Cody Casey
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) and PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) are often-overlooked autoimmune disorders that can lead to changes in thinking and behaviour in children. While there is no single blood test or scan to detect PANDAS or PANS, laboratory testing can help support a diagnosis. The Cunningham Panel, for example, is a series of high-complexity blood tests that aid clinicians in diagnosing infection-triggered autoimmune neuropsychiatric syndromes. The Autoimmune Brain Panel by Moleculera Biosciences, Inc. is another test that can be used to diagnose PANDAS and PANS.
| Characteristics | Values |
|---|---|
| Diagnosis | Clinical diagnosis based on signs, symptoms, medical history, and laboratory findings that cannot be explained by another medical condition |
| Symptoms | Sudden onset of OCD or eating disorder, anxiety, tics, mood changes, and other neuropsychiatric symptoms |
| Testing | No single blood test or scan can diagnose PANS or PANDAS; laboratory tests, physical examinations, and medical history are used to guide diagnosis |
| Treatment | Addressing the underlying cause, managing symptoms, and supporting the immune system; antibiotics are used to treat strep infections in PANDAS |
| Triggers | Infection, immune system issues, environmental factors, allergies, diet, yeast overgrowth, and other bacteria or viruses |
| Testing Options | Cunningham Panel, strep culture, ASO test, blood tests, Autoimmune Brain Panel, CD4 test, IgG deficiency test, metabolic tests |
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What You'll Learn
There is no single blood test to detect PANS or PANDAS
PANS stands for “Pediatric Acute-Onset Neuropsychiatric Syndrome”, while PANDAS stands for "Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections". PANS and PANDAS are clinical diagnoses based on a collection of signs, symptoms, medical history, and laboratory findings that cannot be explained by another medical condition. There is no single blood test to detect PANS or PANDAS, and a correct diagnosis can be made based on behavioural changes and neurologic signs identified during a careful, thorough history and physical exam by a PANS/PANDAS specialist.
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.
While there is no single blood test to detect PANS or PANDAS, lab tests can guide healthcare professionals in the right direction for diagnosing and treating the condition. Doctors will look for abnormalities in these tests, with more positive results meaning a higher likelihood of a diagnosis. Blood work can serve as a helpful diagnostic tool for PANDAS/PANS. A total basic blood workup may include IgE, IgA, IgM, and IgG antibodies, antinuclear antibodies (ANA), a complete blood count (CBC), ferritin (iron), B12, and vitamin D. In addition to basic blood work, providers need to conduct in-office viral and bacterial testing for strep throat. If a child tests positive, a healthcare provider can quickly start a treatment plan before the onset of symptoms.
PANS/PANDAS testing involves a mix of clinical evaluations, lab tests, and a thorough review of the patient's medical history. Testing helps uncover the root cause of the infections and immune triggers that can inflame the brain and cause sudden shifts in mood, behaviour, and thinking. A combination of strep titers, viral panels, Lyme/co-infection testing, and immune function markers are typically used. These tests help paint a full picture of what might be inflaming a patient's brain.
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The Cunningham Panel is a series of blood tests that aid in diagnosis
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 (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) and PANS (Paediatric Acute-Onset Neuropsychiatric Syndrome). PANS and PANDAS are closely related issues that share symptoms and treatment options. The tests are commercially available through Moleculera Labs.
The panel was developed by Dr. Madeleine Cunningham, a strep expert who studied Sydenham's chorea (SC) and other cardiovascular issues involving strep infections. The Cunningham Panel was initially developed to understand how SC, a rare disorder caused by strep bacteria, creates movement issues. Dr. Cunningham's laboratory studies the role of autoimmunity and infection in the pathogenesis of movement and behavioural disorders associated with streptococci.
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 that was possibly triggered by an infection. Test results can provide physicians with laboratory evidence of underlying autoimmune dysfunction. They can also help medical providers determine the appropriate clinical diagnosis and treatment plan.
It is important to note that the Cunningham Panel, like other medical tests, should not be applied in isolation. It is currently used as an aid in diagnosis, rather than as a substitute for careful clinical evaluation. There is growing evidence that in some cases of treatment-resistant symptoms, an undiagnosed immune dysfunction triggered by infections may be the cause.
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The Autoimmune Brain Panel measures autoantibody levels
PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) and PANS (Paediatric Acute-Onset Neuropsychiatric Syndrome) are clinical diagnoses based on signs, symptoms, medical history and laboratory findings that cannot be explained by another medical condition. There is no single blood test or scan that can detect PANDAS or PANS. However, lab tests can help healthcare professionals diagnose and treat PANDAS and PANS.
