A modern understanding of role of tonsillectomy in tonsillogenic neurological diseases and neuropsychiatric disorders

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Abstract

The association between chronic tonsillitis and neurological and neuropsychiatric disorders is well described in the literature. The role of streptococcal infections is considered obvious, although there is no clear understanding of the pathophysiological mechanism. A cross autoimmune reaction with basal ganglia antigens is thought to play a key role in the development of this group of disorders.

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are the most studied of these groups. Antibacterial therapy is the main treatment option, but there are no reliable recommendations for its use.

No significant changes in the clinical manifestations were observed after tonsillectomy, and the positive results described in some observational studies could have been caused by postoperative treatments.

The paper suggests that chronic tonsillitis may have an effect on the risk of other mental disorders, such as obsessive-compulsive disorder, bipolar disorder, attention-deficit/hyperactivity disorder, autism spectrum disorder, anxiety disorders, and migraines.

Large randomized trials are needed to make definitive conclusions about the advisability of tonsillectomy in patients with PANDAS and other disorders. One of the most promising areas is to study the microbiota of the palatine tonsils and its contribution to migraine. If confirmed, these data will increase importance of nonsurgical treatment of palatine tonsils by their thorough irrigation.

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About the authors

Tatiana S. Zaitseva

Center “Head and Neck Surgery”

Email: zaitzevat@gmail.com
ORCID iD: 0009-0000-2818-4006
SPIN-code: 4945-9349

MD

Russian Federation, 21 Novosuschevskaya St., Moscow, 119034

Anna A. Nesterova

Center “Head and Neck Surgery”

Email: annamedical@gmail.com
ORCID iD: 0000-0002-2637-855X
SPIN-code: 1942-5352

MD, Cand. Sci. (Medicine)

Russian Federation, 21 Novosuschevskaya St., Moscow, 119034

Klimentina I. Nesterova

Omsk State Medical University

Email: klnesterova@gmail.com
ORCID iD: 0000-0002-9793-7179
SPIN-code: 9253-9964
Scopus Author ID: 8555826800

MD, Dr. Sci. (Medicine)

Russian Federation, Omsk

Ruben G. Mirakyan

Center “Head and Neck Surgery”

Author for correspondence.
Email: rgmirakyan@lormedcentr.ru
ORCID iD: 0000-0003-3463-2308

MD, Cand. Sci. (Medicine)

Russian Federation, 21 Novosuschevskaya St., Moscow, 119034

Irina A. Shcherbina

Omsk State Medical University

Email: irash1959@bk.ru
ORCID iD: 0009-0007-2909-6826
SPIN-code: 9353-7996

MD, Cand. Sci. (Medicine)

 

