Tonsillectomies and Adenoidectomies Do Not Prevent the Onset of Pediatric Autoimmune Neuropsychiatric Disorder Associated With Group A Streptococcus

Abstract

Background In children presenting with obsessive compulsive disorder (OCD) and/or tics, especially those with a temporal association with streptococcal pharyngitis (e.g., PANDAS; Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus), there is speculation about whether tonsillectomy/adenoidectomy might improve the child’s neuropsychiatric course. Our objective was to examine whether removal of tonsils and/or adenoids impacted streptococcal antibody titers, the timing of onset of OCD and/or tics, and the clinical severity of these symptoms. Methods Study participants (n=112; average age=9.2 ± 2.4; 44 female) were recruited as part of a prospective investigation of neuropsychiatric phenomena with temporal association to streptococcal pharyngitis and examined by family history, diagnostic interview, physical examination, medical record review, psychological testing, and streptococcal antibodies and divided into surgical or non-surgery groups. The surgical group consisted of children having previously had a tonsillectomy and/or adenoidectomy (n=32). The remaining children were categorized as non-surgery (N=76). Measures of OCD and tic severity, streptococcal antibody titers, and PANDAS classification were compared between both groups. Results There were no significant differences as determined by streptococcal antibody titers, PANDAS classification, and OCD or tic severity between the surgical and non-surgery groups. Most participants had surgery before onset of neuropsychiatric symptoms and surgery did not affect symptomology. Conclusions Streptococcal antibodies and neuropsychiatric symptom severity did not differ on the basis of surgical status. From these data we cannot support that tonsillectomy and adenoidectomy are likely to impact positively the course of OCD/tics or streptococcal antibody concentrations.

The PANDAS Controversy: Why (and How) Is It Still Unsettled?

“…However, a recent study compared GAS titers, PANDAS classification, and OCD and tic severity in subjects with OCD and/or tics who had undergone a tonsillectomy and/or adenoidectomy, and those who had not [82]. No significant differences between GAS titers, PANDAS classification, or symptom severity of surgical and nonsurgical groups were found.…”

Diagnosis and Treatment of Acute Streptococcal Pharyngitis in Children

“…Тонзилл-и аденоидэктомия не предупреждают и не способствуют уменьшению симптомов обсессивно-ком-пульсивного расстройства и синдрома PANDAS, сниже-нию титров антистрептококковых антител [53]. В то же время тонзиллэктомия может оказывать негативный эффект на местный иммунный ответ [54].…”

“…В ряде исследо-ваний показано, что частота симптомов БГСА-фарингита снижается в первые два года после оперативного вме-шательства в среднем в 3 раза [55,56], но в течение полугода после тонзиллэктомии отмечается значимое снижение как гуморальных (иммуноглобулины А, М, G), так и клеточных (CD3, CD4, CD8) факторов иммунитета [57,58]. Эти факты порождают дискуссию о возможном влиянии иммуносупрессии вследствие тонзиллэктомии на персистирование осложнений БГСА-инфекции [53].…”

Streptokok Enfeksiyonu İle İlişkili Pediatrik Otoimmün Nöropsikiyatrik Hastalıklar: Kulak Burun Boğaz Hekiminin Yeri

“…Bu çalışma, PANDAS hastalarına spesifik olmaması rağmen sonuçlar kısmında cerrahinin PANDAS hastalarında etkisiz olduğunu belirtmiştir. Ayrıca tonsillektomi olmadan sadece adenoidektomi geçiren hastalarında cerrahi grubunda değerlendirilmesi sonuçların güvenilirliğini olumsuz etkilemektedir 39 .…”