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Check for bartonella! Lymes co-infection. Our son raged and OCD out of no where. If he is young it could be he is entering puberty and that can rock their world as well. For us it was three long years and the fear is always there. We cleaned up his diet and gave supplements based on organic urine test and 23 n me test. Best thing I ever did!! His ups and downs now are mild compared to before (no soy, dairy or gluten) He tells us his brain is calm now. We found that he was depleted of B1 and B2 as well by the test results. I thought big deal when I heard that but big change once we started to supplement. Our immunologist claims that these children have innate immune response to various triggers depending n their genetic predisposition. This causes inflammation and the mental symptoms are a response to that inflammation.

Clearly, you'd want to look for infections. I'd set up an appt with your pandas doc (or whoever; really, any doc who will do it) to run some bloodwork ASAP, both for infections and immune system stuff, IgG levels and so forth. In the meantime, I'd haul the kid off to the nearest urgent care for a swab and throat culture today. It seems to me that this sort of situation is to be expected with PANS/PANDAS.

Perhaps he has a new infection.

Vittorio, Sono una mamma Italiana che vive in America. Non ho ancora avuto una diagnosi ufficiale, ma la mia bambina di 6 anni sembra appartenere alle caratteristiche PANDAS (tic improvvisi + Infezione da streptococco). Non ho ancora abbastanza informazione da condividere (i sintomi sono cominciati recentemente), ma se hai bisogno di aiuto con supplementi, traduzioni, o qualsiasi altra informazione che non puoi reperire in Italia, sono a tua disposizione.