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Hi Fixit, We started the antibiotic route 5.5 years ago - I took any research I could find about antibiotics. They worked well with my son - he would do a 10 day course, symptoms would decrease then we would stop the antibiotics and symptoms would all come back. Paed was not comfortable with long term use unless I got the ok from ID clinic. They gave the ok based on how well he was doing when on them and how he would decline when off them. Neurologist agreed that antibiotics were the route to go based on how well he was doing. She saw no need for other kinds of meds. They are recommending he stay on them until he is 18. We used to go every few months for follow up (at the beginning - then every 6 months then once a year) Last year when we went they suggested that instead of coming in the following year they would just call and check in and see if we needed to have an appointment. We are very lucky - our paed is the one who prescribes them now based on the ID clinics recommendations. I also have a prescription that says every 5 days or as directed which allows me to do full doses when I see fit. I get a new prescription about once a year. I worked hard early on to convince them of the need for long term antibiotics.

My son has been on antibiotics for 5.5 years.

I believe it was Streptococcus thermophilus. Not 100% sure - as cannot remember the brand we used to use so I was not able to google an ingredient list - it was a few years ago. Whatever it was it had the word strep in it.

We just use a plain old acidophilus now. We used to use a probiotic that did have the strep ingredient in it - we did not realize it until later - Ronna had told me her son was not doing great on the probiotics so we tried taking our son off them and he leveled out even more - so when we added it back in we just use the acidophilus to be safe. I keep meaning to go and look for a good probiotic but he has been doing ok with what he has. We ran out a few weeks ago so he has been without - the other day I gave him one of the chewable one's my younger two take. For dosage - yes we give 500mg on one day then 5 days later give another 500mg etc. nothing in between. When we do a full dose run we used to do 1 day at 500 mg then 4 more days at 250 mg. We found that was not always long enough so started to do a 10 day run - 500mg on day one then 250 for the next 9 days. We do just ride out minor tics - we did not want to put him on extra antibiotics unless really necessary. (I had taken a paper in to my doctors about azith - the recommended dose was once every 7 days which is what we had started with but found we had tics leading up do day 7 - so every 5 days worked better (as it did with Ronna's son too). The only antibiotic we have used since the summer he turned 8 is azithromycin. The first two years he was on several antibitoics - biaxin for about 6 months (full dose daily) then amoxicillin for almost 1.5years (prophylactic dose) - then we tried taking him off antibiotics and it was a disaster - all tics came back and he was not doing well at all. Amox no longer worked when we put him back on it - then we tried 5-6 different antibiotics alone and in combo over a period of about 6 weeks. Then azith a week before school was starting - what a miracle.

Hi Angela, No - when tics return for short periods of time I don't see it as the antibiotic not working - we still had ups and downs for many years - there were always other factors - we found anything that bothered his immune system could cause a tic to emerge, be it being overtired, coming down with a cold, raining (molds), seasonal allergies, and most recently we find growth spurts. I think the antibiotics just help keep things leveled out a bit - the immuno modulating effect of the azith I think is key - I used to always talk about the bucket theory. Their immune system is like a bucket that can fill up so much before it overflows - an illness is like a hole being nailed in the bucket - so it leaks right away - the other stuff - allergies - food, environmental etc also fill the bucket and can make it overflow. We found when tics emerged due to other issues - we would become very strict again with food/tv watching etc - all other known triggers to try to empty his bucket a bit. It is when tics get quite bad and the antibiotics are not making a dent that I think it is time to try another antibiotic. We have been on azith for 3 years and he certainly has tics in that time and at no time have I considered taking him off the azith and trying something new. I used to hope that antibiotics would just make it all go away and we would be done with PANDAS and tics - but that did not happen for us - it was a slow process but worth the journey. The antibiotics have been a crucial part of his treatment but so has all the other stuff that we did and still do. (still no gameboys etc and we still limit watching tv and florescent lights still bother him - but not nearly as badly as they used to - he would almost convulse when we went into stores with lighting - it was pretty shocking.) I am assuming you are having her take probiotics (I didn't early on - had never heard of them back then!) Yeast could be an issue if you are on a full round of antibiotics.

