One week your child is themselves. The next, they're gripped by obsessive fears, refusing to eat, raging over nothing, terrified to sleep alone, or suddenly unable to write the way they did last month.
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You know something is medically wrong, but you keep hearing "it's just anxiety," "it's a phase," or "have you tried a therapist?"
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You're not imagining it, and you're not overreacting. A dramatic, abrupt change like this can be PANS or PANDAS: a treatable medical condition in which the immune system, often set off by an infection, mistakenly inflames the brain.
At Neuroveda Health, we take sudden-onset neuropsychiatric symptoms seriously, and we do the testing and treatment that connect the dots between infections, the immune system, and your child's brain.
Seattle clinic with telehealth options for Washington State. We collaborate with your child's pediatrician, therapist, and specialists.
What are PANS and PANDAS?
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) is a condition in which an infection or other inflammatory trigger sets off a misdirected immune response against the brain, causing the sudden, dramatic onset of obsessive-compulsive symptoms or severe food restriction alongside other neuropsychiatric changes. PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) is the well-known subtype triggered specifically by strep.
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In both, antibodies meant to fight an infection instead target areas of the brain involved in movement, emotion, and behavior. That's why a child can seem to change personalities in a matter of days. This is a medical condition, not a parenting problem, and it is treatable.
Common signs of PANS & PANDAS
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Abrupt, dramatic onset of OCD: obsessive fears, rituals, intrusive thoughts that weren't there before
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Severely restricted eating or sudden food refusal
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New motor or vocal tics, or unusual jerky movements
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Intense separation anxiety or panic that appears out of nowhere
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Emotional lability, rage episodes, or aggression far beyond your child's baseline
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Behavioral or developmental regression, like baby talk or lost skills
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A sudden slide in school performance, handwriting, or attention
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New sensory sensitivities to clothing, sounds, or textures
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Sleep disturbance and nightmares
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Urinary frequency or new bedwetting
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The signature of PANS and PANDAS is speed. Most parents can name the week everything changed. Symptoms also tend to flare and settle in waves, often worsening again after a new infection.
It's not bad behavior. It's inflammation.
Families dealing with PANS and PANDAS often bounce between the pediatrician, a psychiatrist, an ER visit, and a string of therapists, collecting diagnoses that never quite fit and treatments that never quite work. That's because the root cause isn't psychological. It's neuroimmune.
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Strep is the classic trigger, but it isn't the only one. We commonly find Mycoplasma pneumoniae (walking pneumonia), influenza and other viral infections, sinus infections, Lyme disease and other tick-borne infections, and mold or biotoxin exposure underneath a PANS presentation. Gut health and nutrient status shape how well the immune system regulates itself, and genetics influence how vulnerable a particular child is.
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Untangling that web takes a clinic built for complex, multi-system conditions.
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That's Neuroveda. Our practice grew out of an integrative neurology clinic, and immune-mediated neurological conditions are core to what we do every day, in patients of every age. We look at your child's whole story: the infection history, the immune system, the gut, the nervous system, and the family context around all of it.
How we diagnose PANS & PANDAS
There is no single test for PANS or PANDAS. The diagnosis is clinical, built on a careful history and exam, and supported by targeted testing that helps confirm the picture, uncover triggers, and guide treatment.
Our evaluation starts with a real conversation, long enough to map exactly what changed and when. Then we test strategically:
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Cunningham Panel (Moleculera Labs): specialty antibody testing that evaluates autoantibodies associated with PANS and PANDAS, one of the few clinics in the Seattle area to offer it
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Strep evaluation: throat culture and strep antibody titers (ASO and anti-DNase B) to look for evidence of recent or smoldering strep infection
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FRAT (Folate Receptor Antibody Test): identifies antibodies that block folate from reaching the brain, associated with PANS/PANDAS and inflammatory presentations
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Neural Zoomer: evaluates 48 neurological autoantibodies, including markers of autoimmune encephalitis and neuroinflammation
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Targeted infection workup: specialty testing for Mycoplasma, Lyme and tick-borne co-infections, and mold/mycotoxin exposure when the history points there
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Gut, nutritional, and immune labs: microbiome evaluation, nutrient status, and immune markers that shape the treatment plan
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NeuroCognitive testing (CNS Vital Signs): a validated cognitive assessment for ages 8 and up that creates an objective baseline, so we can measure recovery instead of guessing
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Explore our full specialty testing menu and our approach to testing.
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You don't need to arrive with a diagnosis, a positive strep test, or a tidy explanation. Bringing us the mystery is exactly the right move.
Integrative treatment for PANS & PANDAS
Published expert consensus organizes PANS/PANDAS treatment into three arms: treat the infection or trigger, calm the misdirected immune response, and support the child's symptoms and family while the brain heals. Most clinics can offer only pieces of that.
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At Neuroveda, all three arms live under one roof, and every plan is personalized to your child's triggers, severity, and history.
Treat the trigger
When testing reveals an active or smoldering infection, we treat it directly: antibiotics for strep and Mycoplasma, targeted antimicrobial and evidence-informed herbal strategies for Lyme and tick-borne infections, and a structured detoxification approach when mold or biotoxin exposure is part of the picture. We also address the reservoirs that keep the immune system provoked, like chronic sinus involvement and gut dysbiosis.
Calm the immune system
Options range from simple, well-tolerated anti-inflammatories (like NSAIDs) to corticosteroids when the situation calls for them. For children whose symptoms are severe or persistent, we offer expert IVIG management: we can order and administer intravenous immunoglobulin infusions directly, or coordinate dosing and monitoring with your existing team.
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For severe or treatment-resistant cases, Therapeutic Plasma Exchange (TPE) can filter inflammatory antibodies from the blood, offered at Seattle's longest-running private TPE clinic. Nutrition, targeted supplementation, and immune-modulating strategies round out the plan so the immune system re-regulates rather than staying stuck in attack mode.
