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