PANDAS: A systematic review of treatment options.
BACKGROUND
Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) is a rare but important condition for pediatric otolaryngologists to recognize. Several treatment options exist including tonsillectomy, antibiotic treatment/prophylaxis, intravenous immunoglobulin (IVIG), and psychiatric medications/therapy.


METHODS
A systematic review of the PubMed, EMBASE, and Scopus databases was performed searching for articles that focused exclusively on the aforementioned treatment modalities in the PANDAS population. Review articles, single patient case reports, and studies examining the natural history or diagnostic strategies were excluded.


RESULTS
Five articles regarding tonsillectomy treatments with level of evidence (LOE) 4 were found but no clear benefit could be determined. Three articles were selected involving the use of antibiotic therapy. One prospective study and one double-blind randomized control trial (DB RCT) supported the use of antibiotics but a separate DB RCT showed no benefit. Two selected articles described the use of IVIG: one unblinded RCT and one retrospective study. One prospective study on cognitive-behavioral therapy (CBT) showed benefit in PANDAS.


CONCLUSIONS
There is a paucity of high-level studies regarding this rare disorder and no hard treatment recommendations can be made. Tonsillectomy should only be performed in those who are surgical candidates based on current published guidelines. Antibiotics are an option but provide uncertain benefit. CBT remains a low-risk option. Studies support the use of IVIG, however more investigation is needed prior to widespread adoption of this treatment given its potential risks.
Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, United States.
Zachary
Z
Farhood
Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, United States.
Adrian A
AA
Ong
Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, United States. Electronic address: discolo@musc.edu.
Christopher M
CM
Discolo
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001327:Autoimmune Diseases / Q000188:drug therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods; D019468:Disease Management; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D009771:Obsessive-Compulsive Disorder; D013290:Streptococcal Infections / Q000188:drug therapy*; D014068:Tonsillectomy / Q000379:methods*
D000900:Anti-Bacterial Agents; D016756:Immunoglobulins, Intravenous
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections; Treatment