Pans Diagnosis: Understanding The Process And Key Indicators

PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a clinical diagnosis characterised by the onset of OCD symptoms or eating disorders after an infection or other trigger to the immune system. PANS symptoms, including OCD, restrictive eating, and other neuropsychiatric symptoms such as irritability, aggression, and oppositional behaviours, can appear suddenly. PANS is diagnosed clinically but can be difficult to recognise as symptoms overlap with many other medical conditions. It is a diagnosis of exclusion and requires that other known medical conditions be ruled out.

Abrupt onset of OCD or restricted eating

PANS (pediatric acute-onset neuropsychiatric syndrome) is characterised by an abrupt, acute, dramatic onset of obsessive-compulsive disorder (OCD) or severely restricted food intake. This is accompanied by at least two other concurrent neuropsychiatric symptoms, which also have a severe and acute onset.

Restricted eating is a common symptom of PANS. In fact, around 1 in 5 children with PANS will have restricted intake of specific foods or all food groups, often resulting in weight loss. The underlying symptom may be contamination fears associated with the food itself or what the food may have been exposed to. In other cases, obsessional fears of choking or vomiting may be the cause of restricted eating. Children with PANS can also develop anorexia, which may require hospitalisation and the use of a feeding tube.

The abrupt onset of OCD or restricted eating is often accompanied by other symptoms, including anxiety, depression, irritability, aggression, behavioural regression, deterioration in school performance, motor or sensory abnormalities, and somatic symptoms such as sleep disturbances and frequent urination.

PANS is diagnosed clinically and requires ruling out other known medical conditions. There is currently no definitive test for PANS.

Presence of additional neuropsychiatric symptoms

To be diagnosed with PANS, a patient must meet the following criteria:

An Abrupt, Acute, Dramatic Onset of Obsessive-Compulsive Disorder or Severely Restricted Food Intake

The clinical course is characterised by the abrupt, dramatic onset of OCD and/or eating restriction along with concurrent symptoms. The onset of symptoms can often be assigned to a particular day or week. Parents can often identify the day when they "lost" their child. Symptoms may reach maximum intensity over a longer time frame.

Concurrent Presence of Additional Neuropsychiatric Symptoms with Similarly Severe and Acute Onset from at Least 2 of the Following Categories:

• Anxiety
• Emotional Lability and/or Depression
• Irritability, Aggression, and/or Severe Oppositional Behaviours
• Behavioural (Developmental) Regression
• Sudden Deterioration in School Performance
• Motor or Sensory Abnormalities
• Somatic Signs and Symptoms, including Sleep Disturbances, Enuresis, or Urinary Frequency

Symptoms Are Not Better Explained by a Known Neurologic or Medical Disorder

The third major criterion of PANS requires that symptoms are not better explained by a known neurological or medical disorder such as Sydenham chorea, systemic lupus erythematosus, Tourette disorder, or others. Thus, to make the diagnosis of PANS, clinicians must perform a diagnostic evaluation that is comprehensive enough to rule out other potential disorders, including toxic effects of drugs or medications. A complete medical history and thorough physical and neurological examination are encouraged.

No other explanation for symptoms

PANS is a clinical diagnosis characterised by an abrupt, dramatic onset of obsessive-compulsive disorder (OCD) and/or eating restriction with at least two coinciding symptoms, including anxiety, mood dysregulation, irritability, aggression, oppositionality, behavioural regression, cognitive deterioration, sensory or motor abnormalities, or somatic symptoms.

PANS is a "diagnosis of exclusion", meaning that other known medical conditions must be ruled out. Symptoms of PANS are not better explained by a known neurological or medical disorder, such as Sydenham's chorea, systemic lupus erythematosus, Tourette disorder, or others. Clinicians must perform a comprehensive diagnostic evaluation to rule out other potential disorders, including the toxic effects of drugs or medications.