Hi Trg, He does not have attention problems now - but when he was first sick he did - not ADHD but just not as able to focus - when he was sick his handwriting would start to go backwards - he could not get as much work done. His issues were more emotional lability - he was hard on himself, was up and down with us at home - those issues all improved on antibiotics. His biggest most troubling symptoms were the tics. At school he was not a behavioural kid - the school did not have any concerns about him academically or behaviourally. The tics were really our main focus.

Hi Kim!!! Thanks for the info on the option button - I have reset it...may just pop in more - I found it so frustrating to read the posts by having to click on each one. My PANDAS son was a picky eater - he ate only ketchup sandwiches for many many months - wonder bread and ketchup! He will try anything now and likes most things. My younger two are terrible. My middle one has had lots of GI issues which has been more our focus over the last couple years - one crisis ends and another begins....anyway he is also getting better and now just starting to try a few new foods. He had a fingernail size piece of cheese at lunch today and it was a victory!!!! I feel since he started on the supplements (he just learned how to swallow pills - previously all I could get into him were flinstones vitamins) he has a sparkle in his eye that has been missing for many years. He is smiling so much more. I am convinced he has been just malnourished. The supplements he is on with hope are going to stimulate his appetite (zinc). He is tiny for his age - and has been borderline failure to thrive (he is almost 9). I feel like we are onto something with these vitamins - he is much happier, outgoing, etc since starting them a few weeks ago. You are right, lots of company here for PANDAS parents now....back then it was just Ronna and I! Thank goodness I had Ronna....Ronna had no one! I was a super picky eater...did not eat vegetables until I was in university. Also would not try new things etc. I am still somewhat picky - won't try most fish - have decided I don't like it without trying it...so my kids do come by it honestly. I do eat much better now though - most vegetables I eat - many only if they are in a soup. I was not as fussy as my kids though - my middle one does not like pizza, pasta, hotdogs, hamburgers, any meat (except one particular chicken nugget), vegetables and most fruits. He eats about 5-6 things and that is it. (mostly dry cereals, dry crackers, dry breads). I have tried juicing, baking with veggies etc - I just try to sneak stuff in wherever I can - mostly in baking - spinach brownies....etc. Amazing how much older our kids are now....13 wow!

Wow - that is a great article to share with doctors - we are passed the point of needing it - but at the beginning (2004) I was begging for this kind of intervention. We did consider going to the states for it. Our doctors said it was too risky for him - as he was doing ok on antibiotics - doing ok is all relative - he was not back to himself which is what I wanted - I did not feel "good enough" was an acceptable outcome.

Hi Faith, I remember you too! I did not keep in touch with Claire - with hope no news from her is also good news! Her son had been doing really well when she signed off - he was a few years older than my son. My son has been on 500mg every 5 days. Yes - antibiotics has been the only medical treatment - no steroids etc. We did remove the foods and added supplements initially which for sure helped. We became very lax with the vitamins when he was getting better - he started not wanting to swallow the 15 pills I would put in front of him through the day so I let it go. We do still do probiotics - but even then I ran out a few weeks ago and have not picked any up - so all in all we are pretty laid back about things now. I just was looking for a good multi for my two non eaters (my PANDAS son eats amazing now!) and came across kirkman vitamins and found one that had lots of the supplements I used to give my PANDAS son and thought I would try them - it is only a few pills a day and all come from the same container - so it seems less daunting. I am hoping it just keeps him leveled out as he goes through his growth spurts (he is so tall! a head above most in his class!). Colleen - our son is on a lower dose than your kids - our doc at the ID clinic has not expressed any concerns about staying on until 18 at the dose he is on - of course there are risks to long terms antibiotics but the risks outweigh the benefits at this point. Azith has truly been a miracle drug. Azith started working within 24 hours - he was in bad shape when we started it - meaning tics every 5 seconds probably. I said a little prayer and gave him the pill before bed. When he woke up the tics were spread out a bit more, this continued and on day 3 things were getting much better. We stayed on for 15 days I think (long time ago) and he was pretty much tic free by then - then we went to every 7 days - but found he would tic leading up on the 5, 6, 7 days - it was Ronna who said her son was on every 5 days - so we tried that and things were better. Again - it was up and down for a while - but the spikes were less and less. Eventually he just leveled out. We used to have to do a 10 day run about every 2-3 months. We actually did one in September as his eyes were really bugging him (we think it was more the lights at school - which they have removed some and moved his seat - things have got better since then - so we expect it was the antibiotics in combo with lighting changes). The last time we did a full run was probably last January - so he had gone 9 months without any need for a full run. During that time he had got sick a few times but tics were not an issue.

