Tiffany Haney
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are clinical diagnoses made by a physician based on a patient's symptoms, examination, and personal and family medical history. There is no single blood test or scan to diagnose PANS or PANDAS. However, lab tests and imaging can help support the diagnosis and rule out other conditions. A PANS/PANDAS specialist should conduct a thorough physical examination and carefully review the patient's history to ensure accurate diagnosis and effective treatment.
| Characteristics | Values |
|---|---|
| Diagnosis | PANS/PANDAS is a clinical diagnosis based on a collection of signs, symptoms, medical history, and laboratory findings that cannot be explained by another medical condition. |
| Testing | There is no single blood test or scan to diagnose PANS/PANDAS. Lab tests can guide healthcare professionals in the right direction for diagnosis and treatment. |
| Symptoms | Abrupt onset of OCD, restricted food intake, tics, anxiety, irritability, uncontrolled emotions, depression, and other neuropsychiatric symptoms. |
| Treatment | Treatment guidelines for PANS/PANDAS focus on psychiatric and behavioral interventions, the use of immunomodulatory therapies, and the treatment and prevention of infections. |
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What You'll Learn
There is no single test for PANS or PANDAS
PANS (Paediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are clinical diagnoses. They are diagnosed by a physician based on a patient's presenting symptoms, examination, and personal and family medical history—not simply on laboratory tests. There is no single test for either condition.
The diagnosis of PANS should be considered when symptoms of OCD, eating restrictions, or tics start suddenly and are accompanied by other emotional and behavioural changes, frequent urination, motor abnormalities, and/or handwriting changes. PANS can be triggered by various infections, but the trigger is often unknown.
PANDAS is thought to be triggered by a Streptococcal infection. A doctor may recommend a throat swab test to check for strep. This involves gently swabbing the back of a patient's throat and tonsils with a sterile cotton swab to collect a sample. The sample is then sent to a lab, where it is placed in a special environment to see if the strep bacteria grow. While rapid tests are available and can give quicker results, a throat culture is more accurate and helps ensure a proper diagnosis.
In addition to the above, a correct diagnosis of PANS or PANDAS can be made based solely upon behavioural changes and neurologic signs identified during a careful, thorough history and physical exam by a PANS/PANDAS specialist. Testing may support the diagnosis of PANS or PANDAS, but it is not absolutely required.
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Diagnosis is made by a physician
PANS/PANDAS is a clinical diagnosis made by a physician based on a patient's symptoms, examination, and personal and family medical history, rather than solely on laboratory tests. The diagnosis requires expert clinical knowledge and careful evaluation of the patient's history. A PANS/PANDAS specialist should conduct a thorough physical examination to ensure that the symptoms are not caused by other serious medical conditions.
The diagnosis of PANS/PANDAS should be considered when symptoms such as OCD, eating restrictions, tics, or other emotional and behavioural changes appear suddenly and are accompanied by neuropsychiatric symptoms. These can include anxiety, irritability, uncontrolled emotions, depression, hyperactivity, impulsivity, aggression, sleep disturbances, brain fog, cognitive impairment, and involuntary movements. The presence of these symptoms, particularly when they emerge abruptly, can guide physicians towards a diagnosis of PANS/PANDAS.
While there is no single blood test or scan to diagnose PANS/PANDAS, laboratory tests can provide valuable information to support the clinical diagnosis. Basic blood work, such as IgA, IgM, IgG, B12 and vitamin D levels, can be assessed. Viral and bacterial testing, such as a throat culture for strep, antistreptolysin O (ASO), and testing for Lyme disease and coinfections, may also be recommended. These tests can help identify current or past infections that could be contributing to the patient's symptoms.
Additionally, the Cunningham Panel, or the Autoimmune Brain Panel™, can assist in identifying autoimmune antibody levels associated with neuropsychiatric disorders. This panel includes tests for Dopamine D1 and D2L receptors, Lysoganglioside GM1, Tubulin, and CaM Kinase II. Elevated levels of these antibodies have been correlated with specific psychiatric symptoms, providing further insight into the patient's condition.
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Lab tests can help guide diagnosis
While PANS/PANDAS cannot be diagnosed with a single blood test or scan, lab tests can help guide healthcare professionals in diagnosing and treating the condition.
PANS/PANDAS is a clinical diagnosis based on a collection of signs, symptoms, medical history, and laboratory findings that cannot be explained by another medical condition. The diagnosis should be considered whenever symptoms of OCD, eating restrictions, or tics start suddenly and are accompanied by other emotional and behavioural changes, frequent urination, motor abnormalities, and/or handwriting changes.
