PANS/PANDAS Diagnostic Considerations

Clinical Presentation and Diagnosis

New motor or vocal tics that weren't present before, such as choreiform movements, are key distinguishing features to assess in PANS/PANDAS diagnosis, as stated by the American Heart Association 1
The behavioral changes, such as screaming, crying, tantrums, alone are too nonspecific and could represent normal developmental variation, especially in a child described as "always moody", according to the American Academy of Pediatrics, as published in Pediatrics 2

Obtain anti-streptolysin O (ASO) titer and anti-DNase B titer to document recent strep exposure, with ASO peaking 3-6 weeks after infection and anti-DNase B peaking 6-8 weeks post-infection, as recommended by the American Academy of Family Physicians 3
Throat culture is indicated if the patient still has any throat symptoms, as stated by the American Academy of Family Physicians 4

First-line treatment for confirmed strep infection is antibiotics, such as amoxicillin 50 mg/kg once daily (maximum 1000 mg) for 10 days, as recommended by the American Heart Association 5
The American Heart Association explicitly states that PANDAS "should be considered only as a yet-unproven hypothesis" and recommends against routine laboratory testing for GAS solely to diagnose PANDAS, as well as against long-term antistreptococcal prophylaxis and immunoregulatory therapy (IVIG, plasma exchange) as first-line treatment 1, 5