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Would you suspect a strep throat infection was to blame if your child suddenly developed OCD, tics, anxiety, and mood swings? Neither would I. But this is exactly what happens in PANDAS.

PANDAS: Coming To A Diagnosis May Be A Long Path

PANDAS is rare, while strep throat is very common indeed. As such, it's important to realize that not every child who displays symptoms of OCD, anxiety, and tics and also has a history of strep throat will have PANDAS by any means. The diagnosis of PANDAS is currently made clinically. That means that, though a throat swap and test for strep is a required part of the diagnostic process and an A strep ASO and D-nase Titer test is often helpful, diagnosis is very much open to interpretation in that there is no test that specifically identifies PANDAS.
In order to qualify for the diagnosis of PANDAS, a very clear connection between strep and the symptoms has to be identified. That means the symptoms develop very soon after the initial infection. 

Not every doctor will have seen PANDAS before, and even those who have may be reluctant to diagnose it even if the symptomatic picture fits. In this day and age, it isn't rare for parents to explore the possible causes of their child's symptoms online. It can happen that you suspect PANDAS before your doctor does. What should you do if your doctor doesn't want to consider the diagnosis of PANDAS, but you are pretty convinced that it is an option? Seeking a second opinion is a good course of action here. Some parents specifically contact the PANDAS Network to look for a doctor who has experience with the syndrome, and you can also look for local doctors who have dealt with PANDAS before via the internet. 

Treating PANDAS

Treatment options depend on whether the strep infection is still present or not. If a strep throat culture comes back positive, the appropriate antibiotics will cure the infection, often allowing symptoms to wane pretty quickly by themselves. Where a throat culture is negative, clinicians should look for occult strep infections, like those present within the sinus. 

If an occult strep infection is present — something that's rare — antibiotics will take longer to work properly. 

Once the strep infection is gone, the neuropsychiatric symptoms associated with PANDAS may still persist. While some parents report that the symptoms of PANDAS improve almost immediately after a course of antibiotics, and others notice a gradual improvement with time, some children continue to suffer with OCD symptoms, tics, and other related behaviors.

Because symptoms may persist, children diagnosed with PANDAS will often benefit from Cognitive Behavioral Therapy to tackle their OCD symptoms. SSRIs may also help here, but the recommendation is to start at low doses due to possible side effects. As for tics, those can be treated medicinally as well. 

Many physicians will recommend that a child previously diagnosed with PANDAS also remains on prophylactic antibiotics for five years after diagnosis, in order to prevent recurrence. 

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