July 11, 2019
Stanford PANS Clinic
The Stanford PANS Clinic was established in 2012 to build a comprehensive program with the goal of orchestrating groundbreaking research while providing tailored care for patients and families....
There are invaluable resources to help clinicians and providers recognize PANS symptoms, do a workup to inform a possible diagnosis and create a treatment plan. ASPIRE has assembled the information below to provide a place to start. Additionally, there are resources throughout the website, including resource articles at the bottom of this page.
PANS Diagnostic Criteria
PANS Consensus Statement on Diagnosing PANS and PANDAS –Clinical Evaluation of Youth with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): Recommendations from the 2013 PANS Consensus Conference. Chang, MD et al (JCAP, Vol 25, No 1, 2015 Mary Ann Liebert, Inc.)
- Abrupt, acute onset of obsessive-compulsive disorder or severely restricted food intake
- Concurrent presence of additional behavioral or neurological symptoms with similarly acute onset and severity from at least 2 of the following categories:
- Anxiety
- Emotional Lability and/or Depression
- Irritability, Aggression, and/or Severe Oppositional Behaviors
- Behavioral (Developmental) Regression
- Sudden Deterioration in School Performance
- Motor or Sensory Abnormalities
- Somatic Signs and Symptoms, including Sleep Disturbances, Enuresis, or Urinary Frequency
- Symptoms are not better explained by a known neurologic or medical disorder
- Age requirement – None
PANS PANDAS Symptoms PANS Consensus Statement
The Diagnostic Process
- Step 1: Review Symptoms, Medical History, Physical Exam
- Step 2: Draw Labs to Understand Infections and Immune System Function
- Step 3: Perform Imaging or Other Testing to Rule Out Other Conditions
More on the PANS Diagnostic Process
The PANDAS Physicians Network (PPN) flowcharts for diagnosis and treatment will help clinicians evaluate their patients and determine the best course of treatment. Guidelines and workflows were approved by practitioners of the PANDAS Physicians Network Scientific Advisory Board. More detailed resources are available at www.pandasppn.org. Diagnosing and treating should be done by a licensed healthcare provider.
Primary care providers play important, ongoing roles in the diagnosis, treatment, and recovery of children with PANS/PANDAS. Children with a moderate or severe/life-threatening onset or a complex presentation may require treatment by an experienced multi-disciplinary team of specialists or a PANS/PANDAS specialist. Additional resources can be found at
PANDAS PPN Seeing Your First Patient
PANDAS PPN Diagnostic Flowchart
New PANDAS Physicians Network Diagnostic Flowchart The diagnostic flowchart and treatment guidelines include a detailed process provided for determining the appropriate diagnosis and symptom severity-based treatment protocols for mild, moderate, and severe/extreme cases.
PANS PANDAS Treatment Guidelines
PANS treatment utilizes three complementary modes of interventions to treat the patient completely. Three-pronged treatment protocols are dependent on disease trajectory, symptoms, and severity as well as lab work and patient history.
- Provide Symptomatic Relief
- Treat Postinfectious Autoimmunity and/or Neuroinflammation
- Treat Source of Infection
JCAP PANS Treatment Guidelines
The PANDAS Physicians Network (PPN) flowcharts for diagnosis and treatment will help clinicians evaluate their patients and determine the best course of treatment. The diagnostic flowchart and treatment guidelines include a detailed process provided for determining the appropriate diagnosis and symptom severity-based treatment protocols for mild, moderate, and severe/extreme cases.
Download PPN Treatment Flowchart
PANDAS PPN Treatment Chart in Detail
ASPIRE PANS PANDAS Toolkits & Resources for Providers
PANS PANDAS Clinician Toolkit
There are invaluable resources to help clinicians learn how to recognize PANS PANDAS symptoms, do a workup to inform a possible diagnosis, and create a treatment plan. ASPIRE has assembled this one-page Clinician Toolkit but there are many resources throughout the website, and we are always adding more. So, check the website often.
Diagnosis & Treatment of PANS PANDAS – Provider Packet
Click the button below to download the twelve-page information packet Provider Information on PANS PANDAS, including Symptoms, Diagnosis, and Treatment.
