Homeopathic Case Study: Treating PANDAS with Tarentula Hispanica

A Case Study on Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep (PANDAS) Successfully Managed with Homeopathy

By Jennifer Bahr, ND, DHANP, FMAPS

Background Summary & Initial Case History: 

LW was an 8-year-old female who presented to my clinic with her mother for CC of Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep (PANDAS) with a primary presentation of hyperactivity and tantrums. An allopathic provider had diagnosed LW, and she was routinely given antibiotics whenever her behavioral symptoms flared. At the time of presentation, LW was not taking any medications but would frequently use 3mg of melatonin at night. Her symptoms were not flaring at the time, but her mother was anxious for a way to resolve the flare rollercoaster once and for all. 

She began at age three and received frequent antibiotics as a result. She had no other health concerns and no surgeries. She was fully vaccinated and had never had any adverse effects from vaccination. Her mother was a strep carrier; otherwise, her family history was unremarkable. 

A flare of PANDAS always starts with hyperactivity and impulsivity. She would jump off tables and laugh hysterically at inappropriate things. She went from being able to sit still to being very restless. Mom said she would frequently get up from the table to spin around in circles or act silly, running around and running into things. If she were forced to sit still, she would bounce her knee. Mom also described a perceptible change in the look in her eyes. She said, “It is almost impish. Like she is planning something.” She would also get more impatient/hurried. 

LW shared that she always sang and needed to jump around. Mom would play music for her, and the music with heavy beats helped her feel calmer. 

The impulsive, silly behavior would ramp up to have more mean, angry behavior. She would throw water at her sister and get much more aggressive than usual. She became more sensitive to being looked at, sometimes leading to aggressive behavior. She has reportedly thrown a chair at someone for looking at her once. Mom described a mean face and clenching her jaw, but no changes in color or appearance were described beyond “mean.”

LW shared that she would get irate and break things like pencils. She said she wanted to break more things but didn’t want to get into trouble. 

She also had separation anxiety with her flares, particularly at night. The separation was specifically from her mom, so she used a pillow with a jacket of her mom’s zipped around it, which she called “faux mom.” 

She had just-right OCD and would get upset if her handwriting wasn’t perfect or if she felt that something was out of place. She would repeat steps or backtrack to make things right. She didn’t have apparent tics but would pull her hair and bite her nails. 

Her review of systems was unremarkable. Her generals were broadly unremarkable other than a fear of dogs and a strong sensitivity to being reprimanded or criticized. 

Case Analysis: 

LW’s main thing was hyperactivity/impulsivity and anger. The hyperactivity was primarily located in her legs with intense restlessness and need to move, and expressed as silly or foolish behavior. There were no clear modalities of inciting cause for each episode, time of day, ameliorating or aggravating factors. Her anger presented with quick, destructive efforts. LW was unable to describe any physical sensations when she was angry. The only thing that would relieve her was hiding alone in her closet, breaking things to ease pressure, or playing music with heavy beats. 

The nature of her OCD (fastidiousness) and separation anxiety is relatively common in PANDAS and important for her overall case but not the most important for remedy selection. Nevertheless, I included it in my repertorization. 

Repertorization: 

Here was my initial repertorization on RadarOPUS using Synthesis repertoire in full view: 

Materia Medica: 

Symptoms of Tarentula hispanica from Allen’s Encyclopedia of Pure Materia Medica¹ (hereafter referenced as AE in text) correspond via similarity to the symptoms of the case include: 

16 – * Great taciturnity and irritability;desire to strike himself and others, [a13].

• Corresponds to her irritability with aggression

24 – * Desire to joke, to play, and to laugh; extreme gayety, [a13].

• Corresponds to her foolish, impulsive behavior

26 – * Singing until becoming hoarse and exhausted, [a13].

• Corresponds to her desire to sing when hyper

28 – Music cheers up, amuses, and relieves; the prover perspires and experiences a general bruised feeling, disappearing with one dose of Zincum 200th, [a13].

• Corresponds to her amelioration from music

59 – * Cross the tendency to get angry and to speak abruptly; is obliged to move the limbs, with tearing and pressing pains in the stomach and in the left side of the chest; great thirst, with the necessity of introducing his fingers into the mouth, [a13].

• Corresponds to her restlessness, specifically in the legs

65 – From the first, there was an indescribable melancholy, anguish, and restlessness; peevishness, the attendants could do nothing to suit me; great haste in whatever I undertook, from a constant fear that something would happen to prevent my finishing it; I would start up suddenly, and hastily change my position, through fear that something would fall on me; when walking I would stop short or suddenly throw my head to one side, through fear of striking it against some imaginary object which appeared to be suspended a few inches above my head. A great fear of an imaginary impending calamity. Great desire to be alone, with fear of being alone, even during daylight. Frightful visions as soon as the eyes were closed, unable to sleep [a16].:

• Corresponds to her fear of being alone, even though she hides alone when she is upset.

Symptoms of Tarentula hispanica from Hering’s Guiding Symptoms of Our Materia Medica² (hereafter referred to as HGS in text) correspond via similarity to the symptoms of the case include: 

1-12 – || Sudden foxlike destructive efforts, requiring utmost vigilance to prevent damage, followed by laughter and apologies.

• Corresponds to her destructiveness and the “impish” behavior her mother described

33-1 – Uneasiness in legs with the necessity of constantly moving them.

• Corresponds to her restless legs

Prescription: 

My initial prescription was Tarentula hispanica 30C. I instructed mom to give her two pellets, dry-dosed sublingually once, and then wait for 72 hours. She would begin giving the remedy daily if she had no aggravation after 72 hours. I opted for daily dosing in this case for ease for Mom and because I didn’t anticipate an aggravation. 

