How do health care professionals diagnose PANDAS?

PANDAS is diagnosed clinically. That means that it depends more on history and physical examination rather than other specific studies. The following summarizes the five criteria used to diagnose PANDAS:

Presence of obsessive-compulsive disorder (OCD) and/or a tic disorder, ADHD symptoms, or oppositional behaviors Abrupt onset and/or symptoms vary in intensity Association with neurological abnormalities, including motor hyperactivity, or abnormal movements, such as choreiform movements (involuntary jerky movements), other combinations of neuropsychiatric symptoms, such as anxiety, emotional lability, bedwetting, or other regressive behaviors (temper tantrums), personality changes and deterioration in math skills and handwriting Onset of symptoms from age 3 years to puberty Association with group A beta-hemolytic streptococcal infection (the bacteria that causes strep throat) either by culture or other evidence of infection, such as scarlet fever or by laboratory test evidence

As mentioned above, there are five criteria used to diagnose the disorder and must include the sudden onset of OCD, tics, ADHD, or a rapid worsening of existing symptoms. To make the diagnosis, one also needs evidence of a recent or active strep infection either by throat culture or by antibody testing for Streptococcus (for example, antistreptolysin O or antideoxyribonuclease B antibodies). A onetime measurement of antibodies is not sufficient for the diagnosis; these antibodies should be measured at two different times (four to six weeks apart) to detect a rise in levels. Along with the clinical diagnosis, it is important to be sure that there is not some other reason for the symptoms, and additional testing might be performed for that reason. In fact, distinguishing PANDAS from Tourette's syndrome (a common tic disorder), OCD, or Sydenham chorea (a movement disorder associated with rheumatic fever also caused by Streptococcus) is not always a simple task.