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Our son had many,many of the same symptoms that you describe with your child. It was awful and I feel like he had these symptoms from about 4 years old. He is 9 now. It has been very hard on everyone, especially him, I can only imagine. We are 1 month post IVIG and I have my sweet, creative, fun, kind son back. I am not exaggerating. Emotional lability, aggressive, mean and oppositional behavior is gone. Insomnia and bed wetting and wetting his pants is gone. Tics are 90% gone, as is hyperactivity. If you have not tried IVIG, I highly recommend it and hope that it will help you as much as it has us. It is also part of the pans consortium guidelines released this year. Good Luck

PANS can be trigger by chronic Lyme and co-infections. Are you still treating for Lyme? Did you treat for any other co-infections? We have three children, all gestational Lyme and have been treating ongoing for last seven years. Our older son was a clear PANS child. Strep, MMR and virus all within three week period woke up a different child at 5 1/2 years old. Younger twins had ASD and Asperger's presentation at 2 1/2 years old. They are now 10, 10 and 13 years old. You would never know of their prior diagnoses. All are living normal lives. Even our DD's learning disabilities have reversed. Eye sight improved, etc. etc. etc. They have had tons of intervention but are well. I would encourage you to revisit the chronic Lyme et al component to resolve PANS