Lab tests can help identify the root causes of these symptoms and rule out other potential explanations. For example, a throat or strep culture can be used to test for a Streptococcal infection, which is thought to trigger PANDAS. Blood tests can also show signs of inflammation and infection, which may be linked to PANS/PANDAS. Basic blood work may include testing for IgA, IgM, IgG, B12, and vitamin D levels. Viral/bacterial testing, such as antistreptolysin O (ASO) and testing for Lyme disease and coinfections, may also be recommended.
In addition to laboratory tests, imaging tests may also be used to help diagnose PANS/PANDAS. However, it is important to note that these tests are not always required for an initial diagnosis. A careful and thorough history and physical examination by a PANS/PANDAS specialist are crucial for making a correct diagnosis.
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Blood tests may show signs of inflammation
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are clinical diagnoses made by a physician based on a patient's symptoms, examination, and personal and family medical history. There is no single blood test to detect PANS or PANDAS. However, blood tests can show signs of inflammation, which, in the context of each child's illness, may be indicative of PANS or PANDAS.
Blood tests for PANS or PANDAS may include basic blood work such as IgA, IgM, IgG, B12, and vitamin D. Viral and bacterial testing, such as a throat swab culture, can also be used to check for a recent infection that could be contributing to the patient's symptoms. While rapid strep tests are available and can give quicker results, a throat culture is more accurate and helps ensure a proper diagnosis.
In addition to these standard blood tests, the Cunningham Panel™ (also known as the Autoimmune Brain Panel™) can be used to identify the level of autoimmune antibodies associated with neuropsychiatric disorders. This panel measures antineuronal antibodies such as lysoganglioside, tubulin, dopamine receptors, and CaM kinase II receptor-stimulating antibodies. These antibodies have been found in patients with Sydenham chorea, Tourette syndrome, and PANDAS.
While blood tests can provide valuable information, it is important to note that diagnosing PANS or PANDAS requires expert clinical knowledge and a careful, thorough history and physical examination by a PANS/PANDAS specialist. Healthcare providers must also rule out other potential causes of the patient's symptoms, as PANS and PANDAS symptoms overlap with many other medical conditions.
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A throat swab can test for strep
A throat swab, or throat culture, is a test that can be used to check for strep throat. Group A Streptococcus, or group A strep, is a type of bacteria that often lives in the nose and throat and can cause strep throat and other infections. Strep throat is an infection that affects the throat and tonsils, causing them to become irritated and swollen, resulting in a sore throat that is especially painful when swallowing. While strep throat is most common in children aged 5 to 15 years old, it can occur at any age.
To perform a throat swab, a healthcare provider will ask the patient to tilt their head back and open their mouth as wide as possible. The provider will then use a tongue depressor to hold down the tongue and insert a special swab to collect a sample from the back of the throat and tonsils. This procedure may cause slight discomfort or gagging, especially if the patient's throat is already sore. The sample is then sent to a lab, where it is placed in a special environment to see if the strep bacteria grow.
There are two types of tests for strep throat: a rapid strep test and a throat culture. The rapid strep test is typically performed first and can provide results within 10 to 20 minutes. It involves swabbing the throat and running a test on the swab to quickly determine if group A strep bacteria are likely causing the illness. However, if the rapid strep test is negative, the healthcare provider may order a throat culture to ensure an accurate diagnosis.
The throat culture, or strep throat culture, is a more accurate test than the rapid strep test, but it can take 24 to 48 hours or even up to 3 days to receive the results. During this test, the swabbed sample is sent to a lab to see if the strep bacteria grow. While it takes longer, a throat culture can sometimes detect infections that the rapid strep test may miss. Therefore, performing a throat culture is important, especially in children and teens, as untreated strep throat can lead to serious complications such as rheumatic fever or kidney disease.
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Frequently asked questions
PANS and PANDAS are clinical diagnoses made by a physician based on a patient's symptoms, examination, and personal and family medical history. There is no single blood test to detect PANS or PANDAS, but a combination of lab tests can help physicians diagnose the disorder.
The most common symptoms among children with confirmed PANS or PANDAS diagnoses include the sudden onset of OCD-like symptoms and/or eating restrictive disorders. Other symptoms include anxiety, irritability, uncontrolled emotions, depression, and tics.
Basic blood work, such as IgA, IgM, IgG, B12 and vitamin D levels, can be used to diagnose PANS or PANDAS. Viral/bacterial testing, such as a strep throat culture, antistreptolysin O (ASO), and testing for Lyme disease and coinfections, can also be useful.
A throat culture is a simple test that involves gently swabbing the back of a child's throat and tonsils with a sterile cotton swab to collect a sample. The sample is sent to a lab to see if strep bacteria grow. While rapid tests are available, a throat culture is more accurate and ensures a proper diagnosis.
The Autoimmune Brain Panel (also known as the Cunningham Panel) can assist clinicians by providing laboratory evidence of an underlying autoimmune dysfunction and helping to determine an appropriate treatment regimen.
