PANS: Diagnosis and Treatment

PANS symptoms, including OCD, restrictive eating and other neuropsychiatric symptoms such as irritability, aggression and oppositional behaviors can appear suddenly.

PANS: Diagnosis and Treatment
“PANS, unlike PANDAS, can be triggered by various infections (it is not limited to strep), or the cause may be unknown. It is diagnosed clinically but can be difficult to recognize as symptoms overlap with many other medical conditions. It’s a “diagnosis of exclusion” and requires that other known medical conditions be ruled out.”
The syndrome is characterized by an abrupt, dramatic onset of obsessive-compulsive disorder (OCD) and/or eating restriction with at least two coinciding symptoms, including anxiety, mood dysregulation, irritability, aggression, oppositionality, behavioral regression, cognitive deterioration, sensory or motor abnormalities, or somatic symptoms. 1

“The diagnosis of PANS should be considered whenever symptoms of OCD, eating restrictions or tics start suddenly, and are accompanied by other emotional and behavioral changes, frequent urination, motor abnormalities and/or handwriting changes.” 3

“Early identification and treatment [of PANS/PANDAS] improve the course of illness and its immediate and likely, long-term impact.” 4

PANS is a clinical diagnosis. Whereas, the Cunningham Panel™ of tests can assist clinicians by providing laboratory evidence of an underlying autoimmune dysfunction and helping determine an appropriate treatment regimen.

One study found, “Antineuronal antibodies (lysoganglioside, tubulin, dopamine receptors, CaM kinase II receptor-stimulating) [as measured with the Cunningham Panel™] that react with human basal ganglia have been found in patients with Sydenham chorea, Tourette syndrome, and PANDAS.” 5


PANS: Diagnostic Criteria

To be diagnosed with PANS, a patient must meet the following criteria, as developed by the PANDAS Physicians Network consortium 3:
  1. An abrupt, acute, dramatic onset of obsessive-compulsive disorder or severely restricted food intake

    “Approximately 1 in 5 children with PANS will have restricted intake of specific foods or all food groups, often with observable weight loss…” 3

    “The acuity of symptom onset and age at onset can distinguish PANS-related eating restrictions from more typical anorexia nervosa.” 3

  2. Concurrent presence of additional neuropsychiatric symptoms with similarly severe and acute onset 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

    “The presenting symptoms often change over the first weeks of illness.” 3

  3. Symptoms are not better explained by a known neurologic or medical disorder
  4. No age requirement

    “PANS has no age limitation, but symptoms typically begin during the grade-school years.” 3

PANS: Treatment Guidelines

Treatment guidelines for PANS and PANDAS were published in 2017 in the Journal of Child and Adolescent Psychopharmacology 6,7,8 The guidelines focused on three treatment areas: psychiatric and behavioral interventions, use of immunomodulatory therapies, and treatment and prevention of infections.

PANS/PANDAS treatment begins with identifying and treating any triggering infections, and addressing the immune dysfunction and inflammation with immune-modulating therapies. 4

“The general ‘principles’ used to treat other brain inflammatory diseases (AE [autoimmune encephalitis], NPSLE [neuropsychiatric lupus], etc.) likely apply to PANS (especially those presenting with severe symptoms):

  1. Patients given immunotherapy do better and relapse less frequently than patients given no treatment;
  2. Patients given early treatment do better;
  3. When patients fail first-line therapy, second-line therapy improves outcomes and reduces relapses.” 6

Furthermore, “Immunomodulatory therapy should be considered early, because NSAIDs [non-steroidal anti-inflammatory drugs] or a short course of oral corticosteroids may be sufficient for symptom remission in recent-onset cases, whereas those with long-standing symptoms often require more intensive and prolonged immunotherapeutic interventions.” 6

