Pediatric Autoimmune Neuropsychiatric Disorders.

What is PANDAS/PANS?

PANDAS — Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections — refers to a subset of children who develop sudden-onset obsessive-compulsive symptoms, tics, or other neuropsychiatric changes after Group A streptococcal infection. PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a broader clinical category for children with similarly abrupt onset of neuropsychiatric symptoms, which may follow streptococcal infection, other infections, or non-infectious immune-inflammatory triggers.

Immune-mediated mechanisms are suspected in selected patients and recognized in the published clinical literature, but diagnosis requires a careful evaluation that considers infection timing, immune workup, and exclusion of other causes. PANDAS/PANS is a clinical diagnosis — there is no single lab test that confirms it.

What does it look like?

The clinical hallmark is abrupt onset, often over days. Reported features include:

• Sudden-onset obsessive-compulsive symptoms (OCD)
• New tics, sometimes complex or distressing
• Severe anxiety or panic, separation anxiety, or emotional lability
• Food restriction or new sensory aversion to food
• Behavioral regression or developmental backsliding
• Sleep disturbance and insomnia
• Sensory sensitivities
• Urinary urgency, frequency, or new bedwetting
• School decline, handwriting deterioration, and fine-motor changes
• In some patients, an episodic or relapsing-remitting pattern with flares

Why it gets missed

Children with these symptoms are often evaluated only as psychiatric or behavioral cases. Standard psychiatric workups may not include infection timing, immune markers, or recurrent infection history. Families frequently describe being told the symptoms are anxiety, oppositional behavior, or a developmental issue — when in fact the symptom pattern (sudden onset, often after infection) deserves a structured immune-focused evaluation. Equally, not every child with sudden behavioral change has PANDAS/PANS, and overdiagnosis is a real concern. The goal is rigorous evaluation, not labeling.

How Dr. McNeil approaches evaluation

Evaluation is individualized but typically includes:

• A detailed timeline of symptom onset, with attention to recent infections (strep, sinopulmonary, viral)
• Review of throat-culture and rapid-strep history when available; new testing when appropriate
• Streptococcal antibody titers (ASO, anti-DNase B) when appropriate
• Standard immune workup including quantitative immunoglobulins, lymphocyte subsets, and vaccine response history
• Inflammatory markers and screening labs as clinically indicated
• Review of records from neurology, psychiatry, pediatrics, and primary care — with coordination as the evaluation proceeds

Evaluation does not promise a diagnosis. The goal is to clarify whether an immune-mediated process is contributing and, if so, to inform a treatment plan with the rest of the care team.

Treatment approach

Treatment is individualized and depends on what the evaluation finds. Possible components include:

• Treatment of active infection when confirmed
• Antibiotic prophylaxis in selected cases when clinical criteria support it, coordinated with infectious disease and pediatrics
• Anti-inflammatory or immunomodulatory therapy in selected severe or refractory cases, when criteria are met
• Continued psychiatric and behavioral support — CBT, ERP for OCD, and psychiatric medications when appropriate, through the patient's existing mental-health team
• Coordination with neurology, pediatrics, psychiatry, primary care, and school as needed

IVIG, plasmapheresis, and other immunomodulatory therapies are reserved for selected severe or refractory cases when the medical record supports their use. They are not routine, and they are not appropriate for every patient with sudden behavioral change.

Insurance and prior authorization

Dr. McNeil does not accept blanket insurance denials when the medical record supports treatment. For qualified patients, the team pursues the available authorization pathways — including written appeals, peer-to-peer discussions with insurance medical directors, and formal prior authorization review. Some carriers make this process harder than others. The practice continues to advocate for medically appropriate treatment regardless of insurance type.

To be clear: evaluation does not guarantee a diagnosis, and a diagnosis does not guarantee insurance approval for any specific therapy. Treatment decisions are individualized based on clinical findings and supported by objective documentation. Where treatment is appropriate, the team works hard on the patient's behalf.

Treatment pathway at Optimed Immunology

Every patient’s situation is different, but the decision logic for PANDAS/PANS generally follows these steps. This is not a script — it is a structure that gets adapted to each patient’s history, findings, and goals.