Even now, you may encounter ignorance from your own pediatrician or family medical Clinician. If you need help, we have shared
the medical research supporting PANS and PANDAS as a clinical reality.
Now that we’ve gotten the word out about the signs and symptoms of PANS and PANDAS, we’ve decided to address one of the most common questions that we get about diagnosing these disorders:
What tests should be performed to confirm a diagnosis of PANS or PANDAS?
It’s a question we receive not only from parents of PANS/PANDAS patients, but also from other physicians who have just begun seeing these children.
Making a PANS/PANDAS Diagnosis
The simplest (and most correct) answer to the question of what lab or imaging abnormalities are required to make the diagnoses of PANS or PANDAS is “none.”
A correct diagnosis of PANS or PANDAS can be made based solely upon behavioral changes and neurologic signs identified during a careful, thorough history and physical exam by a PANS/PANDAS specialist.
You may have been told by a physician new at treating PANS and PANDAS that a negative or normal test (like a strep culture, ASO test, or Cunningham panel, for example) rules out PANS and PANDAS – nothing could be further from the truth! Testing may support the diagnosis of PANS or PANDAS, but it is not absolutely required.
Secondly, every patient requires a hands-on physical examination by a physician well-versed in PANS and PANDAS to ensure the symptoms are not the result of other serious medical conditions, including rheumatic fever or acute brain infections. We want to emphasize that taking a very careful history in these cases is the key to diagnosis.
However, we also understand that labs and imaging are of value and can help offer additional information for PANS/PANDAS patients. We want to do everything we can to help remove the confusion and frustration felt by parents of children with PANS and PANDAS.
Below is a comprehensive list of the tests we most often recommend. Please keep in mind that your child is extremely unlikely to need all of these, and again, technically none of them are required for the initial diagnosis.
If you need more information about any of these tests, including why they might be required, how they are administered, and what results we typically look for, please download our free guide, What You Need to Know about Testing in PANS and PANDAS .
It offers an expanded version of this article with 16 pages of detailed help, and you can download it now by entering your name and email address below. (We will never sell or share your information, and we will only contact you with helpful medical insights and research.)
Common PANS/PANDAS Testing
Testing for Strep infection
Rapid Strep Antigen Testing
Nucleic acid amplification tests (NAATs)
ASO and anti-DNase B titers
Testing for Other Infections
Lyme Disease with CLIA certified labs sensitive enough to detect multiple Borrelia species
Antibody testing (IgG and IgM) for Bartonella, Babesia, and Ehrlichia
Antibody testing (IgG and IgM) for Epstein Barr Virus (EBV)
PCR testing for EBV
Antibody testing (IgG and IgM) for Coxsackie virus
Human herpesvirus 6
HSV1 and 2 antibodies
Antibody testing (IgG, IgA, and IgM) for Candida
Stool study to look for high levels of Candida
Testing the Immune Response
IgG, IgM, IgA levels with IgG and IgA subclasses to look for common variable immune deficiency (CVID)
IgG antibody responses to immunizations; if a child has been immunized and has not made antibodies, they may have what is called a “specific antibody deficiency,” commonly seen in children with PANS and PANDAS.
Antinuclear antibody (ANA) testing
Glutamic Acid Decarboxylase (GAD-65) antibodies
Other Laboratory Testing
Complete blood count (CBC)
Heavy metal testing
Urine mycotoxin tests to look for a history of exposure to mold
EEG Testing and Brain Imaging
MRI of the brain
PET scanning and SPECT scanning
We hope you have found this information helpful. Once again, please remember that PANS and PANDAS are diagnosed clinically. Testing should be used to support the clinical diagnosis, make sure nothing else is causing these symptoms, and identify specific causes to help focus your child’s treatment.
We have both the academic knowledge and clinical experience to solve this medical mystery and help you find your child again. If you would like your child to be seen in our Carmel, Indiana, practice by Dr. Scott Antoine or want to find out more about our comprehensive online program, Defeating PANS and PANDAS , please call our office at (317) 989-8463 or see Becoming a Patient .
Sources Strep: https://www.cochrane.org/CD010502/ARI_what-performance-rapid-tests-diagnosis-strep-throat-children
Lyme and other tick-borne infections: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3292400/
Epstein Barr Virus: