Ella Walter
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) are medical conditions that can lead to OCD, tics, or eating disorders in children. The current standard for diagnosing 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. There is no conclusive blood test for PANS/PANDAS, but lab tests can help guide healthcare professionals in the right direction for diagnosis and treatment. If you suspect your child may have PANS or PANDAS, it is important to work with a healthcare provider who is familiar with treating these conditions and to monitor your child's symptoms.
| Characteristics | Values |
|---|---|
| Diagnosis | Based on behavioural changes, neurological signs, medical history, current symptoms, physical examination, and lab work. |
| Tests | Basic blood work, viral/bacterial testing, autoimmune antibody level testing, throat swab, strep culture, ASO test, Cunningham panel, etc. |
| Symptoms | OCD, tics, eating disorder, anxiety, aggression, sensory abnormalities, somatic symptoms (night terrors, bedwetting, etc.), vision issues, inflamed joints and muscles, etc. |
| Treatment | Tonsillectomy, adenoidectomy, antibiotics, immunology treatment, etc. |
| Age Group | Typically affects children between 3 years old and puberty. |
| Gender | Boys are twice as likely to develop PANS than girls. |
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What You'll Learn
- There is no single conclusive test for PANS/PANDAS
- Diagnosis is based on a collection of signs, symptoms, medical history, and laboratory findings
- A strep swab test can be used to detect strep infections
- The Cunningham Panel is a series of blood tests that aid in diagnosing autoimmune neuropsychiatric syndromes
- Patients with PANS/PANDAS may experience physical symptoms such as dilated eyes, vision issues, inflamed joints and muscles, and peeling skin
There is no single conclusive test for PANS/PANDAS
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. There is no single conclusive test for PANS/PANDAS. The disease course is typically relapsing and remitting but can become chronic/static. Every child's symptoms are unique, and diagnosing PANS and PANDAS relies heavily on symptom presentation. The most common symptoms among children with confirmed PANS/PANDAS diagnoses include the sudden onset of OCD-like symptoms and/or sudden onset of eating restrictive disorders. Abrupt, acute onset of obsessive-compulsive disorder or severely restricted food intake is often observed.
PANS/PANDAS typically affects children between the ages of 3 and puberty. Boys are twice as likely as girls to develop PANDAS. The symptoms can include physical signs such as dilated eyes, vision issues, including distortions or hallucinations, and inflamed joints and muscles. There are also physical signs of strep, such as peeling skin on the hands or feet, a red anal ring, and strawberry tongue. Other physical signs of infection include warts, molluscum, ringworm, and ridged nails.
Diagnosis of PANS/PANDAS is based on an analysis of the child's medical history, current symptoms, and physical examination. Lab work and additional testing can be ordered to identify an infectious trigger, rule out other diagnoses, and inform treatment plans. A diagnosis of PANS/PANDAS is never based on one or two test results. Basic blood work can be done, such as IgA, IgM, IgG, B12, and vitamin D. Viral/bacterial testing, such as a strep throat culture, antistreptolysin O (ASO), and testing for Lyme disease and coinfections, can also be performed.
The Cunningham Panel is a unique series of high-complexity blood tests that aid clinicians in diagnosing infection-triggered autoimmune neuropsychiatric syndromes such as PANDAS/PANS. The panel consists of five individual tests that assess autoimmune antibody levels. These tests are for the dopamine D1 receptor, dopamine D2L receptor, lysoganglioside GM1, tubulin, and CaM kinase II. Elevated levels on one or more of these tests indicate that a child's neuropsychiatric symptoms may be due to a treatable autoimmune disorder that was possibly triggered by an infection.
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Diagnosis is based on a collection of signs, symptoms, medical history, and laboratory findings
PANS/PANDAS is a rare disorder that affects children between the ages of 3 and puberty. Boys are twice as likely as girls to develop PANDAS. The symptoms of PANS/PANDAS include the sudden onset of OCD, restricted food intake, extreme anxiety, aggression, behavioural regression, learning regression, sensory abnormalities, sleep disturbances, and somatic symptoms such as night terrors or bedwetting.
Diagnosis of PANS/PANDAS is based on a collection of signs, symptoms, medical history, and laboratory findings. It is a clinical diagnosis that requires careful evaluation of the patient's history, current symptoms, and physical examination. Laboratory tests and imaging can provide additional information to support the diagnosis, but they are not required for the initial diagnosis.
The first step in diagnosing PANS/PANDAS is to perform a complete medical and psychiatric history, including past infections and the onset of neuropsychiatric symptoms. A physical examination is also necessary to ensure that the symptoms are not due to other serious medical conditions.
Laboratory testing can help identify infectious triggers, rule out other diagnoses, and inform treatment plans. Tests may include basic blood work, viral and bacterial testing for strep throat, autoimmune panels, and metabolic tests. However, it is important to note that there is no single blood test or gold-standard test for PANS/PANDAS, and the diagnosis should not be based on one or two test results.
Working with a healthcare provider who is familiar with PANS/PANDAS and its underlying contributors is crucial for accurate diagnosis and treatment. PANS/PANDAS specialists can help navigate the complexities of the diagnosis and provide proper treatment to manage symptoms and promote healing.
