Table 1.

General Principles for Treating Pediatric Acute-Onset Neuropsychiatric Syndrome

1. Establish that PANS is the correct “diagnosis of exclusion” by completing a comprehensive diagnostic evaluation (Chang et al. 2015).

2. Provide symptomatic relief with psychiatric medications and behavioral interventions, prioritizing treatment of symptoms causing the greatest distress and interference (Thienemann et al. 2017).

3. Treat underlying infections and consider use of therapeutic or prophylactic antibiotics (Cooperstock et al. 2017).

4. Treat symptoms resulting from neuroinflammation or postinfectious autoimmunity with anti-inflammatory or immunomodulatory therapies, chosen on the basis of symptom severity and disease trajectory (Frankovich et al. 2017).

5. Evaluate effectiveness of the treatment regimen at frequent intervals, making modifications as warranted by improvement or worsening of symptoms.

6. Treatment can be tapered downward or stopped when symptoms resolve. However, treatment may be necessary again at some point in the future, given the relapsing–remitting nature of PANS symptoms.

PANS, pediatric acute-onset neuropsychiatric syndrome.