Frequently Asked Questions

PANDAS (and the broader diagnosis of PANS) is a clinical diagnosis, meaning it is determined primarily by a child’s history and symptom pattern—not by a single blood test, MRI, or lab value. Testing can be helpful, but there is no definitive test that “proves” or “rules out” PANS/PANDAS on its own.

My approach is personalized by patient, but below is an example of how this can look:

1. Comprehensive History and Intake

The most important part of diagnosis is a thorough clinical evaluation.

• I spend 45–60 minutes face-to-face with families.

• We review symptom onset, timing, triggers, progression, psychiatric and medical history, infections, treatments tried, and response to prior interventions.

• I also carefully review outside records and prior workups when available.

I use established PANS/PANDAS diagnostic criteria (per Neuroimmune Foundation and consensus guidelines) to determine whether a child meets clinical criteria. This history is often far more informative than any single test.

2. Laboratory Testing (When Helpful and Appropriate)

Labs can support the clinical picture and help guide treatment, but they are not required in every case.

• When indicated, I order a personalized panel, which includes:
  

  • Basic blood counts and inflammatory markers

  • Immune and autoimmune markers

  • Evaluation for infectious triggers (such as strep, mycoplasma, and tick-borne illnesses)

  • Vitamin and nutritional markers

• I do not routinely order expensive outside testing (such as the Cunningham Panel), unless a family specifically wants this information or it would meaningfully change management.

• If a child has severe psychiatric symptoms, significant needle phobia, or clearly meets clinical criteria, I sometimes begin treatment first to stabilize symptoms and draw labs later when the child is more regulated.

MRI and other imaging studies are not diagnostic for PANS/PANDAS and are only used if there are red flags suggesting another neurologic condition.

3. Treatment Approach

Treatment is individualized, but follows evidence-based first-line strategies.

• I typically start with:
  

  • A 1-month course of antibiotics (commonly Augmentin or azithromycin), and

  • Anti-inflammatory support (often ibuprofen, when appropriate)

• Depending on response and the child’s overall picture, future treatments may include:
  

  • Steroids

  • Mast cell–directed treatments

  • IVIG

  • Targeted psychiatric medication management

  • Additional immune-modulating or supportive therapies

The goal is not just symptom suppression, but addressing the underlying neuroimmune dysfunction driving symptoms.

4. Practical Support

I provide support beyond medical treatment, including:

• School letters and accommodation recommendations

• Assistance with forms and documentation

• Coordination with therapists, schools, and other providers as needed

5. Ongoing Care and Follow-Up

PANS/PANDAS is often a dynamic condition, not a one-visit problem.

• We typically check in about monthly (more often if needed).

• Treatment plans are adjusted over time based on response.

• Many children require a few iterations to find the combination that helps them stabilize and truly improve.

I'm happy to answer additional questions before you decide.

You will fill out an intake which Dr Roth will review before meeting. The first consultation is usually divided into

• ± 15 min - History review until this point

• ± 15 min - Diagnosis discussion (detail clarification, labs, "what could this be" discussion)

• ± 15 min - Treatment plan - Collaborative development (prescribing as appropriate, next step planning)

• ± 15 min - Questions

Includes

• Month of email support and prescription management.

• Option to continue care after the month with lower-priced follow-up or membership care

Continuing care for patients with active treatment/medication plans

• Annual commitment, designed for patients

• Designed for patients who want proactive ongoing support

• Includes thoughtful coordination for prescriptions and care continuity

• Includes 6 visits over 6 months (roughly one every 2 months)

• Up to 3 monthly messages clarifications or updates

• Early cancellation fee $450

Asynchronous (email only) care for stable patients who are back at their baseline, not needing regular medication adjustments, for flare prevention and continued prescribing

I can prescribe all medications (including psychiatric, IV, etc) except those which are controlled substances (eg benzodiazepines, adderall/ritalin) due to change laws in telemedicine. If one of those is needed, we can sometime use other non-controlled medications in place of them.

PANS is a clinical diagnosis and I make that diagnosis without bloodwork.

Bloodwork ("labs") can assist in our understanding, lend supporting evidence, give direction, or rule our other possible diagnoses. For those reasons, it is often ordered.

Many patients are not in a state of health that allows them to undergo a lab draw, and then treatment precedes labs.

Less commonly, but I do see adults. PANS/PANDAS has been traditionally considered a pediatric diagnosis, but that clearly does not reflect the reality of the disorder and I occasionally work with adults.

Unfortunately I do not accept insurance. As a solo practice, accepting insurance involves a level of complexity and cost to me that I cannot sustain. Thus the cost of visits or membership is out of pocket.

Prescriptions are generally covered by your insurance. Labs are as well. Re: IVIG - We will work together to apply to your insurance to cover that as well (but it is a process and not guaranteed).

Please write me directly for alternate payment plans. I believe cost should never stop someone from getting the proper care, and I will work with families to ensure this is manageable for them.

If you scheduled an appointment and need to cancel before the appointment, please let me know. You will not be charged.

Early cancellation of memberships will incur a fee equal to 1 month's membership.

My practice is telemedicine only (we meet on zoom). I live overseas and do not maintain a physical office.