PANS PANDAS Guidelines for Children with Autism
ASPIRE’S Professional Advisory Board Toolkit:
Testing & Antibiotic Usage for GAS in PANS & PANDAS
ASPIRE’S Professional Advisory Board Toolkit:
PANS/PANDAS Symptoms Tracking & Rating Tools
PANS is a clinical condition identified by an abrupt onset of a specific cluster of symptoms as a result of a variety of etiologies and disease mechanisms. Therefore, tracking symptoms, onset, severity, and duration is a critical part of making a clinical diagnosis and forming treatment plans. There are two useful PANS Symptom Rating Scale tools.
Developed by Tanya Murphy, MD and Gail Bernstein, MD. Source: PANS/PANDAS: CLINICAL & RESEARCH UPDATE, Gail A. Bernstein, M.D., 12/9/16, University of Minnesota
10 THINGS You Should Know
About PANS PANDAS
- Strep throat is NOT the only infectious trigger. Although group A streptococcal (GAS) infections are associated with PANDAS, PANS is a broad-spectrum syndrome that can result from a variety of disease mechanisms and multiple etiologies.
- Acute onset can be preceded by milder episodes. Mild cases have been documented, and symptoms might look like behavioral problems, isolated tics, and sensory issues, among other issues that require awareness on the part of the parent and provider. These children should be clinically evaluated for PANS/PANDAS.
- Tics are not always present. While tics were part of the original PANDAS diagnostic criteria, they are not required for a PANS diagnosis.
- OCD symptoms vary. While the mean age of OCD in children is between the ages of 9 and 10, in children with PANS/PANDAS it can start much earlier. OCD presentation is acute and disruptive to a child’s normal functioning.
- Restrictive eating can be a primary symptom. Some children with PANS/PANDAS present with Avoidant Restrictive Food Intake Disorder without OCD or tics. A child with severe food restriction resulting in dramatic weight loss or who refuses fluid intake should be examined for PANS/PANDAS.
- Children with PANS/PANDAS may experience recurrence of episodes. Some children experience remission of symptoms after treatment with no recurrence, while a portion experience subsequent exacerbation (relapse) incited by a variety of triggers.
- Prevalence is unknown due to poor diagnosis. PANS/PANDAS affects as many as 1 in 200 children each year according to the PANS/PANDAS consortium.
- Scientific studies strongly support PANS/PANDAS diagnosis. Diagnostic guidelines published by the Journal of Child and Adolescent Psychopharmacology (July 2017) and a recent nationwide study in the Netherlands designed to test PANDAS hypothesis demonstrated that individuals with a positive streptococcal test have an increased risk of neuropsychiatric disorders. The study also demonstrated an increased risk with non-streptococcal throat infections.
- Early diagnosis and treatment lead to improved outcomes. According to Dr. Sue Swedo, “preliminary data suggest that with appropriate treatment early in the course of illness, and effective use of antibiotic prophylaxis, we may be able to prevent up to 25%-30% of childhood mental illnesses.”
- Pediatricians CAN diagnose and treat PANS/PANDAS. The 2017 JCAP Treatment Guidelines issued by the PANS Physician Consortium are designed to provide practical clinical guidelines for the management and treatment of children diagnosed with PANS/PANDAS.
Provider Resources: Articles, Brochures, Webinars
Clinician Resources: Articles, Brochures, Webinars
You can scroll through the pages of the Clinician Resources below. However, clicking on the link to the main Clinician Resources page is easier. Otherwise, you will be redirected to the top of this page each time you scroll to a secondary page in the resources.
July 11, 2019
Children’s Post Infectious Autoimmune Encephalopathy (CPAE) Center of Excellence
CPAE was founded in 2017 in collaboration with The University of Arizona and Banner-University Medicine in collaboration with the National Institute of Mental Health (NIMH). CPAE was the first center...
July 11, 2019
Other Multidisciplinary PANS PANDAS Clinics
A number of universities have started multidisciplinary clinics since 2018. These centers are improving access to care and advancing high-quality research. Massachusetts General Hospita University of...