Review Article

Paediatric Autoimmune Neuropsychiatric Disorder Associated with Group A Beta-Haemolytic Streptococcal Infection: An Indication for Tonsillectomy? A Review of the Literature

Table 1

Summary of case series.

AuthorPatient cohortPANDAS criteria met (including confirmation of GABHS)Neuropsychiatric symptomsData Collation MethodASOT
Threshold
Treatment Provided Prior to TonsillectomyFollow-Up Duration after TonsillectomyOutcome

Demesh et al. Total cohort:   
(8 male, 2 female)
Average age: 6.5 years
Tonsillectomy or adenotonsillectomy:
YesSpecifics:
Tics
Anxiety/OCD symptoms
Retrospective Study
9-item questionnaire (assessed medical history, neuropsychiatric symptoms, symptom response to treatment)
Not reportedAll patients were treated with antibiotics in the past or were receiving antibiotic prophylaxis.
(Antibiotics used were not reported)
3 months
6 months
1 year
3 years
Reduced symptom severity in all 9 patients who underwent Tonsillectomy
Complete resolution in 4 cases

Pavone et al. Total cohort:   
(57 male, 63 female)
Average age: years
Tonsillectomy:   
Adenotonsillectomy:
YesProspective Study
Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS)
Yale Global Tic Severity Scale (YGTSS)
Normal if <266Antibiotic therapy when inflammatory markers raised or if clinical condition required
3rd-generation cephalosporins (5–7 days BD) or azithromycin (3–5 days OD)
IVIG used in 8 patients
Every 2 months for 2 yearsNo difference in remission rates, progression of syndrome, relapse rates, antibody levels, ASOT levels, anti-DNAse B levels

Murphy et al. Total cohort:   
(30 male, 13 female)
Average age: years
Tonsillectomy or adenotonsillectomy:
YesOCD/anxiety
Tics
Motor abnormalities
Prospective Study
Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS)
Yale Global Tic Severity Scale (YGTSS)
Elevated if >200Not reported
(Multiple antibiotic courses)
1 yearNo difference in remission rates, progression of neuropsychiatric symptoms, ASOT levels, anti-DNAse B and anti-ACHO levels