Biological Markers for PANDAS and PANS
Although there is no 100% definitive test for PANDAS/PANS, biological markers can help physicians determine the root cause of your child’s symptoms. Learn more about the various blood tests and biomarkers that may support a PANDAS/PANS diagnosis.
PANDAS/PANS is a clinical diagnosis based on a collection of signs, symptoms, medical history and laboratory findings that cannot be explained by another medical condition. There is no conclusive blood test for PANDAS/PANS, which can make it challenging to get a diagnosis for your child. Every child’s symptoms are unique, and diagnosing PANDAS and PANS relies heavily on symptom presentation. For this reason, parents must diligently research PANDAS/PANS signs and symptoms and work with a healthcare provider who is familiar with treating PANDAS/PANS.
With these disorders, symptoms usually present suddenly and intensely. The most common symptoms among children with confirmed PANDAS/PANS diagnoses include:
Primary symptoms: Sudden onset of OCD-like symptoms and/or sudden onset of eating restrictive disorders.
Plus two of the following ancillary symptoms:
- Emotional lability or depression
- Irritability, aggression or severely oppositional behaviors
- Behavioral (developmental) regression
- Deterioration in school performance
- Sensory or motor abnormalities
- Somatic signs and symptoms, including sleep disturbances, enuresis or urinary frequency
As a parent, you can help confirm your child’s diagnosis by monitoring your child’s symptoms and comparing them to our PANDAS symptoms checklist. With an experienced medical provider, you can review your child’s medical history, lab findings and symptoms to discuss a possible PANDAS diagnosis.
When equipped with the right knowledge and resources, parents can feel empowered to make informed health decisions for their children. Learn more about PANDAS/PANS and how they affect the body if you think your child may be suffering from one of these disorders.
PANDAS and PANS are clinical diagnoses with a particular set of criteria. PANDAS patients experience a sudden and debilitating onset of intense anxiety and obsessive-compulsive tics, with a documented strep infection in the previous months. Take a closer look at the criteria for a PANDAS or PANS diagnosis on our website.
Currently, there is no single blood test that detects PANDAS or PANS. However, lab tests can guide healthcare professionals in the right direction for diagnosing and treating your child’s condition.
If you suspect your child has PANDAS/PANS, then lab testing, in addition to completing the symptoms checklist, can help your healthcare provider make a proper diagnosis. An initial diagnostic workup for your child may include:
- Basic blood work, such as IgA, IgM, IgG, B12 and vitamin D.
- Viral/bacterial testing, such as a strep throat culture, antistreptolysin O (ASO), and testing for Lyme disease and coinfections.
- Additional testing, such as the Cunningham Panel.
Parents can access a printable PDF of basic blood work for PANDAS on our website.
The Cunningham Panel is a unique series of high-complexity blood tests that aid clinicians in diagnosing infection-triggered autoimmune neuropsychiatric syndromes such as PANDAS/PANS.
Dr. Madeleine Cunningham is a strep expert who studied Sydenham’s chorea (SC) and other cardiovascular issues involving strep. The Cunningham Panel was initially developed to understand how SC created movement issues, as SC is a rare disorder initiated by strep bacteria and is not commonly studied. Dr. Cunningham’s laboratory studies the role of autoimmunity and infection in the pathogenesis of movement and behavioral disorders associated with streptococci, including SC, the neurologic manifestation of rheumatic fever and pediatric autoimmune neurologic disorder associated with streptococci (PANDAS).
The Cunningham Panel consists of five individual tests that assess autoimmune antibody levels. These tests are for the dopamine D1 receptor, dopamine D2L receptor, lysoganglioside GM1, tubulin and CaM kinase II. Elevated levels on one or more of these tests indicate that a child’s neuropsychiatric symptoms may be due to a treatable autoimmune disorder that was possibly triggered by an infection.1
Your child may receive help with PANDAS treatment from immunologists if the results of the Cunningham Panel indicate PANDAS-like antibody levels. The tests are commercially available by Moleculera Labs.
What do doctors look for in PANDAS testing?
Test results can provide physicians with laboratory evidence of underlying autoimmune dysfunction. They can also help medical providers determine your child’s appropriate clinical diagnosis and treatment plan.
In metabolic tests like the Cunningham Panel, physicians look for individual test results that exceed their normal ranges. If one or more test values are elevated, it may indicate a clinically significant autoimmune neurological condition.
Lab results can provide explanations for some of the symptoms your child may be experiencing. Elevated levels in these test results correlate with neuropsychiatric symptoms, according to patient research:
- Patients with high anti-dopamine D1 antibodies often report having psychiatric symptoms such as OCD behaviors and tics.
- Those with elevated anti-dopamine D2L antibodies report symptoms such as hyperactivity, impulsivity and other uncontrolled motor movements.
- Patients with elevated anti-lysoganglioside-GM1 antibodies often report obsessions/compulsions, sleep disturbances and aggression.
- Those with elevated anti-tubulin levels experience brain fog, OCD-like symptoms and cognitive impairment.
- Patients with elevated CaM kinase II levels report having involuntary movements, cognitive interference, emotional lability and other neuropsychiatric symptoms.
Although there is no specific biological marker for PANDAS/PANS, a combination of lab tests can help physicians reliably diagnose this disorder. Doctors will look for abnormalities in these tests, with more positive results meaning a higher likelihood of a diagnosis.
What blood test is done for PANDAS?
Blood work can serve as a helpful diagnostic tool for PANDAS/PANS. Biological markers provide additional evidence to physicians looking to confirm a PANDAS diagnosis. Doctors may conduct blood work and other in-office tests to assess your child’s condition. A total basic blood workup may include IgE, IgA, IgM and IgG antibodies, antinuclear antibodies (ANA), a complete blood count (CBC), ferritin (iron), B12 and vitamin D.
In addition to basic blood work, your provider needs to conduct in-office viral and bacterial testing for strep throat. If your child tests positive, your healthcare provider can quickly start a treatment plan before the onset of symptoms. Some children with PANDAS can even react to exposure to strep. For this reason, testing all family members is important to ensure no one is an asymptomatic strep carrier.
Not all people who have strep will have a rise in strep titers, according to recent research. If your child or a family member tests positive for strep, schedule a follow-up strep test two weeks after finishing all antibiotics to minimize the chance of reinfection.
Getting a PANDAS/PANS diagnosis for your child can mean navigating a lot of complexities. Ease the burden of a stressful process by working with a healthcare provider who is familiar with PANDAS/PANS. Find help near you by visiting our directory of U.S. healthcare professionals.
What To Do After a PANDAS Diagnosis
You’ve vigorously researched, met with a qualified healthcare professional, and your child completed their initial diagnostic workup. Your doctor mentioned that some of the blood work came back with a few abnormalities. Based on this, along with your child’s symptoms, they feel confident in making a PANDAS diagnosis—now what?
Now, it’s time to focus on evaluating the best PANDAS treatment options for your child. For specific action items on navigating the next step of your PANDAS journey, read our blog post on what to do after a PANDAS diagnosis.
Whether you are searching for a healthcare provider or your child was recently diagnosed with PANDAS or PANS, remember that we have resources to support you on every step of your journey. Check out our U.S. and international support groups to connect with other PANDAS families in your community and learn from their experiences.