Methylation support helps a lot of children. In the wrong child — or long after the job is done — it produces exactly the rage and agitation you are trying to treat.
The cruel part: these look identical to a flare. So families assume the illness is worsening and increase support — which makes it worse.
Stop the formula and watch. Methyl donors wash out over roughly one to two weeks — long enough to be a clean experiment, short enough to be safe. Change nothing else during that window or you will not know.
B-vitamins and TMG have no withdrawal syndrome, so stopping is safe. But if it was prescribed, loop in the prescriber — especially if it was controlling a high homocysteine.
If a methylation formula genuinely brought a high homocysteine down, stopping it may let it climb again — and homocysteine is itself excitotoxic, so that is not harmless either.
The usual answer is not zero. It is a lower maintenance dose, without the ingredient your child is already over on — and a recheck in six to twelve weeks to confirm.
Want this answered for your own child? A Plan B synthesis reads every lab and note you have — together — and tells you what is driving the picture, what has never been checked, and what to ask for next.
The first one is free, and you keep the list either way. Phone photos of labs are fine.
Plan B for PANS is written by a parent, not a physician. Nothing here is medical advice or a substitute for your child's clinicians — it is meant to make you the best-informed person in the room when you talk to them.