Combined transcranial photobiomodulation and neurofeedback in PANS/PANDAS: a retrospective case series

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Background: PANS and PANDAS are neuroimmune conditions characterized by neuropsychiatric symptoms, including obsessive-compulsive features, cognitive dysfunction, and emotional dysregulation, that may persist despite multimodal treatment. Adjunctive neuromodulation approaches remain underexplored in this population. Methods: This retrospective observational case series describes two adolescents with persistent PANS/PANDAS symptoms despite more than 10 years of multidisciplinary care who received home-based transcranial photobiomodulation (tPBM) using a 1070 nm near-infrared device and adjunctive swLORETA neurofeedback as part of routine clinical care. Multimodal outcomes included the PANS 31-Item Symptom Rating Scale, Yale-Brown Obsessive Compulsive Scale, CogniFit CAB-Pro, BrainGauge, caregiver-reported functional outcomes, and qEEG. Results: Reductions in neuropsychiatric symptom burden and functional gains were observed during the observation windows. One participant showed a 73% reduction in PANS-31 severity with improvements across multiple cognitive domains; the other showed a 50% reduction in obsessive-compulsive symptom severity and progressed from homebound status to full school participation. Changes were observed across clinical, cognitive, functional, and qEEG measures; however, outcome timing differed across participants and instruments. Conclusion: These findings should be interpreted as preliminary, hypothesis-generating observations only. Because of the retrospective design, very small sample size, prior and concurrent interventions, and non-uniform assessment schedules, no conclusions regarding efficacy, causality, or attribution to either intervention or their combined use can be drawn. Prospective controlled studies are needed to evaluate efficacy, optimal sequencing, and intervention parameters.

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