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.
Author
Patient cohort
PANDAS criteria met (including confirmation of GABHS)
Neuropsychiatric symptoms
Data Collation Method
ASOT Threshold
Treatment Provided Prior to Tonsillectomy
Follow-Up Duration after Tonsillectomy
Outcome
Demesh et al.
Total cohort: (8 male, 2 female) Average age: 6.5 years Tonsillectomy or adenotonsillectomy:
Yes
Specifics: Tics Anxiety/OCD symptoms
Retrospective Study 9-item questionnaire (assessed medical history, neuropsychiatric symptoms, symptom response to treatment)
Not reported
All 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:
Yes
Prospective Study Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) Yale Global Tic Severity Scale (YGTSS)
Normal if <266
Antibiotic 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 years
No 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:
Yes
OCD/anxiety Tics Motor abnormalities
Prospective Study Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) Yale Global Tic Severity Scale (YGTSS)
Elevated if >200
Not reported (Multiple antibiotic courses)
1 year
No difference in remission rates, progression of neuropsychiatric symptoms, ASOT levels, anti-DNAse B and anti-ACHO levels