Introduction and practical considerations Ordering all possible laboratory markers can make testing very expensive and burdensome for families. Therefore: Not every child needs every test The choice of tests should be individualized The final decision on which tests are truly necessary and sufficient should be made by Dr. Ken, based on: The child’s clinical presentation History of regression or triggers Prior test results Safety and cost-effectiveness The goal of laboratory testing is not to collect as many results as possible, but to obtain enough high-quality information to guide effective and safe treatment for that specific child.

The most informative tests are those that reflect immune function, inflammation, infections, metabolism, and neuro-biological stress. These include: High-value tests Complete blood count (CBC) with differential Inflammatory markers (CRP, ESR, ferritin) Immune panels (IgG, IgA, IgM, IgE; lymphocyte subsets) Infection serology (TORCH, herpesviruses, Mycoplasma, Chlamydia, Borrelia) Metabolic markers (B12, folate, homocysteine, iron studies) Neuro-stress markers (NSE, S100B) Organic Acids Test (OAT) for dysbiosis and mitochondrial stress Low-informative or misleading when used alone Single “normal” results without clinical context Isolated genetic panels without functional data One-time microbiome tests without correlation to symptoms Laboratory tests are most valuable when interpreted together, not individually.

Most key markers are accessible in Europe through standard or specialized laboratories: Blood tests: CBC, immunoglobulins, CRP, ESR, ferritin, B12, folate Immune panels: Flow cytometry (CD3, CD4, CD8, CD19, NK cells) Infection testing: ELISA / CLIA / immunoblot for EBV, CMV, HSV, Borrelia Autoimmune markers: ANA, anti-DNase B, ASO Neuro markers: NSE, S100B (available in many EU labs) Urine tests: OAT via international labs (e.g., Great Plains, Mosaic) In most cases, European labs are sufficient when the correct markers are requested.

No. A lymphocyte panel is important but incomplete. It shows: T cells, B cells, NK cells (quantitative balance) But it does not show: Functional antibody production Chronic immune activation Cytokine imbalance Immune exhaustion or autoimmunity A full immune assessment requires immunoglobulins, inflammation markers, and infection status.

Standard blood tests include: ELISA / CLIA (screening) Western blot / Immunoblot (confirmation) For monitoring or complex cases: IgG and IgM dynamics over time Coinfection testing (Bartonella, Babesia, Ehrlichia) Inflammatory markers and immune response patterns A single negative test does not always exclude chronic or late-stage infection.

This often indicates non-specific immune activation, such as: Chronic inflammation Persistent viral or bacterial stimulation Gut-derived immune activation Immature or dysregulated immune response It does not automatically mean an acute infection, but it signals immune stress.

High B12 is not always beneficial. It may indicate: Impaired cellular uptake Liver dysfunction Inflammation or oxidative stress Reduced intracellular utilization Functional B12 status should be interpreted together with folate, homocysteine, MCV, and clinical signs.

NSE (Neuron-Specific Enolase) is a marker of neuronal stress or injury. It can be elevated due to: Neuroinflammation Hypoxia or ischemia Seizures Chronic infection-related brain stress Toxic or metabolic injury It reflects active stress, not necessarily permanent damage.

This requires: Clinical correlation (sleep, behavior, regression, seizures) Evaluation for inflammation, infection, and metabolic stress Reduction of neuroinflammatory burden Careful monitoring over time The goal is to identify and remove the driver, not just suppress the marker.

S100 (often S100B) reflects glial activation and blood–brain barrier stress. It may be elevated with: Neuroinflammation Brain injury (including prenatal or perinatal) Autoimmune or infectious processes It complements NSE by reflecting support-cell and barrier involvement.

Yes. Severe dysbiosis can: Produce neurotoxic metabolites Activate systemic and brain inflammation Affect mitochondrial and neuronal function The gut–brain axis is a major contributor to elevated NSE in children.

Indirect markers include: NSE S100B CRP, ferritin (systemic inflammation) Cytokine patterns (when available) There is no single perfect blood test, but combined markers plus clinical signs provide strong evidence.

Direct neurotransmitter levels in blood are limited. Helpful indirect markers: Platelet serotonin Tryptophan and kynurenine pathways OAT neurotransmitter metabolites Clinical response to treatment Neurotransmitter balance is best assessed functionally, not by one lab value.

Common follow-up includes: Stool PCR or culture Inflammatory markers Liver enzymes (before antifungal therapy) Immune status evaluation OAT reflects metabolic impact, not just presence of organisms.

Yes. Importantly, the same laboratory biomarkers and clinical patterns are relevant not only for PANS, but also for other neurodevelopmental and neuropsychiatric disorders (NDDs), including: Autism spectrum disorder (ASD) Sensory processing disorder (SPD / SP) PANDAS Other infection- and inflammation-associated neurodevelopmental conditions There is no single laboratory test that definitively diagnoses PANS, PANDAS, autism, or related conditions. Diagnosis is always clinical, based on: The child’s symptoms and developmental history The pattern of onset or regression Laboratory findings that support immune, inflammatory, or infectious involvement Commonly used supportive laboratory markers include: Inflammation markers: CRP, ESR, ferritin Post-infectious markers: ASO, anti-DNase B Immune imbalance indicators: total immunoglobulins, IgG subclasses, lymphocyte subsets Markers of chronic immune activation: elevated IgM, abnormal T-cell or NK-cell patterns Neuroinflammatory stress markers: NSE, S100B Evidence of infectious triggers: streptococcal, viral (EBV, CMV, HSV), or atypical bacterial serology

Yes — especially if there is: Prenatal or environmental exposure Neurodevelopmental regression Poor detox capacity Baseline testing helps guide safe sequencing of treatment.

MRI shows structure, not current biology. Useful labs include: Inflammation markers Immune function Infection status Metabolic and mitochondrial markers Neuro-stress markers (NSE, S100B) These help assess ongoing, treatable processes.

This depends on the test: Blood counts & inflammation: usually no need to stop Infection serology: antibiotics usually do not invalidate results Microbiome / OAT tests: Antibiotics: ideally stop 7 days before (if clinically safe) Probiotics & antifungals: 3 days before Always balance test accuracy with clinical safety — stopping treatment is not always appropriate.