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Diagnosis

PANS is a clinical diagnosis, often marked by sudden onset and extreme symptom exacerbations. The diagnostic criteria for PANS include the following:

Criterion Description

I. An abrupt, dramatic onset of obsessive compulsive disorder and/or severely restricted food intake;

II. Concurrent occurrence of additional neuropsychiatric symptoms, with similarly severe and acute onset, from at least two of the following categories:

  • 1. Anxiety
  • 2. Emotional lability and/or depression
  • 3. Irritability, aggression and/or severely oppositional behaviors
  • 4. Behavioral (developmental) regression
  • 5. Deterioration in school performance
  • 6. Sensory or motor abnormalities
  • 7. Somatic signs and symptoms, including sleep disturbances, enuresis, or urinary frequency

III. Symptoms are not readily explained better by a known neurologic or medical disorder, such as Sydenham chorea, systemic lupus erythematosus, or Tourette’s Disorder.

Diagnostic issues

When a child has primarily vocal and motor tics, the symptoms may appear to overlap with symptoms of Tourette’s Syndrome; however, the children can be differentiated by observing symptom exacerbations over time.

In PANDAS/PANS children, a streptococcal infection may coincide with symptom exacerbation and once treated, initial exacerbations may generally remit. The rapid onset with significant remission is characteristic of PANDAS.

Researchers have described chronic PANDAS/PANS where the tics and/or OCD have a much more gradual improving course. These cases are difficult to separate from non-PANDAS/PANS tics or OCD. Some researchers have found other immunologic markers (anti-neuronal and anti-basal-ganglia antibodies) that help separate PANDAS and non-PANDAS children.

 
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