The Role of Tonsillectomy in the Treatment of Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS)

Abstract

This PANDAS cohort whose neuropsychiatric symptoms did not respond sufficiently to antibiotics may have gained benefit from tonsillectomy.

Tonsillectomy remains a questionable option for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)

“…Only 8 of 18 articles matched our search criteria and were eligible for further analysis [6], [10], [11], [12], [13], [14], [15], [16]. One article had been cited and was also included [17].…”

“…Complete therapeutic success was reported in 4 [6], [12], [14], [17] of the 8 single cases and in one case series [10] for further 3 patients. A benefit was not verified for the total of 82 patients who had undergone TE in the other two case series [11], [16], not even a positive tendency.…”

“…Demesh et al reported a benefit in 3 of 9 children after TE with complete remission and a tendency of a reduced severity in the remainder. The significance of this study, however, is very limited because the data depended on the memory of the parents, neurological conspicuities were evaluated by means of a non-validated procedures, and the data were not compared by a control group [10]. …”

Individualized Immunological Data for Precise Classification of OCD Patients

“…The effects of antibiotic treatment in PANDAS were also studied. Four studies without control groups found that antibiotics could be effective [118,120,129,133] (Table 5), although a study comparing azithromycin vs. placebo as a treatment for PANS over four weeks failed to find an effect of azithromycin on OCD symptoms as measured with the Children’s Yale–Brown Obsessive Compulsive Scale (CY-BOCS) [123] (Table 5). However, if streptococcal infection is still present during acute episodes of PANDAS, antibiotics are considered as the best treatment [167,168].…”

PANDAS in otolaryngology

“…PANDAS syndrome presents predominantly as an acute onset of OCD‐like symptoms. Other symptoms include ADHD (attention deficit and hyperactivity disorder)‐like behaviour, the child may be emotionally labile, may suffer separation anxiety, poor attention, ‘tic’ development and reduced visual–spatial capabilities . The diagnostic criteria were developed in 1998 by Swedo et al .…”