The Autoimmune Brain Panel™ is a series of five high-complexity blood tests that measure autoantibody levels. Four of these tests measure the levels of autoantibodies directed against specific targets in the brain, including the Dopamine D1 receptor, Dopamine D2 receptor, Lysoganglioside GM1 and Tubulin. Each of these targets is associated with certain neurologic and psychiatric symptoms. 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 neuronal targets included in the Autoimmune Brain Panel™ were selected based upon their biological association with specific neurologic and psychiatric symptoms. An elevated level indicates that symptoms may be due to an infection-driven, autoimmune process. Test results can assist in directing appropriate treatment. Individuals suffering from neurologic and/or psychiatric disorders who have not responded to or whose symptoms worsened on medication may benefit from testing with the Autoimmune Brain Panel™.
In some patients, common infections can trigger an autoimmune reaction, whereby antibodies mistakenly attack healthy tissue in a region of the brain known as the basal ganglia. This attack can cause brain inflammation in that region and disrupt how receptors and cells normally function, leading to the onset of neurologic and psychiatric symptoms. Patients with autoimmune-induced neuropsychiatric disorders often do not respond to standard psychotropic medications and require anti-infective and immunomodulatory treatment to alleviate their symptoms.
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Testing for infections and immune function
PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) are complex conditions with a wide range of symptoms. They are often referred to as neuroimmune conditions and can lead to detrimental changes in brain activity and function. PANDAS is a subset of PANS, and both are clinical diagnoses based on signs, symptoms, medical history, and laboratory findings that cannot be explained by another medical condition.
There is currently no single blood test or scan that can conclusively detect PANS or PANDAS. However, lab tests and imaging can provide additional information to support the diagnosis. The Cunningham Panel, a series of high-complexity blood tests, is often used to aid clinicians in diagnosing PANS and PANDAS. These tests assess autoimmune antibody levels, specifically 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 triggered by an infection.
Other tests that may be considered for PANS and PANDS include:
- Strep culture: A 48-hour culture is recommended as rapid strep tests can miss 15%-20% of infections.
- ASO test: Measures antibodies produced in response to a streptococcal infection.
- Anti-DNase B test: Detects antibodies produced in response to a streptococcal infection.
- IgG, IgM, IgA levels: To look for common variable immune deficiency (CVID) and IgG antibody responses to immunizations.
- CD4 test: Measures a generally over-reactive immune response.
It is important to note that normal test results do not always rule out PANS or PANDAS. A careful medical history, physical examination, and clinical expertise are crucial for making a proper diagnosis.
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Diagnosis based on signs, symptoms, medical history and lab findings
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections) and PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) are clinical diagnoses made by medical professionals based on a patient's symptoms, medical history, and laboratory findings. PANDAS is a subset of PANS, and both disorders can be challenging to diagnose due to their overlapping symptoms with other neuropsychiatric illnesses.
The diagnosis of PANDAS and PANS involves ruling out other known neurological or medical disorders that could explain the patient's symptoms. A thorough medical history, including exposure to illnesses, allergies, diet, and yeast overgrowth, is essential for aiding the diagnosis. In addition, a complete physical and neurological examination is recommended to ensure that the symptoms are not the result of other serious medical conditions, such as rheumatic fever or acute brain infections.
The hallmark trait of PANDAS is the sudden onset of intense anxiety, mood swings, and obsessive-compulsive issues or tics associated with a streptococcal-A (GABHS) infection that occurred prior to the symptoms. PANDAS patients typically have a documented strep infection in the previous months. PANS criteria include a sudden onset of obsessive-compulsive disorder (OCD) or severely restricted food intake, along with additional neuropsychiatric symptoms such as anxiety, emotional lability, depression, irritability, aggression, behavioural regression, and sudden deterioration in school performance. Motor abnormalities, such as dysgraphia, clumsiness, tics, and choreiform movements, are also common in PANS patients.
Laboratory tests, such as the Cunningham Panel, can aid clinicians in diagnosing PANDAS and PANS by assessing autoimmune antibody levels and determining the likelihood of an autoimmune disorder. These tests include assessments of dopamine receptor levels, lysoganglioside GM1, tubulin, and CaM kinase II. While these tests do not provide a definitive diagnosis, they can guide healthcare professionals in the right direction for diagnosis and treatment.
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