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A strep swab test can be used to detect strep infections
Strep throat is a common bacterial infection that affects the throat and tonsils, causing irritation and swelling. It is most prevalent in children aged 5 to 15 years old but can occur at any age. The infection spreads through respiratory droplets, close contact, or sharing utensils with an infected person. Some carriers of the bacteria may not exhibit any symptoms but can still spread the infection.
The strep swab test is typically performed by a healthcare provider, who will ask the patient to tilt their head back and open their mouth wide. 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 a slight gagging sensation or discomfort, but it is generally safe.
There are two main types of strep swab tests: the rapid strep test and the throat culture test. The rapid strep test detects the presence of group A strep bacteria within 10 to 20 minutes. It identifies antigens, which are substances that trigger the immune system to fight the bacteria. If the rapid test is negative but clinical suspicion remains, a throat culture test may be performed. This test is more accurate but takes longer (24 to 48 hours) as it involves growing the bacteria from the swab in a lab. A positive throat culture confirms the presence of group A strep bacteria and usually leads to antibiotic treatment.
Strep infections can have various physical signs and symptoms, such as peeling skin on the hands or feet, a red anal ring, strawberry tongue, and sore throat. Additionally, strep infections are associated with conditions like PANDAS and PANS, which primarily affect children and cause a range of behavioural and neurological symptoms. Diagnosing PANDAS and PANS involves a comprehensive medical history, physical examination, and laboratory tests to identify potential infectious triggers.
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The Cunningham Panel is a series of blood tests that aid in diagnosing autoimmune neuropsychiatric syndromes
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection) are often mistaken for mental illnesses or attributed to poor discipline at home. However, they are far more prevalent than previously thought, and there are tests available to aid in diagnosis and treatment.
The Cunningham Panel is a unique series of high-complexity blood tests that help clinicians diagnose infection-triggered autoimmune neuropsychiatric syndromes such as PANDAS/PANS. The panel was developed by Dr. Madeleine Cunningham, a strep expert who studied Sydenham's chorea (SC) and other cardiovascular issues involving strep bacteria. The Cunningham Panel consists of five individual tests that assess autoimmune antibody levels. These tests are for the dopamine D1 receptor, dopamine D2L receptor, lysoganglioside GM1, tubulin, and CaM kinase II. Elevated levels on one or more of these tests indicate that a child's neuropsychiatric symptoms may be due to a treatable autoimmune disorder possibly triggered by an infection.
The Autoimmune Brain Panel, formerly known as the Cunningham Panel, includes a series of high-complexity blood tests that assist clinicians in determining whether a patient's neuropsychiatric symptoms may be due to a treatable autoimmune dysfunction rather than a primary neurologic or psychiatric illness. The panel measures the levels of specific autoimmune antibodies directed against certain targets in the brain, including the Dopamine D1 and D2 receptors, Lysoganglioside, and Tubulin, and their ability to trigger neuropsychiatric symptoms.
Identifying an autoimmune component is crucial as it typically changes the course of treatment. Treatment often involves eradicating the infection(s), reducing inflammation, and, if necessary, treating the immune system with immunomodulatory therapies. Early diagnosis and treatment have been shown to improve the chances of a full recovery.
It is important to note that a PANS or PANDAS diagnosis is never based on one or two test results. The diagnosis is based on an analysis of the child's medical history, current symptoms, physical examination, and lab work. A complete medical and psychiatric history, as well as a medical exam, are essential in the diagnosis process.
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Patients with PANS/PANDAS may experience physical symptoms such as dilated eyes, vision issues, inflamed joints and muscles, and peeling skin
PANS/PANDAS is a clinical diagnosis based on a physical exam, clinical and family history, and lab tests. Patients with PANS/PANDAS may experience physical symptoms such as dilated eyes, vision issues, inflamed joints and muscles, and peeling skin.
Dilated pupils (mydriasis) can be intermittent during emotional outbursts. Patients can also experience vision issues, including distortions or hallucinations. Rheumatologic workups reveal that 80% of PANS patients have arthralgias, myalgias, and other evidence of inflamed joints and muscles. Patients may also have "piano fingers" movements, which are different from the more significant movements seen in Sydenham Chorea.
There are physical signs of strep infections, which are the most commonly cited trigger for PANS/PANDAS, including peeling skin on hands or feet, a red anal ring, and strawberry tongue. In addition to the throat, strep can occur in the sinuses, ears, gut, skin, vagina, and peri-anal areas. A throat swab is the easiest and least invasive way to test for strep throat, but it will not detect strep infections in other areas of the body. If a child tests positive, treatment can begin quickly, and the correlation between strep and the onset of symptoms can be investigated.
There are also physical signs of other infections. For example, Lyme disease can cause warts, molluscum, ringworm, and ridged nails. If Lyme disease is suspected, the Traditional Western Blot test should be done. Other suspected triggers for PANS include Mycoplasma Pneumoniae, Staph Infections, Coxsackie Virus, Epstein-Barr Virus, and Herpes Simplex Virus.
PANS/PANDAS is increasingly recognized as a form of autoimmune encephalitis (AE), specifically post-infectious basal ganglia encephalitis (BGE). Testing for clinical features of AE includes testing for autoantibody markers in the cerebral spinal fluid (CSF). However, this is a new field of treatment, and CSF can be negative for aberrant, disease-inducing illness.
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