Hi All, I used to post here many years ago....it was here where I found so much help, support, etc. Chemar, Claire, Kim, Mustang Carol, and Ronna along with many others helped me find my way during very dark times. I do still check in every once and a while (but I find the new format of threads difficult to follow - I much preferred the old way!). There is also so much more discussion about IVIG etc which was not discussed too much back then - I did ask our doctors about it and they would not even consider it in Canada at the time, same with the steroid boosts. There also seems to be more focus on OCD on the posts I read.... tics were the big issues for us. My son was diagnosed at 6 with PANDAS (almost 6 years ago) after a sudden (overnight) and SEVERE onset of simple and complex motor and vocal tics (tics by the second) - along with personality change, emotional lability, separation anxiety....etc.....we also discovered he had become photosensitive so lighting and tv became big triggers. It was a very difficult time, antibiotics helped but did not bring him back to the way he was pre-PANDAS. We also did lots of vitamins/supplements and removed many foods based on testing. There was little info out there - but I searched all I could and would go to my doctors with info from sites like this. Fast forward....my son is now 11 - he is a joy, he has been on azith since he was about 9 (after trying to go off amox and do a trial of no antibiotics - which was a disaster) - it then took about 6 tries with different antibiotics and combos of antibiotics - then I read about azith and begged for it - I was told it was the last one they would try...it was a miracle! In the last year he has started to get sick the way normal kids get sick, fevers, chills etc - no longer is illness presented with an increase in tics. He is a competitive hockey player - plays 4-5 times a week, and does well in most sports. He also does well in school and no one would know he has anything wrong with him. He does still have tics (only eye ones) but they are quite subtle, I notice them all but others don't. I recently started him on some vitamins from Kirkmanlabs - as I was feeling like his eyes were ticcing more - and he is at an age where this could affect him socially - I am sure it is because he is going through puberty....the vitamins seem to have settled things down. Our plan is to keep him on azith until he is 18. His diet is much more lax now - he has wheat and is allowed dairy at parties etc. At home we just drink almond milk. I am still in touch with Ronna and I am sure she would not mind me updating that her son is tic free, he is 2 years older than my son. Her story was most like mine (he too is on azith). I hope to give others hope that these kids do get better. 5 years may seem a long time to wait, but the progress has been slow and steady - each month a little better than the month before - we have had a few blips over the years - but nothing significant for the last 2 years. Every once and a while we do a full round of antibiotics if tics emerge due to illness and don't settle down on their own. Again, these tics are minimal - not complex and not vocal. I remember the months of squeaks, coughs, sniffs etc - they would drive me crazy - I would know the minute he was asleep as the house would become silent. Anyway....just wanted to touch base and give others hope. I always wondered what happened to other posters kids - I hoped the fact they were no longer posting meant they were no longer in a crisis and their kids had got better. This is the case for us. Wishing all of you mom's and dad's much happiness and love over the holiday season. I think back and my only regret is probably not enjoying school concerts etc as all I was focusing on was my son's tics....if only I had known they would eventually all go away. I hope this gives at least one of you hope....

My son had his tonsils out at 2 after chronic infections. He had no tics at that time. He was diagnosed with PANDAS 4 years later after a sudden onset of tics.

