Diagnosis and Treatment for PANS and PANDAS

Diagnosis

If your child has a dramatic onset of obsessive-compulsive disorder (OCD), suddenly restricts their food intake, or exhibits tics (involuntary, purposeless movements), and is also experiencing other neuropsychiatric conditions – anxiety, irritability, uncontrolled emotions, and/or depression – we recommend that pediatricians take the following steps:

1. Complete tests for your child for strep infection, including strep culture (if  “rapid” strep tests are negative) and, if that is negative, peri-anal strep culture and/or blood tests for ASO and Anti-DNase B antibody titers.
2. Strep throat culture tests for family members to see if they are strep carriers
3. If the child has had or been exposed to an illness with prolonged coughing, then your pediatrician may consider testing for a bacteria called mycoplasma. 

Treatment

If any of the strep tests are positive, your child’s pediatrician should prescribe antibiotics to resolve the strep infection and consider eradication of carriage states. If symptoms of PANS or PANDAS persist despite treatment, or if no infection can be found, then the patient should be referred to our service for comprehensive evaluation.

Antibiotics can dramatically improve many patients’ neuropsychiatric symptoms. Once treated, the symptoms that came on overnight can stop almost as quickly. Other children with PANS/PANDAS may not respond as readily and will have to take a longer course of antibiotics, anti-inflammatory drugs, steroids, or other treatments, including psychiatric treatment (medications and/or psychotherapy).

For children who are diagnosed early and a cause has been identified, the prognosis can be very good. Some patients respond quickly and are back to 100-percent normal function, but that doesn’t happen for everybody. For those in whom the cause is unknown and who don’t respond as well to antibiotics, we look for alternate treatments shown to work in related conditions.