Demesh Daniel, Virbalas Jordan M, Bent John P
Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York.
Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York2Children's Hospital at Montefiore, Bronx, New York.
JAMA Otolaryngol Head Neck Surg. 2015 Mar;141(3):272-5. doi: 10.1001/jamaoto.2014.3407.
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) in children describes neuropsychiatric symptom exacerbations that relate temporally to streptococcal infections. Recent case reports suggest tonsillectomy may effectively reduce these symptoms; however, no consensus treatment guidelines exist. This study examines whether tonsillectomy improves neuropsychiatric symptoms in children with PANDAS who have incomplete response to antibiotic therapy.
Ten patients met strict diagnostic criteria for PANDAS. Comparisons were made between parental reports of symptom severity at diagnosis, after antibiotic treatment (in 10 patients), and after tonsillectomy (in 9). From a baseline severity score of 10, antibiotics alone improved symptoms to a median (interquartile range [IQR]) score of 8 (6.5-10.0) (P = .03). Nine children who subsequently underwent tonsillectomy reported symptom improvement in comparison with treatment with antibiotics alone, including those with no response to antibiotics. Symptom severity improved at all periods after tonsillectomy compared with antibiotics alone. The median score [IQR] 3 months postoperatively was 3 (0.0-6.5) (P = .01); 6 months postoperatively, 3 (0.0-5.0) (P = .02); 1 year postoperatively, 3 (0.0-5.0) (P = .02); and 3 years postoperatively, 0.5 (0.0-2.3) (P = .03). Four of the 9 had complete resolution after tonsillectomy.
This PANDAS cohort whose neuropsychiatric symptoms did not respond sufficiently to antibiotics may have gained benefit from tonsillectomy.
儿童链球菌感染相关的自身免疫性神经精神障碍（PANDAS）描述了与链球菌感染在时间上相关的神经精神症状加重情况。近期的病例报告表明扁桃体切除术可能有效减轻这些症状；然而，目前尚无共识性的治疗指南。本研究旨在探讨扁桃体切除术是否能改善对抗生素治疗反应不完全的PANDAS患儿的神经精神症状。
10名患者符合PANDAS的严格诊断标准。比较了诊断时、抗生素治疗后（10名患者）以及扁桃体切除术后（9名患者）家长报告的症状严重程度。从基线严重程度评分为10开始，单纯使用抗生素可将症状改善至中位数（四分位间距[IQR]）评分为8（6.5 - 10.0）（P = 0.03）。9名随后接受扁桃体切除术的儿童报告称，与单纯使用抗生素治疗相比症状有所改善，包括那些对抗生素无反应的儿童。与单纯使用抗生素相比，扁桃体切除术后各阶段症状严重程度均有所改善。术后3个月的中位数评分[IQR]为3（0.0 - 6.5）（P = 0.01）；术后6个月为3（0.0 - 5.0）（P = 0.02）；术后1年为3（0.0 - 5.0）（P = 0.02）；术后3年为0.5（0.0 - 2.3）（P = 0.03）。9名患者中有4名在扁桃体切除术后症状完全缓解。
该PANDAS队列的神经精神症状对抗生素反应不充分，扁桃体切除术可能使其获益。