I am so sorry your family is going through this. What antibiotics has your daughter been on to treat the strep? Azith seems to work really well for many PANDAS kids - will your doc give you some to try? She seems to have several key PANDAS symptoms - urinate often, emotional lability, tics (if that is what the shaking is?), separation anxiety, sudden onset of symptoms along with a strep infection, lack of focus, change in personality.

We did this test years ago on the advise of Claire. I don't remember all the details now - but it did confirm the yeast issues - and a few other things. My naturopath talked to them - not me. I don't believe they pushed anything.

I watched this documentary - scary stuff! I think you may be able to see it online at CBC.

Sudden overnight onset of tics - can be caused by a strep infection - did they swab her throat. Even if she has not complained about being sick - get her throat swabbed - and preferably also get her blood tested for ASO titers. My son had throat clearing from ages 3-6 then overnight at 6 had a sudden and severe onset of motor and vocal complex tics - jerking etc - I had never seen anything like it before. You should read up a little on PANDAS. Antibiotics are what is needed if it is illness triggered, and the sooner the better.

Thanks for the warm thoughts Cheri! I am soooo appreciative of all that you and Claire and Ronna did for me in my early days, weeks and months here. I do still check in - but find others are now able to share all of the info that Ronna and I used to. If anyone wants to ask any specifics after reading some of my old posts I am happy to answer - you could also pm me to let me know there is a post for me to answer. This is such a great way to share info and success. Our infections disease docs feel he will be on antibiotics until he is 18. He does still have minor tics that come and go with illness and growth spurts and seasonal allergies - that no one notices but me - he is starting to have normal signs of illness now - fevers. headaches etc - whereas before he just had an increase in tics when others around him were sick . I am ok with it after all we have gone through. He is a wonderful kid - very athletic and does well in school and has lots of friends. He was once so sick he could not walk across the room without jerking every step - he was too exhausted to do any sports and was up and down with emotions. He has come a long way - but it has been a journey. I am so thankful for all I have learned along the way - and the wonderful people I have come to know.

My understanding is that these symptoms will go away as the kids get older. Remember, those who post here are usually in the thick of things - when things start getting better they don't post as much - Ronna and I used to be the two who were on here the most - I am still in touch with her and her son is doing really well - my son too is doing really well - symptoms are less and less - and further apart - my son is 10 and hers is a couple of years older. We seem to both be on the same path - our kids are both on azith and have been for about two years and are doing well. I don't post too much anymore - as PANDAS is no longer the only thing I am thinking about! (Which is soooo nice - as for many years it was all I thought about)

We give 500mg every 5th day (2 pills). If he has an increase in symptoms we try to just let them ride out if they are not too bothersome, but if they linger and we know there has been exposure to strep of another viral illness (particularly when his siblings have been sick) we will do a full course - meaning 500mg the first day then 250mg each day for 4 more days. Sometimes we might add a few extra days - we always see an improvement by day 3. we got the ok from the infectious disease clinic and our ped writes the script. It is left up to me to decide when to increase based on symptoms - it used to be every 3 months at least - but now we can go 4 or 5 months without needing a full round. I took in the article about azith - it says every week - we found that he had symptoms on day 5,6,7 - so we decreased to every 5th day - which is what Ronna does as well with success. We had been on amox for 2 years - he was doing ok so we tried going off it - it was a disaster - he had terrible tics and within the week were back on amox but it was not longer working - we then tried many antibiotics and combo of antibiotics over the course of 6 weeks - he was not doing well - azith was the last one the doctor would agree to trying - it was like a miracle - he got so much better within 24 hours we could see improvement and he kept getting better and better - we stayed on it for about 14 days then went on the once a week - but then down to once every 5th day. We just hope it continues to work for the next however many years until all of this passes. The infectious disease clinic thinks he will be on it until he is 18 - but we are hopeful it won't be quite that long - but we would never consider trying to go off it after our experience going off amox. EAmom - is your daughter on probiotics or some other kind of yeast buster?

our son is on azith every 5 days - when we see breakthrough symptoms with exposure to strep (or other illness) we give a round of antibiotics - a 5 day course will usually settle things down.

separation anxiety is big with PANDAS kids. Video games and TV were a hug trigger for my son. We did a trial of turning off all tvs etc years ago - and he did great. He can tolerate LCD tvs - but florescent lights were terrible for him at school - the school still reduces lighting for him. Again - prior to PANDAS he had not problems with the lights or tv - but once his immune system was attacked - and not working normally things that used to be fine could no longer be tolerated.

