Autoimmune Encephalitis, PANS/PANDAS, and Neuroinflammation: Why Brain-Based Immune Disorders Are Rising in Children, and What We’re Seeing in Adults & Veterans

Across pediatric and adult neurology, clinicians are increasingly recognizing that some behavioral, psychiatric, and cognitive symptoms may not originate purely from psychological causes, but from immune-driven inflammation in the brain.

In children, this pattern is most commonly recognized as PANS or PANDAS, forms of autoimmune encephalitis that affect brain regions responsible for behavior, mood, and executive function. In adults, particularly veterans exposed to traumatic brain injury (TBI), infections, and environmental stressors, we are seeing a similar neuroinflammatory phenomenon that can produce comparable symptoms.

Understanding these conditions requires looking at the brain through a neuroimmune lens.

What Is Autoimmune Encephalitis?

Autoimmune encephalitis occurs when the immune system mistakenly attacks components of the brain. Instead of targeting an infection, antibodies and inflammatory immune signals begin reacting with neural tissue.

In many cases involving PANS and PANDAS, the brain structure affected is the basal ganglia, a region involved in movement, emotional regulation, motivation, and habit formation. 

When inflammation affects these circuits, children can experience sudden changes in behavior, mood, cognition, and physical regulation.

PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) are thought to occur when infections trigger an immune response that mistakenly attacks brain tissue through a process known as molecular mimicry. 

In simple terms, the immune system confuses brain proteins with infectious organisms.

Why PANS/PANDAS Diagnoses Are Increasing

Awareness of these conditions has grown significantly over the last two decades. Some clinicians estimate that as many as 1 in 200 children may experience symptoms consistent with PANS or PANDAS, though exact prevalence remains debated. 

Several biological factors are believed to contribute to this rise.

Infections and Immune Triggers

Originally, PANDAS was linked specifically to Group A streptococcal infections, but researchers now recognize a broader set of triggers.

These may include:

• Strep infections

• Lyme disease and tick-borne infections

• Viral illnesses

• Mycoplasma infections

Chronic infections such as Lyme disease can contribute to persistent immune dysregulation and neuroinflammation, sometimes overlapping with PANS/PANDAS presentations. 

Environmental and Toxic Burden

Functional medicine physicians have increasingly explored how toxic exposures and immune dysregulation may contribute to neuroinflammatory conditions.

Heavy metals, mold exposure, pesticides, and chronic inflammatory stressors may alter immune signaling and weaken blood-brain barrier protection.

This creates conditions where inflammatory molecules and antibodies can more easily influence brain function.

Genetic and Neurochemical Vulnerability

Certain individuals appear to have genetic susceptibility to immune dysregulation, meaning their nervous system is more vulnerable when infections or environmental stressors occur.

This may explain why one child recovers easily from infections while another develops profound neuropsychiatric symptoms.

Clinical Insight from Dr. Nancy O’Hara

Functional medicine pediatrician Nancy O’Hara has been a leading clinician and educator in the field of PANS and PANDAS.

Dr. O’Hara describes these disorders as immune-driven basal ganglia encephalitis, where inflammatory immune responses alter neurological function and behavior. 

Her work emphasizes the need to evaluate:

• infections

• immune dysfunction

• metabolic health

• environmental triggers

rather than viewing symptoms as purely psychiatric.

Dr. Nancy O’Hara is also a leading educator through the Medical Academy of Pediatric Special Needs (MedMAPS), an organization dedicated to training clinicians in the evaluation and treatment of complex pediatric neuroimmune conditions such as PANS, PANDAS, autism, and chronic inflammatory illness. MedMAPS provides advanced physician and clinician education in functional medicine approaches that examine infection, immune dysregulation, environmental exposures, and metabolic health as contributors to neurological symptoms.

At Brain Treatment Center NoVa, our clinical team continues to pursue additional training through MedMAPS to deepen our understanding of these complex neuroimmune disorders. Several of our clinicians are also participating in Dr. O’Hara’s advanced mentorship programs, which provide direct clinical guidance on evaluating and managing patients with PANS/PANDAS and related neuroinflammatory conditions.

Symptoms of PANS/PANDAS

One defining feature of these conditions is abrupt onset.

Children who were previously stable can suddenly develop severe symptoms, including:

• Obsessive compulsive behaviors

• Tics or motor disturbances

• Severe anxiety or panic

• Emotional instability

• Sleep disruption

• Sensory sensitivities

• Cognitive regression or “brain fog”

• Motor coordination difficulties

• Depression or irritability

Physical symptoms can also appear, including sleep disturbances, sensory hypersensitivity, and joint pain. 

For families, the change can feel sudden and devastating.

The Overlap We See in Veterans with TBI

While PANS and PANDAS are most often diagnosed in children, clinicians are increasingly recognizing that similar neuroinflammatory patterns can occur in adults, particularly among veterans and individuals with a history of traumatic brain injury (TBI).

Traumatic brain injury can create a sensitized neurological environment, where the brain becomes more vulnerable to immune activation and inflammatory triggers.

Veterans with TBI commonly experience physiological changes such as:

• chronic neuroinflammation

• disruption of the blood-brain barrier

• immune system dysregulation

• autonomic nervous system instability

• hormonal and metabolic imbalance

These changes can make the brain more reactive to additional biological stressors.

