Kayanne

You chase it as far as you and your son are comfortable chasing it. It is a very personal decision based on how well the tic is being tolerated and if it is interfering with day-to-day life. I have a PANDAS daughter who mostly has OCD for her symptoms. But her siblings have gotten very mild and transient tics. I've tested for strep at those times and the swabs and titers have been negative. Then I ask them if they care about it, and usually they don't. So I don't pursue it anymore. The worst was last year, my son was blowing into his hands for about a month. It never escalated and gradually decreased. He didn't like getting his blood drawn for strep titers, and I think that was the worst thing about it for him. Their Father also has tics that we only came to be aware of when we learned of PANDAS.

I've personally experienced a bit of this. When I consistently take 1000mg of tyrosine for a few days, I start to get waves of a painic feeling of a religious nature...thinking about going to eternal damnation (the other word was censored). It was a real light switch moment for me to realize how much our neurotransmitters contribute to our responses. I took the tyrosine because it pulls away the gauze curtain from my brain and doing daily tasks becomes easy...that's the best way I can explain it. I also want to point out, that I've been told by my doctor that exercise has been shown to balance neurotransmitters too...although I just took his word for it, and didn't research it. I just wanted to put that out there since the question of balance came up...exercise can be a piece of the puzzle that some may not have considered. Sending best wishes to everyone

Great Idea! How about trying to ask the audience to recall the last time someone jumped out and scared them...and explain that someone with panic disorder can't shut that scared feeling off? I thought about actually scaring the audience, but I'm not sure that would be wise...

:) Great news! I hope you see continued progress!

I'm not a doctor, but wouldn't strep in the basal ganglia be a serious health emergency?

My husband and I were 30 when I had my second child, who is diagnosed with PANDAS. We both have seasonal hay fever. So do all of our children. I believe that my other 3 children have had one or two PANDAS symptoms in the past, but they never seemed to get worse. My husband also has an anxiety/panic disorder, and tics very mildly (which we only realized were tics after learning about PANDAS), has tendencies for having obsessive thoughts and resulting compulsions (but for the most part keeps them in check). Many members of his family are similar. He also has a sister with Juvenile Diabetes. He and a few others in his family also have vitiligo. His father was recently diagnosed with pernicious anemia. Mitral valve regurgitation/prolapse is also common in his family. I believe I have undiagnosed ADD. My sister has diagnosed ADD. My maternal uncle and grandmother both had Rheumatic fever. My Sister's son was in the hospital this summer with myocarditis (he did have elevated strep titers). His sister also had Post-streptococcal glomerulonephritis and has had some intense fears and school refusal as a child (she leans OCDish). My Maternal Aunt has had a couple of episodes of viral infections that caused a real change in her personality. Adult onset diabetes is rampant in my family - My Mother and Brother (definitely-poor lifestyle choices contribute to this). Another Maternal aunt has had colitis that nearly killed her - she was told it was autoimmune. My cousin also has Rheumatic Arthritis. One of my maternal great Aunts has had a few "nervous breakdowns" and needed to be admitted to a psych hospital a couple of times. Whew...it's been a while since I put up family history. I know I've reported all this to Dr. Cunningham (with the exception of the mycarditis and pernicious anemia--which I think is significant, but just haven't had the time to wrap my brain around it.) So, our family history falls right in line with what Dr. Swedo reported - OCD on one side and RF on the other.

It depends on what type of liquid. The concentrated prednisone can't be flavored, but if you read the instructions, you can mix it with a liquid. The only thing that my daughter would take it with was soda. I used sprite or a caffeine free one. Mixing it with apple juice was nasty. Prednisolone, is usually not concentrated and you can add flavorings. My sons have had it a few times for allergy reasons, and they like it. Pedia-pred can also be flavored. This last time, my daughter took the pills, and hated that she could taste them before swallowing. I would suggest asking about getting a switch to a flavored liquid at the pharmacy.

My PANDAS daughter is also thriving. She's not 100%...but the OCD we see would most certainly be considered sub-clinical. She continues to do great in school, is in the gifted program, has friends, and is just an overall amazing girl. She's had 3 exercerbations, each time treated with a monthly taper of prednisone and returned to 100% within about 2 months from stopping the pred (there is a time element here that healing needs) Since 2009, she has continuously been on antibiotics either full-strength or prophylaxis. Sept 2012 was the last time she tested positive for strep with no physical symptoms at all. I took her in to see if I could get titers ordered because the night before we just knew her symptoms were returning. I didn't think she would test positive since she was on 150mg of Omnicef daily. I was very shocked when the doctor said she was positive. Since she's had 2 exacerbations while on prophylaxis, we don't feel it has been effective. In December, in consultation with her pediatrician, we decided to take her off of the antibiotics. She was 100%, but after taking her off, some worry and anxiety came back...but not enough to make us feel she's backsliding. Also, we are finding that keeping with the good vitamins, fish oil and occasional L-tryptophan at night is really helpful. Over the holiday, she started to read "What to do when your brain get stuck," and I think she's really liking the intellectual approach to keeping her OCD in check. I cannot tell you how proud I am that she goes into that school building every day even though she is worried about being sick or someone else getting sick. I agree with Dcmom, treat each exercerbation quickly and aggressively. This is manageable. For some silver lining--my daughter will have skills and empathy that many adults never acquire.

