimmune-encephalitis-and-lyme.html I have PANS as well as Lyme, Babesia, and Bartonella. I've had pretty much all of the symptoms you described. I was 95% better after IVIG and a year on a Lyme/Babesia protocol, but when I started Bartonella treatment in August, PANS came raging back. I thought it was a Herx or Bartonella at first, but no antibiotics (or break from antibiotics) seemed to help, so I was forced to treat the autoimmune component directly. I'm now back to normal. If you're not making any headway with antibiotics/Lyme and co-infections treatments, it might be worth going to a doctor who knows more about PANS––or ideally, PANS and Lyme. Also, a few thoughts on the symptoms you mentioned… Being totally absorbed or obsessed with an activity is something I used to do to try to block out my disturbing OCD intrusive thoughts and the depression. But at other times, the depression/cognitive issues are so bad that doing anything at all is too overwhelming and exhausting. I also sometimes have an uncontrollable urge to eat when not hungry as a form of self-medicating my depression, so that could be why he keeps asking for food. Has he ever seen a therapist for the OCD/depression? Therapy isn’t always possible in the middle of a flare, but sometimes it can give tools to deal with the symptoms while pursuing the proper medical treatments. And the whole thing is so difficult to live with that it might be helpful for processing it.
  3. Coimbra Vitamin D Protocol for PANS?

    Thanks for the information! Sorry for taking so long to respond. I've been caught up in college graduation and the holidays. I did the initial bloodwork that they requested, and it turned out that my vitamin D levels were way too high just from supplementing at 10,000 IU. Coimbra probably would have put me on 50,000 IU/day, so I'm not going to try it after all. At least not right now. After 9 weeks of IV steroids, this latest PANS relapse has come to an end, and I'm back to baseline. It turned me around so much that I went from failing assignments to getting all A's! I seem to have turned a corner, so my PANS doc has me in a wait and see phase right now. I'm still treating Lyme and co-infections, but yes, I'm winning! My LLMD thinks I've had Lyme the entire time, but I'm not sure. The initial illness that triggered my PANS in 2006 consisted of fatigue, joint pain, and insomnia, which sounds a lot like Lyme. All that went away after a few months. We did the CDC tests and of course they were negative, but I grew up in the woods and have been bitten by ticks more times than I can remember. My PANS doc of course thinks the initial illness was Rheumatic Fever--especially since I later developed severe chorea. Who knows? I definitely was infected (or reinfected) in 2016 when I had a flu-like illness followed by pericarditis and POTS... And positive Igenex. The 2014 flare was from EBV and Strep.
  4. Have any of you heard about the Coimbra protocol for MS and other autoimmune diseases? I'm considering trying it for PANS. https://www.coimbraprotocol.com Basically, it's extremely high doses of daily vitamin D: ~50,000 IU or more, along with some other supplements and close monitoring by a doctor. The premise is that people with autoimmune disease cannot properly absorb and make use of Vitamin D, so they need mega doses just for their bodies to be able to do what healthy people's do with more "reasonable" amounts of Vitamin D. Apparently Vitamin D boosts the immune system while suppressing autoimmunity--exactly what we PANS people need! My PANS doc was talking about moving on to Rituxan, but my LLMD says that's a bad idea with Bartonella still present. I've done multiple rounds of IVIG which haven't cured me, so that's off the table. My Lyme/co antibiotics kicked up the inflammation so much that I had a full-blown PANS relapse and have had to do weekly steroid infusions--which are only a band-aid. Basically, Vitamin D seems to be my best option at this point while I continue to treat Lyme/co. Unlike Rituxan, Vitamin D is supposed to boost the immune system and probably help me fight off the infections while knocking down the autoimmunity. I've never heard of anyone doing this protocol for PANS, but it's supposed to have 95% success rate for putting people with MS into remission (another neurological autoimmune disease). I'm always skeptical of anything that claims as much, but Dr. Coimbra isn't trying to sell anyone anything, and he lets other doctors come train with him free-of charge. I'm reassured that it doesn't seem like he's trying to take advantage of anyone. And there are thousands of people around the world who have had success with this for MS, RA, Crohn's, Sjogren's, and other autoimmune diseases. What do you think? Have you heard of this protocol before? Would you try it?
