title: Pediatric autoimmune neuropsychiatric disorder associated with group a streptococcal infection: the role of surgical treatment.
abstract: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus (PANDAS) is a well-defined syndrome in which tics (motor and/or vocal) and/or obsessive compulsive disorders (OCD) consistently exacerbate in temporal correlation to a Group A beta-haemolytic streptococcal infection. In children with PANDAS, there is speculation about whether tonsillectomy or adenotonsillectomy might improve the neuropsychiatric course. Our objective was to examine whether such surgery impacted remission or, in patients without remission, modified clinical course of the disease, streptococcal antibody titers, neuronal antibodies or clinical severity of Obsessive-Compulsive Disorder (OCD) and/or tics. Study participants (n = 120) with positive PANDAS criteria were recruited, examined, and divided into surgical or non-surgery groups. The surgical group consisted of children with tonsillectomy or adenotonsillectomy (n=56). The remaining children were categorized as non-surgery (n=64). Clinical follow-up was made every 2 months for more than 2 years. Surgery did not affect symptomatology progression, streptococcal and neuronal antibodies, or the clinical severity of neuropsychiatric symptoms in these children. In conclusion, in our series clinical progression, antibody production, and neuropsychiatric symptom severity did not differ on the basis of surgical status. We cannot uphold surgical management as likely to impact positive remission rates, course of OCD/tics, or antibody concentrations in children with PANDAS.
authors.affiliation: U.O. of Pediatrics and Pediatrics Emergency, Azienda Ospedaliera Universitaria, Policlinico Vittorio Emanuele, Catania, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Pavone
authors.affiliation: Occupational Medicine, Vittorio Emanuele, Policlinico Hospital, University of Catania, Catania, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Rapisarda
authors.affiliation: Department of Medical Surgical Specialties, ENT Clinic, University of Catania, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Serra
authors.affiliation: Department of Pediatrics, Child Neurology Division, Policlinico Umberto I, Sapienza University, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Nicita
authors.affiliation: Department of Pediatrics, Child Neurology Division, Policlinico Umberto I, Sapienza University, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Spalice
authors.affiliation: ISBN, The National Research Council of Italy, CNR, Catania, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Parano
authors.affiliation: Child Neuropsychiatric Division, Department of Pediatrics, AUO OVE, Policlinico, University of Catania , Catania, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Rizzo
authors.affiliation: Department of Medical Surgical Specialties, ENT Clinic, University of Catania, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Maiolino
authors.affiliation: Department of Medical Surgical Specialties, ENT Clinic, University of Catania, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Di Mauro
authors.affiliation: U.O. of Pediatrics and Pediatrics Emergency, Azienda Ospedaliera Universitaria, Policlinico Vittorio Emanuele, Catania, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Vitaliti
authors.affiliation: U.O. of Pediatrics and Pediatrics Emergency, Azienda Ospedaliera Universitaria, Policlinico Vittorio Emanuele, Catania, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Coco
authors.affiliation: U.O. of Pediatrics and Pediatrics Emergency, Azienda Ospedaliera Universitaria, Policlinico Vittorio Emanuele, Catania, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Falsaperla
authors.affiliation: Morristown Children's Hospital, New York, USA.
authors.forename: R R
authors.initials: RR
authors.lastname: Trifiletti
authors.affiliation: Department of Medical Surgical Specialties, ENT Clinic, University of Catania, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Cocuzza
mesh_terms: D000233:Adenoidectomy; D001327:Autoimmune Diseases / Q000209:etiology*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000209:etiology*; D013290:Streptococcal Infections / Q000150:complications*; D013297:Streptococcus pyogenes; D020323:Tics / Q000209:etiology*; D014068:Tonsillectomy