We just gave our daughter 3 doses of Diflucan (150mg) every other day. I don't really think she has any evident yeast issues, but her pediatrician felt it was just better to prescribe it than actually using a scope to check for yeast. It's really just to follow up on the years of anitbiotics...which we also stopped last week. However, we have not done more than tell her to take a few more of her chewable probiotics. So, would you mind sharing your prebiotic and probiotic regimen? I'd like to hear what you did. I think she has a bit of ADD going on right now, but I couldn't tell you if it was from yeast or not...I strongly believe that ADD is in my family.

Was she on a lower prophylactic dose of Keflex? My daughter was taking a lower dose of Omnicef (150mg daily) and she tested positive on the rapid test in September. The ped put her on full strength Omnicef, and when we saw Dr. L again she kept her on that. That did clear her strep. I think Omnicef is a good antibiotic, but be ready to jump if she continues to test positive because - like you already know - it's the same class as keflex. A better option than zithromax is clindamycin. Zithromax has documented strep resistance, but I know many see good results with it. Clindamycin is one of the "go-to" antibiotics for clearing a strep carrier...just wanted to throw that out as an option. Good Luck...crossing my fingers that your daughter doesn't flare!

I like this Therapist's website, although I haven't contacted him: http://overcomeocd.net/rx.html

Personally, I think it's more a case of misdiagnosed autism and not that PANDAS is a treatable form of autism. Is there mention of autism throughout the literature of PANDAS? I know the Hornig paper mentions autism behaviors briefly, but I'm pretty sure most of it has been limited to OCD, TS and the other common co-morbidities. I would love to see the numbers of "autistic" children who participated in the study (I put that in quotes because I believe it is a mis-diagnosis in these cases), and know the numbers of how many are no longer on the spectrum. I hope with all of my heart that all autistic families find relief. I firmly believe that a PANDAS child can look autistic. I saw my daughter go from a perfectly normal, independent 6 year old to a child who couldn't do anything for herself-she even stopped talking. I was afraid to say it at the time (because I'm not an expert and self-diagnosing is not my thing), but later after she recovered, I asked the school if they thought she looked autistic, and her teacher said yes. I'm eternally grateful that this didn't happen at 15mos or 18mos...who knows what would have been her diagnosis? But to classify PANDAS as a treatable form of autism is just not supported in the literature, and crossing that line is going to cause a lot of physicians who are already sitting on the fence waiting for more "evidence" to pull back and have more reservations about PANDAS/PANS. I'm just a lay person, and by no means an expert in medical ethics, but this feels wrong. Especially if you put it in the context of how many autistic families are preyed upon by practitioners of unproven therapies. Publish the proof before you make the claims, or put in on another page (not prominently displayed on the front) that many families anecdotally have found that their children were mis-diagnosed with autism but there have been no studies to prove it yet. I have no problems with that. PANDAS/PANS has come so far, and making claims that are too broad of what it encompasses without the proof, I'm afraid, may derail it.

I'm really confused about that! I asked about that on facebook under the thread that Dr. T started. No response or thoughts from anyone. I absolutely believe that PANDAS/PANS can look like ASD, but personally, I feel it muddies the water on what PANDAS/PANS really is. Also, I'm worried that being too closely aligned or thought of as a "biomedical" treatment for Autism is going to just marginalize PANDAS/PANS even more or just be outright dismissed by a large segment of mainstream doctors. It feels like a marketing ploy. I would just love clarification on it.

I would just like to point out that going to one of the recognized PANDAS specialists does not mean you are going to get the "big expensive treatments" such as IVIG or plasmapheresis. Going to a recognized PANDAS specialists means that your child will be evaluated by that doctor, with strong consideration of a PANDAS/PANS diagnosis. That doctor will hopefully be able to give a reasonable diagnosis and treatment plan based on an exam, patient history, and if needed ordered tests. Missmom, I know that the jist of what you were saying, is that if a parent feels that a more aggressive treatment plan is needed, you are more likely to get that type of support from one of the doctors who routinely sees and recognized PANDAS/PANS, and I know that you have zero intentions of making this sound bad. However, in a way it does. It marginalizes these doctors and characterizes them as automatically willing to perform these treatments...which is not true.