Diagnostic Tests

At this time, there are no commerically available tests for diagnosing PANDAS. Research currently indicates there are differences in specific antibodies that can be tested in blood serum. [Kirvan2006] [Church2006][Martono2007].  Additional research funding is needed to repeat the experiments at independent laboratories and confirm the diagnostic effectiveness.

A throat culture for Group A Beta-Hemolytic streptococcus (GABHS) at time of exacerbation onset is recommended to diagnose a pharyngeal streptococcal infection [Swedo2004]. If the culture is negative, a blood test may be able to test for streptococcal exotoxins. A common blood test is Anti-Streptolycin O (ASO titer test) and the Anti D-NaseB titer test. While these tests can confirm a current or recent strep infection, they cannot exclude a prior infection or a diagnosis of PANDAS. This test is affected by many factors and in one study over 46% of children did not have a rising ASO titer despite having colonized strep [Shet2003].

For children affected by PANDAS, a GABHS infection is considered to be the triggering event that causes an initial episode. However, as is the case with Sydenham’s Chorea, subsequent PANDAS exacerbations may be triggered by recurrent GABHS, or by other bacterial or viral infections (ear infections, sinusitis, pneumonia, meningitis, impetigo) further complicating diagnosis [Swedo1998].

Other considerations

Other autoimmune illnesses that may cause sudden onset OCD and other neuropsychiatric disorders include: Lyme Disease, Thyroid Disease, Celiac Disease, Lupus, Sydenham Chorea, Kawasaki’s disease, and acute Rheumatic Fever [Schneider2002]. Some children have been found to have Immunology challenges such as IgG subclass deficiencies. Children will need to be evaluated for this issue by an immunologist. In addition, while there is good evidence of anti-neuronal antibodies in PANDAS, the diagnosis remain controversial primarily due to the observations by Johns Hopkins researchers who have not been able to detect such antibodies in their research subjects [Martono2007].