  5. Recovery Time

    I agree that everyone is different. So much depends on how old a person is, how severe, how long it's been untreated, and what kind of treatment they get. And sometimes, there seems to be no rhyme or reason to how fast or slow one person recovers. In my experience, I was untreated for eight years, had my first IVIG at 19, and after another IVIG and a tonsillectomy, I'd say I made a full recovery over a year later. I've since relapsed twice, but that's because I caught Lyme disease, which complicates things a great deal. From what I've observed in my own journey, it's very hard to give an accurate percentage of recovery, or to figure out when I've gotten all the way back to myself. I don't know if I've ever been 100% symptom-free since I became ill eleven years ago. I've stopped trying to assign a number to where I am in recovery, and I just gauge whether or not I'm able to live my life as I wish. Ultimately, I think that's the best a lot of us can do. For me, there's never been a day or even a month when I've suddenly realized everything was back to how it was before. It usually seems to be a painfully slow process where I shed symptoms and regain my "self" so slowly that I might not even realize it's happening. It's easy to over-analyze ever day, every tic, and every little compulsion, but the overall trajectory is what's most important. There will be ups and downs and flares for pretty much everyone, but hopefully, the underlying trend is towards the positive. At my age and given how long this went untreated, it's possible I'll always have some minor symptoms. But even if this is so, thanks to treatment, PANS hasn't stopped me from doing anything I've wanted to accomplish in my life. So hang in there! You might be in this for the long haul, and there may be a lot of ups and downs, but yes, your daughter can and will get better with the right treatment.
  6. I've been doing 9 weeks of 1g of IV Solumedral once a week, and it's been miraculous. (I'm 22, eleven years of PANS, diagnosed at 19.) I'd relapsed in August or September, I was completely dysfunctional, suicidal, unable to do any school, and just generally a different, totally tormented person. After three steroid treatments (3 weeks), I was back to baseline. I've had Lyme and co-infections for almost two years, and this PANS relapse was probably caused by the antibiotics kicking up the inflammation in my body too much. (It's very unusual to use steroids when someone has Lyme, but my LLMD thought mine was one of the few cases when it was warranted.) My PANS doc said that the steroids definitely weren't fixing the underlying problem for me, so your instincts about that may be right. I've heard of some people who did heal after a few weeks or months of IV steroids and then that was it (especially in someone who is younger and hasn't had PANS for years like I have). But sometimes, I think steroids are just used to alleviate suffering and buy time until you can get more curative treatments. It's definitely important to figure out whether or not there is still an underlying infection. Does your DD still have tonsils/adenoids? Strep can hide in there even on antibiotics. Have you considered testing for Lyme and co-infections with Igenex? I wish I'd done Igenex much sooner. I've never tested positive for Strep in all eleven years of my journey, so it's definitely not the only thing to look out for. As far as tics, for me, the steroids often make them worse for the first day or two, but then after that, they're better than they were before the dose. I've heard of a lot of people whose tics are worsened by steroids, though, so it's not unusual. I think it can take a little time for them to knock down the inflammation, so don't give up on it yet!
  7. Relapse or Rifampin Herx? What to do?

    Thanks so much for the encouragement! I don't know if my pdoc is a herx non-believer, though he's the first one to admit that the intricacies of treating late-stage Lyme are out of his wheelhouse. He's very against SSRI's for me, as they've always made me worse, but both he and my LLMD agree about increasing my Lamictal. I guess I'm just getting discouraged, because I'm nine months into Lyme treatment and was so much better a few weeks ago--maybe even the best ever, and it lasted most of the summer. But in the last month, I've suddenly gotten worse and worse and am barely functioning by this point. Is this normal? Usually my herxes last at most a few days, are lessened with detoxing, and then I'm better than before I herxed. I'm not taking any antibiotics this week, but I'm still continuing to go downhill. Could someone have a month-long herx? Or is the bacteria coming back? I've not been having the flu-like symptoms, joint pain, and fatigue I normally get in my herxes. It's all just these debilitating psychiatric and neurological problems.
