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What are the symptoms of PANS/PANDAS?

The acute and dramatic onset of mood and behavioral changes are red flags of possible PANS and PANDAS.

The symptoms of PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) include an acute onset of:

  • OCD and/or
  • Restrictive Eating Disorder
  • PLUS additional symptoms from at least 2 of the following categories:
    • Anxiety and/or separation anxiety
    • Emotional lability and/or depression
    • Irritability, aggression, and/or severe oppositional behaviors
    • Behavioral regression
    • Deterioration in school performance
    • Sensory or motor abnormalities (including tics)
    • Somatic signs and symptoms, including sleep disturbances or urinary frequency

PANS is thought to be an immune reaction to a number of physiological stressors including Group A Streptococcal infection, Mycoplasma pneumonia infection, influenza, upper respiratory infections, sinusitis, Lyme, and psychosocial stresses. PANS has no age limitation. Learn more about PANS at https://www.pandasppn.org/pans.

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) is a subset of PANS. PANDAS has five distinct criteria for diagnosis, including:

  • Abrupt OCD or dramatic, disabling tics
  • A relapsing-remitting, episodic symptom course
  • Young age at onset (average of 6–7 years)
  • Presence of neurologic abnormalities
  • Temporal association between symptom onset and Group A strep infection

The 5 criteria usually are accompanied by similar comorbid symptoms as found in PANS. Learn more about PANDAS at https://www.pandasppn.org/pandas.


Is PANS/PANDAS the same as childhood OCD?
Why does the diagnosis matter?

PANS/PANDAS may be considered a form of Basal Ganglia Autoimmune Encephalitis. The presentation of PANS/PANDAS varies from traditional childhood OCD, and it has different treatment options. View the comparison chart to learn how PANS/PANDAS  differs from traditional childhood OCD.

I suspect PANS/PANDAS.
What are the next steps?

Familiarize yourself with the PANS/PANDAS flowcharts.

The flowcharts for diagnosing and treating PANS and PANDAS walk you through evaluating patients for possible PANS/PANDAS then guides you through treatment considerations based on symptom severity.

Review Seeing Your First Child with PANDAS/PANS.

“Seeing Your First Child with PANDAS/PANS” is a medical guide consisting of: overview and current theories, PANDAS/PANS symptoms and diagnostic criteria, workup recommendations, and expectations.

Read the PANS Research Consortium papers.

The consensus paper and management recommendations include details on PANS/PANDAS treatment options including antibiotics to remove the source of inflammation (streptococcus or another infection), anti-inflammatories, IVIG, behavioral therapies, and more.

Access the PPN Practitioner Directory.

Primary care providers can diagnose PANS/PANDAS and implement the majority of treatments. If you need help finding a doctor or medical professional familiar with PANS/PANDAS, visit the PPN Practitioner Directory. Practitioners can request to be listed in the directory by becoming a member of the PPN.