The Cunningham Panel for PANS/PANDAS: What It Tests, What It Can't Tell You, and Whether It's Worth It

If you have spent any time in PANS/PANDAS parent groups, you have heard about the Cunningham Panel. You have probably also heard it described in two completely incompatible ways: as the test that finally proves what is happening to your child, or as an expensive test that does not really tell you anything.

Neither of those is quite right. Here is the version I give families in my clinic.

What the Cunningham Panel actually measures

The Cunningham Panel is a blood test developed by Moleculera. It does not look for infection. It looks for evidence of an autoimmune process directed at the brain.

Specifically, it measures a set of autoantibodies that can target structures in the brain involved in movement and behavior, along with a measure of how strongly a patient's serum stimulates an enzyme called CaMKII in neuronal cells. The general idea is that in some children, antibodies produced in response to an infection cross-react with brain tissue, and this panel is an attempt to detect the fingerprints of that process.

That is a genuinely interesting idea, and it lines up with the neuroimmune theory underlying PANS and PANDAS.

What a result does, and does not, mean

This is the part that matters most, and it is where families are most often misled.

PANS and PANDAS are clinical diagnoses. They are made by a physician evaluating the pattern and timing of a child's symptoms, particularly the abrupt onset. There is currently no single blood test that confirms or excludes them, and the Cunningham Panel is not an exception to that.

Which means:

• A positive result does not, by itself, diagnose PANDAS. It may add supporting evidence to a clinical picture that already points that way.

• A negative result does not rule PANDAS out. I have treated children with a clear clinical story and unremarkable panel results who responded well to treatment. If a doctor tells you your child cannot have PANS/PANDAS because a panel came back negative, get another opinion.

A test that cannot confirm the diagnosis and cannot exclude it is, by definition, not a decisive test. It is one input.

The scientific debate, stated honestly

I am not going to pretend there is consensus here, because there is not.

The Cunningham Panel has been the subject of published scientific criticism. Peer-reviewed evaluations have raised questions about its reliability and its ability to distinguish affected children from unaffected ones. If you search for the test, one of the first academic results you will find is a paper titled, plainly, "The Cunningham Panel: concerns remain."

At the same time, many experienced doctors in this field find the panel useful in specific situations, and the underlying autoimmune model it is built on continues to be an active area of research.

You should know both of those things. A clinic that shows you only the promotional material is not preparing you to make a good decision, and neither is one that dismisses the test without explaining why.

Cost and insurance

Two practical realities families should walk in knowing:

• The Cunningham Panel is generally expensive, and

• it is frequently not covered by insurance, though coverage varies by plan.

For families already carrying the financial weight of this illness, that is not a small consideration. I would rather a family spend that money on treatment that is likely to help their child than on a test whose result will not change what we do next. Which brings us to the only question that actually matters.

The question I ask before ordering any test

Will the result change what we do?

If a child has a clear, abrupt-onset clinical picture and we are already going to treat, a panel result, positive or negative, often does not change the plan. In that case, ordering it mainly costs the family money.

But there are situations where it can genuinely earn its place:

• When the clinical picture is ambiguous and additional supporting evidence would meaningfully shift the assessment.

• When a family or another treating doctor needs more objective support to move forward with a treatment decision.

• When it may help support an insurance appeal or a conversation with a skeptical doctor, though it is no guarantee.

That is a real but narrow set of circumstances. It is not "everyone should get this test," and it is not "this test is worthless."

What we do instead, and alongside

A careful diagnostic evaluation for PANS/PANDAS is not one test. In our clinic it means taking a detailed symptom-onset history seriously, looking for infectious triggers such as strep, screening for the mimickers and contributors that can look like PANS/PANDAS or make it worse, and assessing nutritional and immune factors, then building a treatment plan around the actual child rather than around a lab value.

Testing supports that process. It does not replace it.

The bottom line

The Cunningham Panel is a legitimate, scientifically interesting test with real limitations and real controversy attached to it. It can be a useful input in the right situation. It is not a diagnosis, not a requirement, and not something you have failed to do for your child if you have not run it.

If someone is telling you that this single blood test will settle the question, be careful. If someone is telling you it means nothing at all, be equally careful.

If you would like a doctor to actually walk through your child's picture and tell you honestly whether this test would change anything, that is what our PANS/PANDAS clinic is for, and for families who cannot travel, a virtual consultation includes a full records review and a written plan for your local doctor.

This article is for general educational purposes and is not a substitute for medical advice. Testing decisions should be made with a qualified doctor who knows your child's history.