  8. Hi everyone, Have any of you had a dramatic regression/increase in symptoms from starting Rifampin? To give context, I’m 22 and had untreated PANS for eight years. I got diagnosed at 19 in 2014, had two IVIG’s, a tonsillectomy, a year of steroids, and I went into complete remission by the end of 2015. I got Lyme in 2016 and relapsed, and I’ve since had another IVIG and have been treating Lyme and co-infections with an LLMD. I didn’t start Lyme treatment until December—nine months after the initial infection. I also tested positive for Babesia and Relapsing Fever. I was doing really well this summer and was definitely getting much better, but in the last few weeks, I’ve gone downhill fast. When I started Rifampin two weeks ago (in a MWF pulse dosing), it dramatically accelerated my decline. I still have an occasional, pretty-good day, but most of the time, I’m so depressed I can barely take care of myself. My word-finding issues have returned, and I speak nonsense frequently. The atonic seizures (one of my most severe PANS symptoms since 2014) have come back, too. I feel confused and disoriented often, with periods of time when I feel dissociated and really far away from everything around me. I’m having all of the symptoms that I get when all breaks loose with a full-blown PANS exacerbation/relapse. Yet my parents claim I don’t have the same “look” as when I’m really at rock bottom. My LLMD thinks I’m herxing, but my psychiatrist thinks it sounds more like PANS (purely autoimmune) and that Rifampin is making my psych drugs (Wellbutrin, Lamictal, and Seroquel) less effective. My LLMD did warn that this new Lyme protocol could make my mood symptoms worse, but why so many other symptoms? So far, my other herxes have never lasted as long as this, so I’m afraid this is an autoimmune thing again. I'm detoxing with Burbur and Alka-Seltzer Gold, but any reduction in symptoms never lasts long. Has anyone else had a similar experience with Lyme treatment, and especially Rifampin? If so, what do you do to make this better? I’m so tempted to do a Prednisone burst, because that’s almost always made PANS symptoms go away, but I know that’s a bad idea with an active infection. But how am I supposed to keep living like this?
  9. Severe stuttering

    Wow, this is definitely among the most frustrating symptoms to deal with. Sorry your DD is having these difficulties. I'm 22, diagnosed at 19, and I've never exactly stuttered, but speech difficulties have been a symptom that comes and goes. Sometimes, I start saying gibberish syllables. Other times, I just don't remember words and take long pauses in the middle of a sentence while I try to remember. I also have a few nonsensical words and phrases that tend to come out when I can't remember what to say (for a while, I called everything a "butt," which led to some interesting exchanges with strangers...). I almost always know what I'm trying to convey in my mind, but I'm unable to say the words. I've always thought of these issues as part of my PANS/Lyme, and they tend to come and go with my other symptoms. Hopefully they will resolve for your daughter soon, too.
  10. Hi Rhnv, I'm sorry to hear that your daughter is having all these symptoms. I've had PANS for about ten years, undiagnosed until 2014, and Lyme at least since April 2016. I've had three high-dose IVIG treatments since August 2014, and it was a different experience each time. I've also done eight low-dose treatments for an immune deficiency. Is she doing low or high dose? The first two times I had high-dose IVIG (7 months apart after I relapsed severely), I had a post-IVIG flare about two weeks later, when all of my symptoms were terrible, and possibly worse than before treatment. I did Prednisone bursts to get through the flares, and then I slowly improved over several months. Recovery has never been linear--if I got rid of one symptom, another one would crop up. It often felt like I wasn't getting better, but I was, though very, very slowly. My second IVIG combined with tonsillectomy put me into remission for several months, and yes, it started with a regression. I think I would've stayed in remission if I hadn't caught Lyme a year later. Basically, in my experience, the IVIG healing process can be extremely slow and unpredictable, and it's a two steps forward one step back kind of thing--and sometimes it's one step forward two steps back. Six weeks might be a bit too soon to tell much of anything yet. Hang in there!
