Reply

We appreciate the thoughtful letter by Drs Thienemann and Frankovich in response to our commentary in which we evaluated pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS) research and provided diagnostic and therapeutic recommendations. Their reply was framed in terms of decision-making under conditions of uncertainty, and they cogently described challenges faced by clinicians, particularly in the neurosciences, when we encounter suffering children and families and unclear underlying biology.

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