Hi Williams dad, Just want to give you some hope....my belief is that these kids do grow out of PANDAS - and the key is to reduce the tics until that happens, by dealing with their immune system. These kids have messed up immune systems - and things that they used to be able to tolerate they can no longer - food sensitivities, environmental sensitivities, lighting. Think of their immune system as a bucket - the strep infection has filled it up - so the other things that used to be managed in small doses now cause the bucket to spill. Our son had a sudden and severe onset of tics at age 6 - he is now 10. He is currently on azithromycin and doing well (last 2 years) previously was on amoxycillin - early on we also saw a naturopath and did food sensitivity testing - and removed those foods listed on his test - we were shocked to find he was sensitive to milk - which he drank tons of. Once off - he improved. We also removed other foods but have reintroduced them without a problem. There are certain supplements that we have found have helped our son as well - he used to take tons of different supplements but now he is strong, healthy and eating well so really just gets a multi and fish oil. Our son does still have tics at times but they are minimal and no one other than us notices. He can still be triggered by things in the environment - yesterday he played in the leaves and his eyes were ticcing in the evening and he said they were stinging. My guess is he will wake up this morning and be fine. On azith my son got better within days. He now takes it once every 5 days but if he is exposed to strep or other viral illnesses his tics can increase - probably once every 3-4 months we have to give him a round of azith - 5 days in a row - and that settles things right down again - it has an immuno-modulating effect. I researched non stop too - and took the info in to doctors and advocated for the antibiotics. 4 years ago a lot less was known about PANDAS - there is so much more info now. Good Luck - you will get lots of support here. We have all been where you are now.

our sons titers were very elevated - over 2000 and took years to slowly come down - every few months they were down a couple hundred. He had a sudden and severe onset of symptoms. we have not checked them for a long time - we used to check every 4-6 months. From what I understand - usually the titers remain elevated for a few months after infection and then should go back to normal. I think they are highest 6 weeks after the infection. I cannot remember all the details.

My son did much better off certain foods - as PANDAS is an auto-immune disorder the goal is to keep any attacks on the immune system at a minimum - we did blood work and found he was sensitive to dairy and gluten - so by removing them his immune system was not being bothered by that too. I always go back to the bucket theory - with your immune system being a bucket - strep can fill the bucket up - so the goal is to keep the bucket as empty as possible - by removing anything else (prior to PANDAS by son ate all the foods with no issues - so I was shocked when he showed he was sensitive and even more shocked at how much better he was once we removed the foods).

Our son is 10 and was diagnosed with PANDAS at 6 with a sudden onset of tics. We used amox. for several years - we are now on azithromycin which has done wonders. Our son was very sensitive to sunlight, florescent lights (he could not go into stores for a long time - and the school limits them in the classroom and he sits next to the window), and tv - we now only have LCDs in the house and he can tolerate them ok - but when he is sick even those will increase symptoms. We find he does have an increase in tics during growth spurts. Right now he has some symptoms and we were trying to figure out what might be causing them (could be back to school - and florescent lights), and thought it may be because our youngest has a cold - but now think it is a growth spurt - he is eating unbelievable amounts and is always "starving!" We see a naturopath and did a lot of vitamin therapy with our son - with good results. Removing dairy made a huge difference for him. He now has some but we limit it - we also try and limit gluten too. Wishing you all good luck -glad you have a doc who knows something about PANDAS.

increase of yeast while on antibiotics can also cause tics - is she also on a probiotic?