Support the child and the family
Healing accelerates when the nervous system feels safe. We can support your child, and you, with therapies like:
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The Safe and Sound Protocol (SSP), a gentle, evidence-based auditory program originally developed for children that improves emotional regulation and resilience
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Gentle acupuncture and Ayurvedic support for sleep, digestion, and anxiety.
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Nutrition plans that calm inflammation without turning every meal into a battle.
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We also work hand-in-hand with your child's therapist: behavioral therapies like CBT and ERP do their best work once brain inflammation is being treated, and we'll coordinate so nothing falls through the cracks.
Care from a team that connects the dots.
PANS and PANDAS care at Neuroveda is led by clinicians who work with immune-mediated neurological conditions every day.
DNP, ARNP, IFMCP
is our Medical Director and a certified functional medicine and Ayurvedic practitioner who specializes in multisystem complex and chronic diseases, neuroinflammatory conditions, and the gut-brain connection. Her whole-life-history approach is exactly what untangling a PANS presentation requires.
ND, MSAS
brings deep expertise in chronic infections and psychoneuroimmunology, the science of how infections and immune activation shape the nervous system. When Lyme, tick-borne co-infections, or mold exposure are part of your child's picture, Dr. Giles leads that piece of the plan.
Behind them stands our full integrative team: functional medicine, Ayurveda, Chinese medicine, and integrative neurology, because a condition this complex deserves more than one set of eyes.
What your first visit looks like
Connect.
Fill out our inquiry form and tell us your child's story: what changed, when it changed, and what you've already tried. We'll match you with the right provider and confirm scheduling and pricing up front.
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Deep-dive consultation.
The initial visit is a true evaluation of the whole picture: symptom timeline, infection history, medical and family history, and the questions that most need answering. No 12-minute appointments here.
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A personalized plan.
You leave the first visit with a working assessment, targeted testing orders, and an initial treatment plan, plus a clear path for follow-up as results come in. You stay in the driver's seat.
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We see patients in person at our Seattle clinic and via telehealth for Washington State residents. For families outside Washington, we offer educational consultations that equip your local providers with our recommendations.
Frequently asked questions about PANS & PANDAS
What is the difference between PANS and PANDAS?
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PANDAS is specifically linked to streptococcal (strep) infection and classically involves sudden-onset OCD and/or tics in a child. PANS is the broader diagnosis: the same abrupt neuropsychiatric onset, but the trigger can be any of several infections (like Mycoplasma or influenza), mold or biotoxin exposure, or other inflammatory stressors, and the defining symptom can be OCD or severe food restriction. The evaluation and treatment approach for both follows the same logic: find the trigger, calm the immune response, support recovery.
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Is PANDAS a real, recognized diagnosis?
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Yes. PANDAS was first described by researchers at the National Institute of Mental Health in the 1990s, and PANS diagnostic criteria and peer-reviewed treatment guidelines have since been published by a consortium of academic clinicians. Awareness among frontline providers still varies widely, which is why so many families go months or years without answers. If your instincts say your child's change was too fast and too dramatic to be ordinary anxiety, that instinct deserves a real workup.
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Does my child need a positive strep test to be evaluated?
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No. Strep antibody levels can lag or normalize, strep can hide in the sinuses or elsewhere without a positive throat swab, and many PANS cases involve triggers other than strep. A negative strep test does not rule out PANS or PANDAS. We evaluate the whole clinical picture and test for a wide range of triggers.
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What is the Cunningham Panel?
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The Cunningham Panel (Moleculera Labs) measures autoantibodies directed against brain targets, along with a marker of immune-cell activation, to help evaluate whether a child's neuropsychiatric symptoms may be immune-mediated. It doesn't diagnose PANS or PANDAS by itself, but it adds meaningful evidence to the clinical picture. We're one of the few clinics in the Seattle area that offers it.
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Do you offer IVIG for PANS and PANDAS?
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Yes. We provide expert IVIG management and can order and administer infusions directly at our clinic, or coordinate dosing and monitoring with your existing providers. For severe, treatment-resistant cases, we also offer Therapeutic Plasma Exchange (TPE), which filters inflammatory antibodies from the blood.
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Can teenagers or adults have PANS?
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PANS and PANDAS classically begin in childhood, but onset can occur in adolescence, and many adults live with symptoms that began, unrecognized, in childhood. Emerging research also describes adult-onset cases. We evaluate suspected immune-mediated neuropsychiatric symptoms across ages, and we never turn away a complex story just because it doesn't fit the textbook age range.
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Will you replace my child's therapist or pediatrician?
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No, and we wouldn't want to. We collaborate with your child's existing care team. Behavioral therapies like CBT and exposure-response prevention often become dramatically more effective once the underlying inflammation is treated, and your pediatrician remains an important partner for everyday care.
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Do you offer telehealth for PANS/PANDAS care?
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Yes, for patients located in Washington State. In-office services like blood draws and infusion therapies happen at our Seattle clinic, and many specialty lab kits can be completed from home. For families outside Washington, we offer educational consultations that deliver our evaluation and recommendations to your local providers to carry out.
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Will insurance cover my child's care?
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Neuroveda is a direct-pay clinic; we provide Superbills and billing codes so you can seek reimbursement from your insurer. Some lab testing is often covered by insurance, and we keep pricing transparent so you can plan ahead. Provider rates are listed on each provider's page.
Your child is still in there
PANS and PANDAS can make it feel like your child has been replaced overnight, and like no one believes what you're seeing. We believe you. With the right testing, the right treatment, and a team that treats the whole picture, children with PANS and PANDAS can get better, and families can get their lives back.