Testing For Pandas: A Comprehensive Guide

PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections, is a complex disorder with a range of symptoms that vary from patient to patient. While there is currently no definitive test for PANDAS, there are several ways to test for the disorder. This includes a variety of blood and urine tests, strep cultures, and allergy tests, among others. In this article, we will explore the different testing methods for PANDAS and provide an overview of the disorder, its symptoms, and treatment options.

Strep throat swab test

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections) is a complex disorder with a range of symptoms that vary from patient to patient. The underlying cause of PANDAS is believed to be an autoimmune attack on healthy brain tissue following a strep infection.

Strep throat is a bacterial infection that affects the throat and tonsils, causing a sore throat and white spots or a coating on the throat and tonsils. It is caused by Group A Streptococcus bacteria, which can be detected with a strep throat swab test. This test is typically carried out 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 sterile cotton swab to rub the back of the patient's throat near the tonsils. The patient may experience gagging or discomfort during the test, which only lasts a few seconds.

There are two types of strep throat swab tests: a rapid strep test and a throat culture. The rapid strep test detects antigens to strep A and can provide results within 10-20 minutes. If the rapid test is negative, a throat culture may be ordered, which is more accurate but can take up to 48 hours for results. During the throat culture test, the provider may need to scrape the back of the patient's throat several times to improve the chances of detecting bacteria.

It is important to test for strep throat to distinguish it from a viral infection, as strep throat requires treatment with antibiotics. Additionally, untreated strep throat can lead to serious health complications such as rheumatic fever or kidney disease. Testing for strep throat is especially important in children, as they are more susceptible to rheumatic fever following an untreated strep infection.

Blood work

PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcus) is a clinical diagnosis that is based on a collection of signs, symptoms, medical history, and laboratory findings that cannot be explained by another medical condition. There is no single test or combination of tests that can diagnose PANDAS. However, lab tests can help guide healthcare professionals in the right direction for diagnosis and treatment.

If you suspect your child has PANDAS, basic blood work can be done to test for the following:

• IgA
• IgM
• IgG
• B12
• Vitamin D

In addition to basic blood work, viral and bacterial testing for strep throat is important. If your child tests positive, your healthcare provider can quickly start a treatment plan before the onset of symptoms. Some children with PANDAS can react to exposure to strep, so it is important to test all family members to ensure no one is an asymptomatic carrier.

• Strep throat culture, 48-hour culture, or perianal culture
• Antistreptolysin O (ASO)
• Lyme disease and co-infections
• Epstein-Barr Virus Panel
• Coxsackie A & B Titers
• Mycoplasma Pneumoniae IgA & IgM
• Pneumococcal Antibody Titers

The Cunningham Panel is a unique series of high-complexity blood tests that can aid clinicians in diagnosing infection-triggered autoimmune neuropsychiatric syndromes such as PANDAS. The panel consists of five individual tests that assess autoimmune antibody levels:

• Dopamine D1 receptor
• Dopamine D2L receptor
• Lysoganglioside GM1
• Tubulin
• 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.

Cunningham Panel*

The Cunningham Panel™ is a series of five highly complex metabolic tests that can help identify the level of autoimmune antibodies associated with neuropsychiatric disorders. Four of these tests measure circulating levels of specific autoantibodies in a patient's serum at the time the specimen is drawn. The fifth test, the CaMKII assay, measures the ability of a patient's autoantibodies to stimulate this enzyme, resulting in an upregulation of brain neurotransmitters such as dopamine, epinephrine, and norepinephrine. This increase can trigger a variety of neurologic and/or psychiatric symptoms.

The Cunningham Panel™ includes five individual tests:

• Anti-Dopamine D1 Receptor
• Anti-Dopamine D2L Receptor
• Anti-Lysoganglioside-GM1
• Autoantibodies Against Tubulin
• Calcium/calmodulin-dependent protein kinase II (CaMKII) – a brain cell stimulation assay

The Cunningham Panel™ is considered positive if one or more of these individual test results exceed their normal ranges. The test results can aid a clinician's diagnosis with supportive laboratory evidence of an autoimmune dysfunction directed against certain biological targets in the brain. By identifying an underlying autoimmune dysfunction, these results can assist the clinician in selecting an appropriate treatment regimen.

The Cunningham Panel™ is available in the United States from Moleculera Labs and can be ordered by visiting their website. International patients and physicians can find more information on the Moleculera Labs website as well.

While the Cunningham Panel™ can be a useful tool in the diagnosis of certain autoimmune disorders, there have been concerns raised about the reliability of the test. A study published in Translational Psychiatry in 2019 found that the test may not accurately predict response to intravenous immunoglobulin (IVIG) treatment and that Moleculera Labs' threshold for positivity for CaMKII may be based on a small sample size. The authors of the study advise Moleculera Labs to publish a larger sample of healthy controls and to investigate the diagnostic and predictive value of the Panel.

MRI scan

PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections, is a complex disorder with a range of symptoms that vary from patient to patient. While there is currently no definitive test for PANDAS, medical professionals employ a variety of methods to diagnose the condition, including strep cultures, allergy tests, immunological tests, brain scans, and the Cunningham panel, which assesses the likelihood of an autoimmune disorder.

In one study, researchers at Stanford Medicine used MRI scans to compare the brains of 34 children with PANDAS to those of 64 children without the disorder. They found that the PANDAS patients exhibited greater water diffusivity in certain brain structures, indicating inflammation or swelling. This finding supported the theory that PANDAS is associated with an immune-system attack on the brain.

While MRI scans can provide valuable information about brain structure and function, they are not always abnormal in PANDAS patients. Some individuals with PANDAS may have normal MRI findings, even when they exhibit physical or neurological signs of basal ganglia dysfunction. As such, MRI scans are just one tool in the diagnostic toolkit for PANDAS, used in conjunction with other tests and clinical assessments.

PET scan

PANDAS (Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections) is a complex disorder with a range of symptoms that differ from patient to patient. There is currently no single definitive test for PANDAS, but several tests can be used to aid diagnosis, including strep cultures, allergy tests, immunological tests, brain scans, and the Cunningham panel.

One of the brain scans used to help diagnose PANDAS is a Positron Emission Tomography (PET) scan. PET scans produce detailed 3-dimensional images of the body and can highlight abnormal areas and how well certain functions of the body are working. They are often used to investigate cancer and brain conditions such as dementia.

In the case of PANDAS, PET scans can be used to detect inflammation in the basal ganglia of the brain, which is thought to be affected by the disorder. The basal ganglia are several brain structures located in the centre of the brain that function as a communication route to other parts. They are also involved in memorisation, cognitive and emotional processing, and initiating movement.

The PET scan works by using a radioactive material, PK-11195, to target the inflammatory cells of the brain. This chemical is attracted to these cells and can give information on how the basal ganglia are functioning. Some PET scans on PANDAS patients have identified inflammation in the basal ganglia, which could be useful as confirmation of the disorder.

Dr Harry Chugani, Division Chief of Neurology at the Nemours Neuroscience Center, has stated that PET scans of inflammation are currently a research tool, whereas PET scans of glucose metabolism are used clinically for epilepsy, tumours, and dementia. However, he believes that PET scans of inflammation are the best way to get to the "heart of the matter" when it comes to PANDAS and understanding whether there is inflammation in the brain.

Frequently asked questions