In many cases, ongoing neuroinflammation may be compounded by underlying contributors such as chronic infections, environmental exposures, and immune dysfunction.

Potential contributors may include:

• tick-borne infections such as Lyme disease

• chronic viral or bacterial infections

• mold exposure and mycotoxins

• environmental toxicants or heavy metals

• persistent inflammatory stress

When these factors interact with a previously injured brain, the result can be dysregulation of the same neural circuits affected in pediatric autoimmune encephalitis, particularly those involved in emotional regulation, stress response, and executive function.

As a result, veterans may experience symptoms that closely mirror pediatric autoimmune brain conditions.

Common overlaps include:

• anxiety and panic

• mood instability

• cognitive dysfunction or brain fog

• irritability and emotional reactivity

• sleep disturbance

• sensory overload

• autonomic nervous system dysregulation

In these cases, what is often labeled as PTSD, anxiety disorder, or mood disorder may also involve underlying neuroimmune dysregulation affecting brain function.

Recognizing these biological contributors can open the door to a more comprehensive approach to care, one that considers the interaction between brain injury, immune function, environmental exposures, and nervous system regulation.

Functional Impact on Daily Life

Whether in children or adults, neuroinflammatory brain disorders affect nearly every domain of functioning.

Patients may experience:

• school or work decline

• impaired concentration

• emotional instability

• chronic anxiety

• social withdrawal

• sleep disruption

• fatigue

• difficulty regulating stress

Families often feel confused because symptoms may appear psychiatric while the underlying drivers are biological.

How Brain-Based Care Can Help

At Brain Treatment Center NoVa, we focus on identifying and supporting the neurological systems affected by inflammation, injury, and nervous system dysregulation.

Many patients struggling with anxiety, mood instability, cognitive changes, or behavioral shifts may be experiencing disruptions in brain network regulation. Our approach focuses on restoring neurological stability and supporting the biological systems that influence brain health.

This comprehensive approach may include several layers of evaluation and support.

Brain Mapping (qEEG)

Quantitative EEG brain mapping allows us to evaluate patterns of brain activity and identify areas of dysregulation across networks involved in mood regulation, cognitive function, and stress response. This information helps guide individualized treatment approaches.

Precision Neuromodulation (MeRT) and rTMS

Magnetic EEG-guided resonance therapy and repetitive transcranial magnetic stimulation (rTMS) are non-invasive neuromodulation approaches designed to help regulate disrupted neural circuits and improve communication between brain networks involved in emotional regulation, attention, and executive functioning.

Functional Health Evaluation

Because neuroinflammation and brain dysregulation are often influenced by underlying biological factors, we also evaluate potential contributors to neurological symptoms, including:

• metabolic health

• environmental and toxic exposures

• chronic infections

• nutrient imbalances

• inflammatory stress

This whole-person perspective helps identify factors that may be contributing to ongoing neurological symptoms.

Nervous System Regulation and Rehabilitation

Many individuals with brain injury, chronic stress, or neuroinflammatory conditions live in a persistent fight-or-flight state. Our programs incorporate occupational therapy, somatic regulation techniques, and targeted neurological rehabilitation to help calm the nervous system and restore healthier regulation patterns.

Integrative Mental Health Support

Our clinic also offers integrative psychiatric care. Our psychiatric nurse practitioner provides medication management and ketamine therapy for adults with treatment-resistant depression, PTSD, and complex mood disorders.

Beginning in May, we will also offer root-cause-oriented mental health therapy, integrating biological, psychological, and nervous system perspectives to better support long-term recovery.

Supportive Neurological Therapies

To further support brain recovery and physiological regulation, our clinic offers additional therapies such as:

• soft-sided hyperbaric oxygen therapy (HBOT)

• red light therapy

• PEMF (pulsed electromagnetic field therapy)

These therapies can support cellular energy production, circulation, and neurological recovery in individuals dealing with complex neurological or inflammatory conditions.

A Brain-Based Approach to Complex Symptoms

When behavioral or psychiatric symptoms appear suddenly or persist despite treatment, it is important to consider that brain and immune function may be involved.

Children with PANS/PANDAS and veterans with TBI may share a common biological thread: neuroinflammation affecting brain regulation networks.

Addressing those underlying mechanisms can open new paths toward recovery.

Care for Northern Virginia, Washington DC & Beyond

Brain Treatment Center NoVa serves families and veterans across:

• Northern Virginia

• Washington DC

• Maryland

• and beyond

If you or someone you love is experiencing complex neurological or psychiatric symptoms, a brain-based evaluation may help uncover contributing factors.

*Tricare billed for covered services

BTCNVA.com

703-857-2560

References

Arcilla, C. K. (2024). Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. National Center for Biotechnology Information. 

Leonardi, L., et al. (2024). Pediatric acute-onset neuropsychiatric syndrome (PANS). Psychiatr Clin North Am. 

O’Hara, N. (2024). Demystifying PANS/PANDAS: A Functional Medicine Desktop Reference on Basal Ganglia Encephalitis. 

Autoimmune Institute. Neuroimmune mechanisms in PANS and PANDAS. 

MedMAPS. Lyme disease and immune dysregulation in PANS/PANDAS.