Dr. Kumar’s Take:
This study adds to the small but growing body of research on tonsillectomy as a possible treatment for PANDAS, especially when antibiotics fail. While it’s a small retrospective case series, the findings are promising: 9 out of 10 kids experienced symptom relief after tonsillectomy, and 4 had complete resolution. For families struggling with recurrent strep infections and persistent OCD or tics, this could offer an additional option to consider.
Key Takeaways:
✔ Tonsillectomy led to significant and lasting symptom relief.
✔ 33% of children had complete symptom resolution after surgery.
✔ Symptom scores improved steadily for up to 3 years post-op.
✔ No serious adverse events were reported from surgery.
Actionable Tip:
If your child has PANDAS and is not improving with antibiotics alone, ask your ENT or pediatrician whether tonsillectomy might be a reasonable next step. Though more research is needed, it may help reduce future symptom flares.
Brief Summary:
This retrospective study followed 10 children diagnosed with PANDAS. All had OCD, tics, or anxiety symptoms linked to strep infections. Nine children then underwent tonsillectomy and were followed for up to 3 years. Most saw dramatic symptom reductions, and one-third had full resolution. This suggests tonsillectomy could benefit PANDAS patients who do not respond well to antibiotics.
Study Design:
- Type: Retrospective case series
- Location: Montefiore Children’s Hospital, Bronx, NY
- Participants: 10 children meeting strict PANDAS criteria
- Treatment: All received antibiotics; 9 later underwent tonsillectomy with adenoidectomy
- Follow-up: Up to 4.6 years post-surgery
- Symptom tracking: Parent-reported severity scores (0 to 10) at diagnosis, after antibiotics, and at intervals after surgery
Results:
- Baseline symptom score: Median 10 (severe)
- After antibiotics: Reduced to 8 (P = .03)
- After tonsillectomy:
- 3 months: Score dropped to 3 (P = .01)
- 6 months: Score remained at 3 (P = .02)
- 1 year: Score stable at 3 (P = .02)
- 3 years: Score further dropped to 0.5 (P = .03)
- Complete resolution: Reported in 4 of the 9 surgical cases
- No surgical patients had symptom flares afterward
Why Might Tonsillectomy Help in PANDAS?
The hypothesis is that removing the tonsils and adenoids might reduce future strep infections, which can trigger autoimmune responses in susceptible children. Since the basal ganglia may be targeted in PANDAS, lowering immune activation from strep may help stabilize the brain’s inflammatory signals.
Related Studies and Research
PANS Treatment: Large Survey Study – Examines treatment trends and outcomes in a large community-based sample.
PANDAS Antibiotics Prevention Study – Investigates how antibiotic use affects recurrence and prevention of PANDAS symptoms.
IVIG for PANDAS: Pediatric OCD Trial – Reviews IVIG’s effectiveness in a randomized trial.
Podcast: Could Your Child’s Behavior Changes Be Cured with an Antibiotic? – A deep dive into the link between strep infections and dramatic neuropsychiatric symptoms.
This current study suggests timing of tonsillectomy might matter—helping after PANDAS starts, not before.
Frequently Asked Questions
Does tonsillectomy cure PANDAS?
Not always. In this study, 4 out of 9 kids had complete resolution, but all improved significantly. Tonsillectomy may reduce symptom severity and prevent relapses, especially when antibiotics alone don’t help.
Is tonsillectomy a standard treatment for PANDAS?
No. It’s not part of current guidelines, but some doctors may consider it for kids with ongoing symptoms and frequent strep infections.
Are there risks with tonsillectomy?
As with any surgery, there are risks like bleeding and infection. But in this study, no serious adverse events were reported.
How long does it take to see results?
Many parents reported symptom relief within 3 months, and improvements continued at 6 months, 1 year, and even 3 years after surgery.
Conclusion
Tonsillectomy may offer real relief for children with PANDAS who don’t fully respond to antibiotics. While not a cure-all, the procedure appears to reduce symptom severity, and in some cases, eliminate symptoms altogether. This study encourages further research and consideration of tonsillectomy as part of the PANDAS treatment toolkit.