  1. Frankovich J, Thienemann M, Pearlstein J, Crable A, Brown K, Chang K. Multidisciplinary clinic dedicated to treating youth with pediatric acute-onset neuropsychiatric syndrome: presenting characteristics of the first 47 consecutive patients. J Child Adolesc Psychopharmacol. 2015;25(1):38-47. doi:10.1089/cap.2014.0081
  2. Kiki Chang, Jennifer Frankovich, Michael Cooperstock, Madeleine W. Cunningham, M. Elizabeth Latimer, Tanya K. Murphy, Mark Pasternack, Margo Thienemann, Kyle Williams, Jolan Walter, Susan E. Swedo, and From the PANS Collaborative Consortium. Journal of Child and Adolescent Psychopharmacology.Feb 2015.3-13.
  3. PANDAS Physicians Network (PPN).
  4. Margo Thienemann, MD, Jennifer Frankovich, MD, MS. Sudden Onset of Tics, Tantrums, Hyperactivity, and Emotional Lability: Update on PANS and PANDAS. Psychiatric Times. April 25, 2017.
  5. Cutforth T, Demille MMC, Agalliu I, Agalliu D. CNS autoimmune disease after Streptococcus pyogenes infections: animal models, cellular mechanisms and genetic factors. Future Neurol. 2016;11:63-76.
  6. Margo Thienemann, Tanya Murphy, James Leckman, Richard Shaw, Kyle Williams, Cynthia Kapphahn, Jennifer Frankovich, Daniel Geller, Gail Bernstein, Kiki Chang, Josephine Elia, and Susan Swedo. Journal of Child and Adolescent Psychopharmacology. Sep 2017.566-573.
  7. Jennifer Frankovich, Susan Swedo, Tanya Murphy, Russell C. Dale, Dritan Agalliu, Kyle Williams, Michael Daines, Mady Hornig, Harry Chugani, Terence Sanger, Eyal Muscal, Mark Pasternack, Michael Cooperstock, Hayley Gans, Yujuan Zhang, Madeleine Cunningham, Gail Bernstein, Reuven Bromberg, Theresa Willett, Kayla Brown, Bahare Farhadian, Kiki Chang, Daniel Geller, Joseph Hernandez, Janell Sherr, Richard Shaw, Elizabeth Latimer, James Leckman, Margo Thienemann, and PANS/PANDAS Consortium. Journal of Child and Adolescent Psychopharmacology. Sep 2017.574-593.
  8. Michael S. Cooperstock, Susan E. Swedo, Mark S. Pasternack, Tanya K. Murphy, and for the PANS/PANDAS Consortium. Journal of Child and Adolescent Psychopharmacology. Sep 2017.594-606.
PANDAS targets the basal ganglia region of the brain.

PANS symptoms can be triggered by various infections and is not limited to strep.

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    The Cunningham Panel™ – Antibody testing that helps determine whether an autoimmune response may be triggering neurologic and/or psychiatric symptoms.

B. Robert Mozayeni, MD

Medical and Clinical Advisor

B. Robert Mozayeni MD

Dr. B. Robert Mozayeni was trained in Internal Medicine and Rheumatology at Yale and at NIH. He has had pre- and post-doctoral Fellowships in Molecular Biophysics and Biochemistry at Yale, and also at NIH where he was a Howard Hughes Research Scholar at LMB/DCBD/NCI and later, Senior Staff Fellow at LMMB/NHLBI/NIH. Editorial board of Infectious Diseases – Surveillance, Prevention and Treatment. Past President of the International Lyme and Associated Diseases Society (ILADS).

He is an expert in Translational Medicine, the science and art of advancing medical science safely and efficiently. He is a Fellow of the non-profit Think Lead Innovate Foundation and is a co-founder of the Foundation for the Study of Inflammatory Diseases. He is a Founder of the Foundation for the Study of Inflammatory Diseases to crowd-source medical solutions for complex conditions using existing knowledge, diagnostic methods, and therapies to meet patient needs immediately. He is the Chief Medical Officer of Galaxy Diagnostics, LLC. He is a Board member of the Human-Kind Alliance. Dr. Mozayeni has held admitting privileges (since 1994) on the clinical staff of Suburban Hospital, a member of Johns Hopkins Medicine and an affiliate of the National Institutes of Health Clinical Center.

