He was a healthy 16-year-old, active in school and sports. Within days, he seemed unrecognizable. His story shows how Lyme and PANS can suddenly change a teenager’s life.

Once outgoing and confident, he suddenly became anxious, irritable, and trapped in repetitive rituals. Teachers noticed his handwriting deteriorated, his grades plummeted, and he withdrew from friends. “It felt like we lost our son overnight,” his father recalled.

His parents were told, “It’s psychiatric.”

But the truth was different. Lyme disease had actually triggered PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) — an autoimmune condition where the immune system produces antibodies that mistakenly attack not only the infectious pathogen but healthy tissue in an area of the brain known as the basal ganglia. This attack causes brain inflammation and disrupts how cells and receptors function, resulting in abrupt and severe changes in mood, behavior, and functioning.

What is PANS?

PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is defined by five core diagnostic criteria:

1. Abrupt, dramatic onset of OCD or eating restriction

2. Presence of two or more additional symptoms, such as:

   • Anxiety, depression, or irritability

   • Developmental or academic regression (e.g., handwriting, math skills)

   • Sudden motor or sensory changes (e.g., tics, dilated pupils, light or sound sensitivity)

   • Sleep disturbance or urinary frequency without infection

   • Decline in school performance

3. Symptoms not better explained by another neurologic or psychiatric disorder

4. Association with an infectious trigger (Lyme, strep, viral illness)

5. Episodic course, often with relapses

Prevalence: PANS/PANDAS may affect as many as 1 in 200 children and adolescents, though most remain undiagnosed or misdiagnosed.

PANDAS vs PANS

Parents often hear both terms and wonder what they mean. PANS refers to a broader medical condition in which neurologic and psychiatric symptoms are triggered by various infections, such as Lyme disease, mycoplasma, influenza, or even viruses.

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections) is a subset of PANS and refers specifically to cases triggered by strep infections.

Both PANS and PANDAS involve an autoimmune process where the body’s immune system — in response to an infection or trigger — produces antibodies that mistakenly attack healthy brain tissue, particularly in the basal ganglia, a brain region involved in behavior, movement, and emotions. This happens due to a process known as molecular mimicry, a phenomenon whereby the immune system confuses brain proteins with those of the triggering infection.

This autoimmune response causes brain inflammation and disrupts how cells and receptors function, resulting in neuropsychiatric symptoms.

How does Lyme impact PANS?

Lyme disease, caused by the Borrelia burgdorferi bacterium, has been identified as a potential infectious trigger for PANS. In some children, a Borrelia infection or co-infection (such as Bartonella or Babesia) can trigger an abnormal immune response. Instead of clearing the infection normally, the immune system can mistakenly attack the child’s own brain tissue — particularly the basal ganglia — through a process known as molecular mimicry. This autoimmune reaction can result in the sudden onset of neurologic (tics, abnormal movements) and psychiatric symptoms like OCD, anxiety, rage episodes, cognitive decline, or sensory processing issues — hallmark signs of PANS.

Why Lyme and PANS are Missed

1. Psychiatric focus: Sudden OCD or mood swings are often treated as primary psychiatric disorders.

2. Fragmented care: Teens may see pediatricians, psychiatrists, and neurologists separately—without anyone connecting infection to new symptoms.

3. Limited awareness: Many clinicians are unfamiliar with PANS/PANDAS diagnostic criteria.

4. Stigma: Families are sometimes dismissed as overreacting, while teens are labeled with psychiatric diagnoses instead of post-infectious autoimmune syndromes.

Other Conditions to Consider

Not every sudden change in behavior is due to PANS. Clinicians must rule out other conditions including:

1. Primary psychiatric disorders (major depression, generalized anxiety, OCD)

2. Autoimmune encephalitis, such as anti-NMDA receptor encephalitis

3. Neurologic conditions (Tourette syndrome, seizures)

4. Endocrine or metabolic disorders

Some labs and research groups, including Moleculera Biosciences, have described how autoantibody testing can help clinicians explore whether a child’s psychiatric or neurologic symptoms may be linked to immune activity against the brain. These panels look for antibodies that target proteins in the basal ganglia. The results may provide additional insight, but they are not diagnostic on their own. PANS is primarily a clinical diagnosis and testing must be interpreted carefully in the context of history and exam findings.

What Parents Can Do When Facing Lyme and PANS

📌 If your teen changes within days to weeks:

1. Trust your instincts—abrupt psychiatric changes deserve medical evaluation

2. Document exposures (tick bites, strep throat, viral illness)

3. Keep a daily symptom and behavior journal

4. Request combined medical and psychiatric evaluation

5. Explore school accommodations (504 plans, IEPs) to support learning and social functioning

Treatment and Recovery in Lyme and PANS

Teens with Lyme-triggered PANS often require a multimodal approach:

1. Antibiotics or antimicrobials for infection control

2. Anti-inflammatory therapies (e.g., steroids, NSAIDs) to calm immune activity

3. Psychiatric and behavioral support to address OCD, anxiety, and mood symptoms

Long-Term Prognosis

The prognosis for PANS varies depending on several factors, including how quickly the condition is recognized and treated, the severity of symptoms, and the individual’s response to therapy. Many children experience significant improvement or even full recovery with early and appropriate treatment, which often includes antibiotics, anti-inflammatory medications, and supportive therapies. However, some children may have persistent symptoms that continue into adolescence or adulthood, and relapses are fairly common, especially if triggers like infections recur.

Clinical Takeaway

Lyme disease and PANS can trigger sudden, life-altering psychiatric and neurologic symptoms in adolescents. Recognition requires a balanced approach that includes medical evaluation, psychiatric care, and infection management.

Has your teen experienced sudden behavioral changes after illness? Document the timeline and seek evaluation from a clinician experienced in PANS and Lyme.

⚠️ Disclaimer

PANS is a clinical diagnosis that requires ruling out other conditions. Not all sudden psychiatric changes are caused by PANS. This blog is for educational purposes only and not a substitute for medical advice. Mention of organizations or labs (such as Moleculera) is for educational context only and does not imply endorsement.

Related Articles:

PANS and PANDAS Overview

Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS)

PANDAS and Persistent Lyme disease

Lyme Disease Neuropsychiatric Presentations

Adolescents and Lyme disease