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[quote=Anonymous][quote=Anonymous]Np here, if titers are not elevated,not PANS, right?

My child had sudden onset OCD symptoms.  I asked for a strep test, it was positive.  Dr. gave 10 day course of antibiotics.  Wouldn't give more.   Tested months later with different doctor and levels not elevated.  Some symptoms remain though not at level of initial onset.  [/quote]

Complicated question.  But some kids do not show the elevated titers many do based on what I've seen on discussion boards.  I am pretty sure Dr. Swedo, the PANDAS guru who is at NIH, agrees that you do not need elevated titers.  What you need is a history of strep very close to sudden outbreak of OCD.  The history could come through a swab or through titers.  Looks like your DS met this through the swab.  He might have met it through titers at the time, but you don't have this information.

What you are seeing is lingering OCD that should tail off.  It can take a year or more after a first outbreak to be completely resolved, although often in a first outbreak it is shorter.  I'd say with my child the first two outbreaks had symptoms that took five to six months to go away.  But the symptoms were not overwhelming--quite manageable--and I put it down to kids sometimes do quirky things (both outbreaks occurred before publication of Swedo's seminal paper).   We did not know it was PANDAS so just had the usual 10 day course of abx for strep.

On the third outbreak, however, the world crashed.  I kissed my child goodbye in the morning and came home to an alien.   Again the usual ten days of abx.  It took nearly a year and a half for the symptoms to subside.  The fourth outbreak was similarly awful, and it took two and half years, including a year and a half of ERP to bring my child back to baseline.

You could be very lucky, and this could be a one time occurrence because your DS is fortunate enough to not get strep.  I have read that a very high percentage of people (like over 90%) become more or less immune to strep throat by age 14 or so.  (Just tried to verify on internet, though, and couldn't find in the minute or two I allotted.) We thought this was the case with our child, who went blessedly free of strep/PANDAS through high school, only to have it strike twice in college.

But your DS could get PANDAS again if he gets strep.  What you need to know is that each outbreak is worse and persists longer than the previous one.  This was certainly true for my child, but is also the clinically recognized course.  It is very important if this happens again that your DS get the abx treatment very promptly.  NIH recommends at least one month to six weeks of abx for a PANDAS outbreak. (Many of the PANDAS specialists will do longer, however.) If that does the trick, great.  If not you have to go on to more aggressive measures.  What I can't say enough is that early, prompt, and adequate treatment is the way to go here.  You do NOT want this to become a chronic condition.  My child was diagnosed at the NIH but rejected for their study because he was too chronic.

I would suggest you see Dr. Latimer even if things are manageable now.  This would position you to address any new outbreak as quickly and as aggressively as needed.  If your DS never has another outbreak, you have lost little but the cost of the visit.  But if he does, you will be prepared and could save yourself a world of hurt down the road.
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