January 10, 2015

Tonsillectomy "May" Help with PANDAS?

Only in kids, there is a VERY rare (and controversial) disorder where strep throat infections can rapidly lead to involuntary tics including chronic throat clearingcough, head/neck movements, sneeze, etc as well as OCD behavior.

Known as PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus), it is felt to be an autoimmune reaction triggered by antibodies produced by the body when fighting a strep infection. With this disorder, an evaluation with a pediatric neurologist is warranted.

However, what role if any an ENT may play is less certain. Obviously, the main ENT related concern is whether tonsillectomy and adenoidectomy is helpful.

Certainly, this surgery should be pursued if the child meets the guidelines from an infectious standpoint in any child regardless of whether PANDAS is present or not:

• 7 or more tonsil/strep infections within past 12 months OR
• 5 infections in each of the last 2 years OR
• 3 infections in each of the last 3 years

But does the surgery help with PANDAS? A research paper published in 2015 suggested that in patients whose "neuropsychiatric symptoms did not respond sufficiently to antibiotics may have gained benefit from tonsillectomy." However, this study was only a small case series conducted in only 10 patients.

According to another research with a larger sample size of 112, no significant differences were found between children who had tonsillectomy and adenoidectomy compared to those who did not in terms of PANDAS classification, and OCD or tic severity. In fact, most children with PANDAS had surgery before onset of neuropsychiatric symptoms and surgery did not affect symptomology.

Although it is generally thought that T&A does NOT seem to affect the onset nor influence the neuropsychiatric course of a child suffering from PANDAS, given treatment is so limited, surgical intervention may not be unwarranted given there is some, albeit small, evidence that it "may" help, though this is far from certain.

More info about PANDAS can be found here.

To find a doctor who is familiar with PANDAS, click here.

Watch a video showing how a tonsillectomy is performed here!

Tonsillectomies and Adenoidectomies Do Not Prevent the Onset of Pediatric Autoimmune Neuropsychiatric Disorder Associated with Group A Streptococcus. Pediatr Infect Dis J. 2013 Mar 20. [Epub ahead of print]

The Role of Tonsillectomy in the Treatment of Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS). JAMA Otolaryngol Head Neck Surg. 2015 Jan 8. doi: 10.1001/jamaoto.2014.3407. [Epub ahead of print]

PANDAS: A systematic review of treatment options. Int J Pediatr Otorhinolaryngol. 2016 Oct;89:149-53. doi: 10.1016/j.ijporl.2016.08.008. Epub 2016 Aug 12.
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

1 comment:

Kathy at LucyandMei said...

For parents who are looking for solutions for this frightening disorder, "may" is a word that we cling to.
Although the study group is small, it did say that 4 of the 9 children found complete resolution after the procedure.
Complete resolution of this disorder for even 4 patients is a huge deal!

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