To be diagnosed with PANS, a patient must meet the following criteria:

• An abrupt, acute, dramatic onset of obsessive-compulsive disorder or severely restricted food intake.
• Concurrent presence of additional neuropsychiatric symptoms with a similarly severe and acute onset from at least two of the following categories: anxiety; emotional lability and/or depression; irritability, aggression, and/or severe oppositional behaviours; behavioural (developmental) regression; sudden deterioration in school performance; motor or sensory abnormalities; somatic signs and symptoms, including sleep disturbances, enuresis, or urinary frequency.
• Symptoms are not better explained by a known neurologic or medical disorder.
• There is no age requirement for PANS, but symptoms typically begin during the grade-school years.

PANS symptoms can appear suddenly and can be so extreme that parents may say their child seemed to "change overnight". PANS can be treated with medicines and therapy, and doctors and mental health experts can provide guidance and support to families.

Blood tests showing inflammation

Blood tests are an important tool in the diagnosis of PANS (Pediatric Acute-onset Neuropsychiatric Syndromes). While there is no single definitive test for PANS, blood tests can help guide healthcare professionals in the right direction for diagnosis and treatment.

If you suspect your child has PANS, lab testing can help your healthcare provider make a proper diagnosis. An initial diagnostic workup may include basic blood work, such as IgA, IgM, IgG, B12, and vitamin D levels. These tests can provide valuable information about a child's overall health and nutritional status, as well as offer insights into possible underlying inflammatory processes.

In addition to basic blood work, viral and bacterial testing is often recommended. This may include a strep throat culture, antistreptolysin O (ASO) test, and evaluations for Lyme disease, Mycoplasma Pneumoniae, and other co-infections. These tests are crucial in identifying potential infectious triggers of PANS, as the condition is often associated with preceding infections.

Furthermore, more specialized tests such as the Cunningham Panel can aid in diagnosing infection-triggered autoimmune neuropsychiatric syndromes. The Cunningham Panel consists of five individual tests that assess autoimmune antibody levels, including dopamine receptor antibodies, lysoganglioside GM1, tubulin, and CaM kinase II. Elevated levels in these tests can indicate a clinically significant autoimmune neurological condition and provide valuable insights into a child's neuropsychiatric symptoms.

It is important to note that PANS is a clinical diagnosis based on a comprehensive evaluation of signs, symptoms, medical history, and laboratory findings. While blood tests play a crucial role, they should be interpreted in conjunction with other clinical findings to establish a definitive diagnosis of PANS.

By utilizing blood tests in conjunction with other diagnostic tools, healthcare professionals can better understand the underlying causes of a child's symptoms and develop effective treatment plans for PANS.

Clinical diagnosis

PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) is a clinical diagnosis. It is diagnosed based on signs, symptoms, medical history, and laboratory findings that cannot be explained by any other neurological or medical disorders.

PANS is characterised by the onset of OCD symptoms or eating disorders after an infection or other triggers to the immune system. The diagnostic guidelines for PANS specify the sudden onset of symptoms because children typically experience dramatic changes in their behaviour. However, it is important to note that some children with PANS have a more gradual onset of symptoms, and these cases are less likely to be diagnosed.

The criteria for a PANS diagnosis include:

• Abrupt, dramatic onset of obsessive-compulsive disorder or severely restricted food intake
• Concurrent presence of additional neuropsychiatric symptoms with a similarly severe and acute onset from at least two of the following categories:
• Emotional lability and/or depression
• Irritability, aggression, and/or severe oppositional behaviours
• Behavioural (developmental) regression
• Sudden deterioration in school performance
• Motor or sensory abnormalities
• Somatic signs and symptoms, including sleep disturbances, enuresis, or urinary frequency

It is important to note that PANS symptoms should not be better explained by a known neurological or medical disorder. PANS can be triggered by various infections or the cause may be unknown. Therefore, it is essential to rule out other medical conditions before diagnosing PANS.

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