Health Team

Rare strep throat complication can cause OCD behaviors, tics

Posted February 20, 2013

— The parents of a 10-year-old Raleigh boy began noticing strange behavior in their son about a year ago but had no idea that it could be the result of strep throat.

Chris Martin complained of stomachaches and restlessness, his parents said.

"He would, all of the sudden, just blank out and become unresponsive," Amy Martin said. "He was having, just, tics and OCD behavior like crazy."

Chris had increasing anxiety, and his school work began to suffer.

"He'd ask me to take him to the hypnotist so that he could forget his bad thoughts," Tim Martin added.

Chris never had a fever or sore throat, but because of the neurological complications, doctors eventually gave him a strep test, which came back positive. 

Left undiagnosed and untreated, strep throat can result in scarlet fever, rheumatic heart disease or in rare cases, pediatric autoimmune neuropsychiatric disorder associated with streptococcus, or PANDAS.

Raleigh boys suffers from rare strep-related condition Raleigh boys suffers from rare strep-related condition

"The PANDAS syndrome is characterized by the rapid and explosive onset of two major psychiatric symptoms – obsessive compulsive disorders and tics," said Dr. Richard D'Alli, a pediatric psychiatrist at Duke University Hospital. 

PANDAS occurs is less than 1 percent of children with strep throat. If a child suddenly begins showing obsessive compulsive behaviors and tics, such as repeated blinking or scratching, parents should ask their doctor for a strep test.

Antibiotics and cognitive behavior psychotherapy are required to treat PANDAS. In some cases, doctors also prescribe anti-depressants.

Chris takes the medications while he is in school.

"It helps me to focus more in class," he said. "(And) just stops the stomachaches."

In the year since his diagnosis, Chris is progressing. 

"I'm feeling less worried, sometimes I get a little timid," he said.

"My hope is that he will be normal and be just fine," Amy Martin said. "That's my hope."


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  • JAT Feb 25, 2013

    These kids don't really 'have' strep in most cases. They've been exposed and are carriers but they aren't physically ill in most cases.

  • babbleon Feb 22, 2013

    Whoa - I had a lot of strep as a kid, and OCD, though not rapid onset. I still wonder if there's a relationship...

  • JAT Feb 22, 2013

    1000's of parents are probably still less than 1% - it IS rare and it is certainly not the cause of most of the OCD cases and symptoms in kids.

  • julchicago Feb 21, 2013

    I am happy to see any attention brought forth for PANDAS/PANS. However, there are many inaccuracies in this article. PANDAS is NOT rare; 1000's of parents can attest to this. Often there is more than one child per family with PANDAS. It was stated that PANDAS occurs in less than 1% of children with strep throat. There is no statistical evidence supporting this statement, that was an arbitrary figure.

    The diagnostic criteria is not limited to OCD or tics. In fact, many children do not have tics with PANDAS (some do).

    There is now mounting evidence that other infections trigger this autoimmune disease; Mycoplasma, Lyme disease, viruses (coxsackie, HHV6, EBV) to name a few.

    I am glad this child has found interventions that work for him, but it should be noted that many PANDAS kids have had severe adverse reactions to psych medications.

    Based on shared experience from other parents it is my understanding that Duke was turning away PANDAS patients & have a lot to learn about PANDAS.

  • WhiteDog Feb 21, 2013

    I think it is more common than previously thought; my barber's son had the same issue.

    My son was diagnosed 8 years ago (his was 6 years ago) when we were referred to a neuorologist for all sorts of scary symptoms. After testing for brain tumors, she did a strep test and his titer (a blood test for the presence of antibodies) was 10 times the normal level, which indicates exposure. The symptoms responded very well to the antibiotics she gave him.

    He still has occasional bouts, but at least now we know what it is and how to deal with it. The OCD symptoms are only one of the many symptoms one can experience with this.

  • JAT Feb 21, 2013

    And alot of doctors, especially those who are studying PANDA, are super duper quick to want to pin the cause of OCD type symptoms on it. Parents, DON'T readily accept a diagnosis of PANDA. It IS indeed rare and trying to go that route when it's really a psychological issue is only hurting your child.

  • mom3sons4cats Feb 20, 2013

    Kowen, you are so correct! There are so many children being misdiagnosed with Tourette's syndrome (as my son was) when it is really caused by strep. My son has struggled with this condition for over 9 years now and is going into adulthood with terrible neurologic tics and OCD caused by a case of strep with no typical symptoms of strep.

  • kowen3985 Feb 20, 2013

    This condition is not nearly as rare as it appears. It is important to know that strep is not the only thing that triggers P.A.N.D.A's....lyme disease and other tick borne illnesses are just as often the cause. Research and treatment for this horrific condition needs to done immediately.