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PANS/PANDAS: Lab Testing

The current standard for diagnosing PANS/PANDAS is a clinical diagnosis. We encourage clinicians to refer to the PPN diagnostic flowchart for guidance in evaluating patients. The diagnostic flowchart includes information on symptomatology, presentation, and lab test considerations.

To add to a clinical evaluation, clinicians may utilize a list of laboratory tests to help determine an infectious trigger, rule out other diagnoses, and aid in the development of a treatment plan. The laboratory workup list was developed from testing recommendations published in the PANS Research Consortium guidelines found in the Journal of Child and Adolescent Psychopharmacology. It is not a complete compilation of available or future testing a clinician may consider, nor are the tests conclusive of ruling in or ruling out PANS/PANDAS. This list will be updated on a regular basis. For additional guidance in diagnosing and treating PANS and PANDAS, please refer to the PPN diagnostic flowchart and the PPN treatment chart.

Initial testing

  1. Strep A rapid test and throat culture
    1. If negative, check ASO and AntiD-Nase-B
  2. CBC with differential to check for other infections
  3. Urinalysis to assess hydration and rule out UTI when urinary complaints are present
  4. Rule out other neurologic or medical disorders.

Additional considerations depending on presentation and symptom severity:

  1. Perianal strep swab, if indicated
  2. ENT referral for tonsil and adenoid evaluation
  3. Swallowing studies might be indicated for children with restricted food intake
    1. Particularly when related to fears of choking or vomiting
  4. Quantitative immunoglobins (IgG, IgA, IgM, IgE) with IgG subclasses
  5. Anti-nuclear antibodies
  6. The Autoimmune Brain Panel™ by Moleculera Biosciences, Inc.