Understanding The Overlap Between Lyme Disease And PANS/PANDAS

When Infection Affects the Brain: Understanding the Overlap Between Lyme Disease and PANS/PANDAS

Lyme disease is one of the most common tick-borne illnesses in the United States. The CDC estimates more than 476,000 Americans are diagnosed each year, though some research suggests the true number may be higher. Caused by Borrelia bacteria transmitted mainly by ticks, Lyme disease has earned the nickname “the great imitator” because it can mimic many conditions, ranging from arthritis and neurological disorders to psychiatric illness.

In recent years, doctors have begun to recognize that Lyme disease and related infections may overlap with PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection). Understanding how these illnesses intersect can help families and clinicians better identify and treat the root causes.

A Complex Web of Tick-Borne Infections

Lyme disease rarely occurs alone. Ticks can carry multiple microbes, meaning one bite may transmit several infections simultaneously.

Common co-infections include:

• Bartonella
• Babesia
• Anaplasma
• Ehrlichia
• Rickettsia
• Mycoplasma
• Viruses such as Powassan virus

These pathogens can intensify illness and complicate diagnosis. They may also affect the nervous system and immune system in ways that contribute to neuropsychiatric symptoms.

Patients with tick-borne illness often experience a wide range of symptoms affecting many body systems, including:

• Severe fatigue and exercise intolerance
• Migrating muscle and joint pain
• Brain fog and memory problems
• Headaches or neck stiffness
• Digestive issues
• Mood changes and sleep disruption
• Dizziness, heart palpitations, or temperature instability

In some cases, neurological complications such as neuroborreliosis or brain inflammation may occur.

One reason these infections can be difficult to treat is their ability to evade the immune system. Bacteria such as Borrelia and Bartonella can hide inside cells, change their surface proteins, or form protective biofilms to avoid immune system detection. These strategies allow them to persist even after treatment. Some research has detected evidence of chronic Borrelia infection in more than 40% of patients with post-treatment Lyme disease symptoms using advanced detection technologies.

When the Immune System Stays “Switched On”

Normally, the immune system activates to eliminate pathogens and then returns to baseline. However, chronic infections can disrupt this rhythm and keep the nervous system on high-alert.

Persistent infections stimulate the ongoing release of inflammatory signaling molecules called cytokines. These molecules help fight infections, but when they remain elevated for long periods they can cause symptoms such as fatigue, pain, cognitive problems, sleep disruption, and mood changes.

In the process, the immune system may become less effective at clearing infections. Researchers describe this paradox as a state where the immune system is both overactive and weakened by this overactivity.

Autonomic Nervous System Disruption

Chronic inflammation can also affect the autonomic nervous system, which controls automatic bodily functions like heart rate, digestion, and blood pressure.

This disruption—called dysautonomia—can produce symptoms such as:

• Rapid heart rate or palpitations
• Dizziness when standing
• Digestive motility problems
• Temperature sensitivity
• Exercise intolerance
• Cognitive “brain fog”

Inflammation can interfere with vagal nerve signaling and other regulatory pathways, creating a cycle in which immune activation worsens nervous-system imbalance (and vice versa).

PANS and PANDAS: Infection-Triggered Behavioral Changes

PANS and PANDAS are both conditions in which infections trigger sudden psychiatric symptoms, particularly in children.

PANDAS specifically follows Group A strep throat infections, while PANS can be triggered by various infections—including Lyme disease and its co-infections.

Symptoms often appear abruptly and may include:

• Sudden obsessive-compulsive behaviors
• Severe anxiety or separation anxiety
• Motor or vocal tics
• Emotional outbursts or aggression
• Sleep problems
• Cognitive regression or decline in school performance
• Food restriction or sensory sensitivities

Current research suggests infections may trigger antibodies that mistakenly target brain tissue, particularly areas of the brain called the basal ganglia, which help regulate movement and emotions. Inflammatory cytokines can also disrupt neurotransmitters such as dopamine.

For this reason, these conditions are increasingly viewed not as primary psychiatric disorders, but as immune-mediated brain inflammation.

The Gut–Immune–Brain Connection

Gut health plays an important role in immune regulation. About 70% of immune activity occurs in gut-associated lymphoid tissue, and the microbiome helps regulate inflammation and immune balance.

However, infections, antibiotics, toxins, and chronic stress can disrupt the microbiome. This imbalance—known as gut dysbiosis—can weaken the intestinal barrier and allow inflammatory molecules to enter the bloodstream, perpetuating immune activation.

Because of this, restoring gut health is often an important part of recovery in chronic inflammatory illnesses such as Lyme disease and PANS/PANDAS.

A Systems-Based Approach to Healing

Treatment can be challenging, because reducing infection alone does not necessarily resolve immune dysfunction or inflammation. In fact, long courses of antibiotics may further disrupt gut bacteria.

Many holistic clinicians—like a certified Naturopath or Functional Medicine Doctor—therefore use integrative, systems-based approaches that address several components at once:

• Reducing infectious burden
• Regulating immune responses
• Supporting the nervous system
• Repairing gut health
• Reducing inflammation and oxidative stress

Certain botanical medicines are sometimes included in the treatment plan because they have multiple actions simultaneously.

Examples include:

• Japanese knotweed (Polygonum cuspidatum) – contains resveratrol and compounds that help regulate inflammatory signaling and support vascular and neurological health.
• Cat’s claw (Uncaria tomentosa) – contains alkaloids that help modulate immune activity and inflammation.
• Astragalus membranaceus – traditionally used to support immune resilience.
• Cryptolepis sanguinolenta, Houttuynia cordata, and Sida acuta – used in some protocols for their antimicrobial and anti-inflammatory properties.

These botanicals are often used alongside other therapies aimed at restoring immune balance and nervous-system stability.

Moving Toward Recovery

Lyme disease, co-infections, PANS, PANDAS, and post-viral immune syndromes may appear very different on the surface. Yet they often share underlying mechanisms: chronic infection, immune dysregulation, inflammation, and nervous-system imbalance.

For many patients, meaningful recovery occurs when treatment addresses the whole system, not just the infection. By restoring immune function, calming inflammation, supporting gut health, and stabilizing the autonomic nervous system, clinicians are increasingly helping patients regain function and quality of life.

This article is based on clinical perspectives presented by Dr. Myriah Hinchey, ND, FMAPS (2026), adapted for a general audience