I had also considered Hyoscyamus niger because it treats the same symptoms that are most characteristic in her case that Tarentula hispanica does – foolish behavior ( 9 -Foolishness, [a68]) singing (AE¹ 58 – * He sings amorous and obscene songs, [a21a].), anxiety in the evening (AE¹ 80 – Anxiety, soon after dinner, as though a sad occurrence impended(after six hours), [_a2].) and aggressive behavior (AE¹ 107 – * He is violent, and beats people, [a21c].). The similarity of the same symptoms was stronger in Tarentula hispanica, and the specific amelioration and description of the impish behavior were more confirmatory for Tarentula hispanica. 

I additionally considered Phosphorus primarily for the expression of anxiety (AE¹ 96 – * Great anxiety and irritability when alone, [_a1].) (AE¹ 112 – * Fear and dread, in the evening, [_a1].) (AE¹ 117 – * Did not like to be alone, [a50].). It also covers laughing (AE¹ 31 – Great excitement; she sang, laughed, and afterward fell asleep; on the following day woke with great anxiety (after half an hour), [a135].:), irritability (AE¹ 131 – Irritable and peevish, [_a1].) and destructiveness (HGS² 1-32 – || Maniacal attacks, coming on during sleep; fury and extreme violence, so that no one dares approach him; destroys everything in the room; eyes remain closed; after two or three hours lies down and sleeps a few minutes, recollects nothing on waking.). It covers restlessness but is mainly associated with anxiety and sleep, less so in general, and it is more likely to be aggravated by music (HGS² 3-10 – ¤ Sick-headache: with pulsations and burning primarily in forehead; with nausea and vomiting from morning until noon; agg from music, while masticating, and in a warm room). Phosphorus ultimately didn’t cover the most characteristic symptoms, similar to Tarentula hispanica. 

Follow-up: 

Date 1: March 24, 2015

I always do a brief free check-in after starting with a new patient to assess for aggravation and answer any questions the patient might have, especially when they are new to homeopathy. At our brief free check-in, LW’s mother said she hadn’t started the remedy. She was wholly unfamiliar with homeopathy when she booked the appointment with me and was alarmed at the remedy that was recommended to her daughter. I had spent significant time explaining how remedies are made and their safety profile when we wrapped up our first visit, but she needed more information to feel comfortable. Unfortunately, internet searches made her more scared. She additionally shared that she was worried about aggravation because she was generally doing well at the moment. 

I spent the visit explaining homeopathy in more detail and asked her what she would be comfortable with. She agreed to take a single dose of the remedy on Friday so that if she aggravated, it wouldn’t interfere with school. I instructed her to give two dry pellets of Tarentula hispanica 30C SL DU and follow up in 2 weeks. 

Date 2: April 14, 2015

As instructed, Mom had given exactly one dose of the remedy. She reported being a bit moody, but no more than usual, and she seemed greatly improved. Mom reported the following: 

• Signs of strep infection: None
• Hyperactivity: None
• Impulsivity: None
• Anger: Some, but quickly reigned in. 
• Separation anxiety: Minor
• Negative self-talk: Not much
• Destructiveness: None
• Sleep: Good

She reported no new symptoms and an overall trend of doing better, which surprised Mom because she had thought she was generally doing well before the remedy. 

Given Mom’s previous hesitancy with the remedy, we discussed dosing as needed. Mom was very interested in this approach, having seen her daughter improve with the single dose she had. 

I assessed that she had had a positive response to the remedy, and potency recommended that she continue the same medicine, Tarentula hispanica 30C. My directions were to give two dry pellets sublingually as needed for mood or sleep changes or at the first signs of upper respiratory or strep infection. We scheduled her follow-up for 6 weeks later. 

Date 3: April 20, 2015

LW’s mom emailed me between visits because LW had been exposed to strep through a friend. She was starting to show signs that she typically gets in response to strep, so mom gave a dose. She woke up anxious the following day and showed signs of school refusal. Mom was concerned about aggravation and sought guidance about whether to provide an additional dose or wait. I explained to her that when there is an acute infection, we often need to dose more frequently, even when dosing PRN. I instructed her to give another dose that day and to continue to dose as needed until symptoms resolved. 

Date 4: May 29, 2015

LW recovered quickly from the strep exposure with only two doses of the remedy. She did well for a week and then had anger return “out of nowhere,” which caused her to get angry and destroy some paper. Mom recognized this as an indication of a dose, so she gave one, and the next day, the anger was gone. 

A few weeks later, the family went on a short vacation. LW’s nighttime anxiety increased on the trip, and she started asking for the faux mom. Eager to put that crutch in the past, Mom decided to give LW a dose of her remedy to see if it would help. She was happy to report that it did and that faux mom was not needed. 

Reviewing symptoms, we found that LW never got any physical signs of strep infections and that all of her other symptoms increased following exposure, and all improved with the doses she was given. 

I assessed that she had responded positively to the remedy and was still responding. She would continue Tarentula hispanica 30C, two dry pellets SL PRN, and follow up in 4 weeks.

Conclusion

I continued to work with LW for several years. Her primary presenting complaint was resolved with Tarentula hispanica by her first anniversary of care, with one exception of a short-lived resurgence in the summer of her second year after a viral pharyngitis that quickly and permanently resolved with Tarentula hispanica. She continued to work with me after that for non-PANDAS-related anxiety. During our work together, she also responded to Ignatia amara, Lycopodium clavatum, and Argentum nitricum at times when anxiety was her only concern. Her anxiety has fully resolved. Since then, her mother has checked in sporadically to share that she is still doing well. 

---

---

References

1. Allen, T.F. (1874). Encyclopedia of Pure Materia Medica. Boericke and Tafel. 
2. Hering, C (1879). Guiding Symptoms of Our Materia Medica. The Estate of Constantine Hering.