Safedin Sajo Beqaj, PhD, HCLD, CC (ABB)

Moleculera Labs, Clinical Laboratory Advisor
Medical Database, Inc., President and CEO

Sajo Baqaj, PhD

Dr. Sajo Beqaj is board certified in molecular pathology and genetics and licensed as a Bioanalyst and High Complexity Laboratory Director. He has been practicing as a laboratory director since 2005.

Dr. Beqaj served as a technical director and was part of the initial management team for several well-known laboratories in the clinical lab industry including PathGroup, Nashville, TN; DCL Medical Laboratories, Indianapolis, IN, and Pathology, Inc, Torrance, CA. He is currently serving as off-side CLIA laboratory director for BioCorp Clinical Laboratory, Whittier, CA and Health360 Labs, Garden Grove, CA.

Dr. Beqaj received his Ph.D. in Pathology from Wayne State University Medical School, Detroit, Michigan. He performed his post-doctoral fellowship at Abbott Laboratories from 2001-2003 and with Children’s Hospital and Northwestern University from 2003-2005.

Dr. Beqaj has taught in several academic institutions and has published numerous medical textbook chapters and journal articles. He has served as a principal investigator in clinical trials for several well-known pharmaceutical and diagnostic companies such as Roche HPV Athena, Merck HPV vaccine, BD vaginitis panel, Roche (Vantana) CINtec® Histology clinical trials, and has presented various scientific clinical abstracts and presentations.

He is a member of several medical and scientific associations including the Association of Molecular Pathology, American Association of Clinical Chemistry and the Pan Am Society for Clinical Virology. He has served on a number of clinical laboratory regulatory and scientific committees, and has assisted several laboratories and physicians as a Clinical Laboratory Consultant.

Rodney Cotton, MBA

Moleculera Labs Board Member

Rodney Cotton, MBA

Rodney Cotton, MBA is an entrepreneurial thought leader in the pharmaceutical/biotech industry who is known for his holistic perspective, bias for action in the face of challenges, and commitment to agile processes.

Rod is an independent director for Orchard Software, a private equity-backed health technology company owned by Francisco Partners; an advisory board member to Flo2 Ventures, a venture capital-backed healthcare and health equity accelerator; and a member of the board of directors and three board committees (Audit, Compliance & Finance; Governance & Equity; and Quality of Care) for Community Health Network.

He built a successful career at Roche spanning more than two decades and culminating in the role of SVP, Head of Strategy & Transformation, and Chief of Staff to the CEO for Roche Diagnostics, the North American headquarters of the world’s largest ($17B) diagnostics company.

While at Roche, Rod led key enterprise initiatives, such as milestone corporate communications, health equity coalitions, the US/Roche Group audit, and global/US acquisition integrations. With 40+ years of experience, he drove the financial turnaround and cultural transformation of four global healthcare companies, led teams of up to 280 total reports, managed P&L of more than $1 billion, and served as a key member of the senior leadership team executing the most significant restructuring of the company in two decades.

In the face of the COVID-19 pandemic, Rod and his team at Roche accelerated six ground breaking products in 11 months, including the first launch of the market’s most accurate and in demand molecular diagnostic test. He also solved extraordinary challenges of product scarcity, supply chain, product allocation, and logistics to achieve accelerated global sourcing and self manufacturing in line with testing guidelines.

A frequent public speaker on health equity and other topics, Rod was named one of the Most Influential Black Executives in Corporate America by Savoy Magazine and one of the Top Blacks in Healthcare by He also received The Sagamore of the Wabash Award, one of the highest Indiana State honors, bestowed by Indiana Governor Eric J. Holcomb.

Rod holds an M.B.A. from California State University, Dominguez Hills, an M.S. in Strategic Management from the University of Southern California, and a B.A. in Biological Sciences & Technology from the University of California at Santa Barbara.