Dr. Kumar’s Take:
This is a small case series, ten children who met strict PANDAS criteria at one center, with symptom severity tracked by parent report rather than by a blinded rater. There is no control group, so I read it as a signal and not as proof. That said, the signal is worth attention: every one of the nine children who went on to tonsillectomy reported improvement compared with antibiotics alone, including children who had no response to antibiotics at all, and four of those nine had complete resolution. For families dealing with strep-triggered flares of OCD or tics that antibiotics have not settled, this is a conversation worth having with an ENT.
Key Takeaways:
✔ Antibiotics alone moved the median severity score from a baseline of 10 to 8 (P = .03).
✔ All nine children who underwent tonsillectomy reported improvement compared with antibiotics alone.
✔ Four of the nine had complete resolution after tonsillectomy.
✔ Severity scores were lower at every time point measured after surgery, out to 3 years.
Actionable Tip:
If your child has PANDAS and is not improving on antibiotics alone, ask your ENT or pediatrician whether tonsillectomy is a reasonable next step. This is a ten-patient series, not a trial, so treat it as one input into that discussion rather than a settled answer.
Brief Summary:
Ten children met strict diagnostic criteria for PANDAS. Parents rated symptom severity at diagnosis, after antibiotic treatment, and, in the nine children who had surgery, after tonsillectomy. From a baseline severity score of 10, antibiotics alone brought the median to 8. After tonsillectomy the median fell to 3 at 3 months and stayed at or below that through 3 years, and four of the nine children had complete resolution. The authors conclude this cohort, whose symptoms did not respond sufficiently to antibiotics, may have gained benefit from tonsillectomy.
Study Design:
- Type: Case series with parent-reported outcomes
- Location: Albert Einstein College of Medicine and Children’s Hospital at Montefiore, Bronx, New York
- Participants: 10 children meeting strict PANDAS criteria
- Treatment: All 10 received antibiotics; 9 subsequently underwent tonsillectomy
- Follow-up: Assessments at 3 months, 6 months, 1 year, and 3 years after surgery
- Symptom tracking: Parent-reported severity scores at diagnosis, after antibiotics, and after tonsillectomy
Results:
- Baseline symptom score: Median 10
- After antibiotics: Median 8 (IQR 6.5 to 10.0), P = .03
- After tonsillectomy:
- 3 months: Median 3 (IQR 0.0 to 6.5), P = .01
- 6 months: Median 3 (IQR 0.0 to 5.0), P = .02
- 1 year: Median 3 (IQR 0.0 to 5.0), P = .02
- 3 years: Median 0.5 (IQR 0.0 to 2.3), P = .03
- Complete resolution: 4 of the 9 children who had surgery
- Response in antibiotic non-responders: Children with no response to antibiotics also reported improvement after tonsillectomy
Why Might Tonsillectomy Help in PANDAS?
PANDAS describes neuropsychiatric symptom exacerbations that relate temporally to streptococcal infections. The working hypothesis behind removing the tonsils is that reducing the tissue where strep repeatedly takes hold reduces the infections that trigger those exacerbations. This series was not designed to test that mechanism, so the reasoning remains a hypothesis rather than a demonstrated pathway.
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.
Frequently Asked Questions
Does tonsillectomy cure PANDAS?
Not for everyone. Four of the nine children who had surgery in this series had complete resolution, and the rest reported improvement compared with antibiotics alone. That is nine children at one center, so I would not promise any individual family a cure.
Is tonsillectomy a standard treatment for PANDAS?
No. The authors note that no consensus treatment guidelines exist. Some clinicians consider it for children whose symptoms persist despite antibiotics.
Are there risks with tonsillectomy?
Tonsillectomy is surgery, and the risks belong in a direct conversation with the surgeon who would perform it. This report tracked parent-rated symptom severity, so it is not the place to look for a full accounting of surgical safety.
How long does it take to see results?
Severity scores were already lower at the first post-surgical assessment, 3 months, and remained lower at 6 months, 1 year, and 3 years.
Conclusion
In this ten-patient series, children whose PANDAS symptoms did not respond sufficiently to antibiotics reported improvement after tonsillectomy, and four of the nine had complete resolution. The design is small, uncontrolled, and reliant on parent report, so the honest reading is that tonsillectomy deserves a proper trial rather than a place in routine practice. For a family that has run out of antibiotic options, it is a reasonable question to raise.
