80 / 232
references of full-text included articles were scanned for additional
sources. Level of evidence was assessed using the Oxford Centre for
Evidence Based Medicine criteria
[2]
.
3. Results
The results of our search strategy are shown in
Fig. 1
. Thirteen
articles were ultimately included in this review. The following
sections details the search results by treatment modality.
3.1. Adenotonsillectomy
Six articles regarding tonsillectomy treatments were found
[3
e
8]
; all PANDAS patients received tonsillectomy for conditions
which met the criteria of the American Academy of
Otolaryngology-Head
&
Neck Surgery
[9]
. Orvidas
&
Slattery re-
ported two siblings who although responded symptomatically to
antibiotic treatment during Group-A Beta-Hemolytic Streptococcus
(GABHS) infections, underwent tonsillectomy with resolution of
symptoms in one child and improvement in the other 11 months
Table 1
Swedo criteria for diagnosis of PANDAS.
Swedo criteria
1 Presence of OCD and/or a tic disorder.
2 Symptom onset between 3 years of age and the beginning of puberty.
3 Episodic clinical course: abrupt symptom onset or exacerbations of OCD/tics. Symptoms usually decrease between episodes or may resolve completely.
4 Association of the exacerbation with evidence of group A
b
-hemolytic (GABHS) streptococcal infection, i.e., a positive throat culture and/or increased levels of anti-
GABHS antibody titers.
5 Association with neurologic abnormalities such as adventitious movements and/or motoric hyperactivity.
Table 2
Search methods used in systematic review.
Term
PANDAS AND
(tonsillectomy OR adenotonsil*)
(antibiotic* OR penicillin OR augmentin
OR cephalosporin* OR azithro*)
(intravenous immunoglobulin OR IVIG)
(cognitive behavioral therapy)
(
fl
uoxetine OR
fl
uvoxamine OR sertraline
OR paroxetine OR SSRI OR selective serotonin reuptake inhibitor)
Fig. 1.
Literature search results.
Z. Farhood et al. / International Journal of Pediatric Otorhinolaryngology 89 (2016) 149
e
153
58