  11. Hi Peridot, I’m 22, and I’m in a similar boat. I have PANS, Lyme, Babesia, and Tick-Borne Relapsing Fever. My anorexia came on suddenly, a few days before I had the first flu-like symptoms of Lyme disease last April. I ended up losing 20 lbs in four months from my ed (and I was almost underweight to begin with), and I’m pretty sure the only reason I wasn’t hospitalized was because my psychiatrist knew I was about to get IVIG when he found out what I was doing (thankfully he’s PANS-friendly). It’s like you say, though—I don’t think anyone really knows what to do about my eating disorder. I saw a nutritionist for months and tried therapy for a while, but it didn’t help. I regained the weight, but I still have so many food rituals and fears, and now I’ve been in a binge-restrict cycle for almost six months. I'm so sorry your daughter is dealing with these two awful things! Either one alone is so much to handle, and together, it's really tough. I hope she finds some relief soon. If you’d like to connect more, feel free to PM me.
  12. Hi July, 40 mg seems like it could be a bit low for a burst for a 16 y/o. When I did my first steroid burst, it was 50 mg for five days, and I weighed 99 lbs. I’ve also done steroid tapers, and those usually started at 60 mg. Every one is different, though. That first time I did a five-day burst, I saw improvement on the third day. I’ve had other flares when it took a few days, and still others when I improved within a day on steroids. There have also been a few when the steroids didn’t help at all, but that was when I had infections that I didn’t know about. If there’s an active infection, it’s entirely possible that the steroids will either not work, or they’ll make him worse. Have you looked into Lyme disease through Igenex testing yet? It’s so important to treat Lyme if it’s there—otherwise, a lot of the PANS treatments won’t have their full effect. Does he still have his tonsils/adenoids? Infections can hide there, too, and antibiotics won’t reach them.
  13. Cognitive effects of PANDAS

    Everyone is different, but for me, it was about a year and-a-half after my first IVIG and six months after T&A that I really felt like myself again and didn't notice any significant cognitive difficulties. I relapsed last year, and everything came back, but I'm doing much better now. My cognitive improvements following IVIG were like night and day. Whenever I flare now, the cognitive problems return, but a steroid burst pretty much always takes care of them. I still can't remember or recognize faces very well and have trouble telling new people apart, so I might be getting some kind of occupational therapy for this. Not sure yet. But almost certainly not more IVIG just for this one issue. Unfortunately, I also still have a great deal of anxiety that makes school difficult. I'm so used to having trouble concentrating and understanding assignments, that I'm always anxious about starting any homework because it used to be so dreadful, so it all still takes me a long time, but not because of any real cognitive problems--I just anticipate them even though they're not there anymore. I'm sure there's inflammation exacerbating my anxiety, but it also feels like I truly do have purely psychological fallout from ten years of PANS, too. I think it's important to distinguish this sort of PTSD-like anxiety versus cognitive symptoms because you'll treat them very different ways.
  14. Hello, has anyone here ever seen binge eating/bulimia as a result of PANS and/or Lyme/co-infections? I had severely restricted food intake for four months starting last April and lost 20 pounds (I was small and borderline underweight to begin with), but then I got another high-dose IVIG and started eating more again. Since then, I’ve cycled between restriction and binging/purging through excessive exercise, and honestly, it’s ruining my life and my body. Any insights/sharing your experiences would be greatly appreciated. Is there anything besides therapy that I can do? Or is there a particular type of therapy that any of you have found helpful? P.S. Yes, I have Lyme and Babesia (likely since my relapse last year). I’m twenty-two with at least 10 years of PANS (8 untreated), but I was in remission until I caught Lyme last year. At this point, I don’t have many other symptoms, but this one is completely out-of-control, and traditional eating disorder therapy has been of little use.
  15. 18 y/o with PANDAS

    Hi Sarah, I'm twenty-two and have had PANS since I was eleven, and probably even longer. Most PANS specialists will treat adults, because there are plenty of us who still have it. My worst episode started when I was about nineteen, and that was the first time I went to see a "pediatric" doctor who specialized in PANS. I was successfully treated by this doctor and went into remission until I got Lyme a few months ago. There's a list of specialists on the PANDAS Network website that you could look into. I'd be happy to talk if you'd like to message me!