Russian Federation, Omsk

References

  1. Karpishchenko SA, Lavrenova GV, Baranskaya SV. Tonsillitis and tonsillogenic conditions. Russian bulletin of otorhinolaryngology. 2016;81(4):69–71. EDN: WIAACR doi: 10.17116/otorino201681469-71
  2. Lavrenova GV, Nesterova KI, Yaremenko KV, Nesterova AA. The rationale for the conservative treatment of chronic tonsillitis in the patients of the older age groups by the “soft” therapy methods. Russian bulletin of otorhinolaryngology. 2016;81(4):22–26. EDN: WHZZYL doi: 10.17116/otorino201681422-26
  3. La Bella S, Scorrano G, Rinaldi M, et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): Myth or reality? The state of the art on a controversial disease. Microorganisms. 2023;11(10):2549. doi: 10.3390/microorganisms11102549
  4. Karpishchenko SA, Svistushkin SM, Lavrenov GV, editors. Chronic and acute tonsillitis. Immunological and clinical aspects. Saint Petersburg: Dialog; 2020. 264 p. (In Russ.) EDN: ZRHBGL
  5. Swedo SE, Leonard HL, Garvey M, et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: Clinical description of the first 50 cases. Am J Psychiatry. 1998;155(2):264–271. doi: 10.1176/ajp.155.2.264
  6. Calaprice D, Tona J, Parker-Athill EC, Murphy TK. A survey of pediatric acute-onset neuropsychiatric syndrome characteristics and course. J Child Adolesc Psychopharmacol. 2017;27(7):607–618. doi: 10.1089/cap.2016.0105
  7. Thienemann M, Murphy T, Leckman J, et al. Clinical management of pediatric acute-onset neuropsychiatric syndrome: Part I – Psychiatric and behavioral interventions. J Child Adolesc Psychopharmacol. 2017;27(7):566–573. doi: 10.1089/cap.2016.0145
  8. Gewitz MH, Baltimore RS, Tani LY, et al. Revision of the Jones criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography. Circulation. 2015;131(20):1806–1818. doi: 10.1161/CIR.0000000000000205
  9. Uspenskaya TL, Vinogradova TV, Ipatova SL, et al. Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (Pandas syndrome): Real-world practice and clinical case. Children infections. 2019;18(3(68)):53–56. EDN: BFNSQZ doi: 10.22627/2072-8107-2019-18-3-53-56
  10. Kirvan CA, Canini H, Swedo SE, et al. IGG2 rules: N-acetyl-β-D-glucosamine-specific IGG2 and TH17/th1 cooperation may promote the pathogenesis of acute rheumatic heart disease and be a biomarker of the autoimmune sequelae of streptococcus pyogenes. Front Cardiovasc Med. 2023;9:919700. doi: 10.3389/fcvm.2022.919700
  11. Garvey MA, Giedd J, Swedo SE. Topical review: Pandas: The Search for environmental triggers of pediatric neuropsychiatric disorders. Lessons from rheumatic fever. J Child Neurol. 1998;13(9):413–423. doi: 10.1177/088307389801300901
  12. Kumar A, Williams MT, Chugani HT. Evaluation of basal ganglia and thalamic inflammation in children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection and tourette syndrome: a positron emission tomographic (PET) study using 11C-[R]-PK11195. J Child Neurol. 2015;30(6):749–756. doi: 10.1177/0883073814543303
  13. Kirvan CA, Swedo SE, Kurahara D, Cunningham MW. Streptococcal mimicry and antibody-mediated cell signaling in the pathogenesis of Sydenham’s chorea. Autoimmunity. 2006;39(1):21–29. doi: 10.1080/08916930500484757
  14. Chain JL, Alvarez K, Mascaro-Blanco A, et al. Autoantibody biomarkers for basal ganglia encephalitis in Sydenham chorea and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections. Front Psychiatr. 2020;11:564. doi: 10.3389%2Ffpsyt.2020.00564
  15. Cox CJ, Sharma M, Leckman JF, et al. Brain human monoclonal autoantibody from Sydenham chorea targets dopaminergic neurons in transgenic mice and signals dopamine D2 receptor: Implications in human disease. J Immunol. 2013;191(11):5524–5541. doi: 10.4049/jimmunol.1102592
  16. Xu J, Liu RJ, Fahey S, et al. Antibodies from children with pandas bind specifically to striatal cholinergic interneurons and alter their activity. Am J Psychiatr. 2021;178(1):48–64. doi: 10.1176/appi.ajp.2020.19070698
  17. Lougee L, Perlmutter SJ, Nicolson R, et al. Psychiatric disorders in first-degree relatives of children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). J Am Acad Child Adolesc Psychiatr. 2000;39(9):1120–1126. doi: 10.1097/00004583-200009000-00011
  18. Gilbert DL, Mink JW, Singer HS. A pediatric neurology perspective on pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection and pediatric acute-onset neuropsychiatric syndrome. J Pediatr. 2018;199:243–251. doi: 10.1016/j.jpeds.2018.04.035
  19. Cocuzza S, Maniaci A, La Mantia I, et al. Obsessive-compulsive disorder in pans/pandas in children: in search of a qualified treatment-a systematic review and metanalysis. Children (Basel). 2022;9(2):155. doi: 10.3390/children9020155
  20. Demesh D, Virbalas JM, Bent JP. The role of tonsillectomy in the treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). JAMA Otolaryngol Head Neck Surg. 2015;141(3):272–275. doi: 10.1001/jamaoto.2014.3407
  21. Murphy TK, Lewin AB, Parker-Athill EC, et al. Tonsillectomies and adenoidectomies do not prevent the onset of pediatric autoimmune neuropsychiatric disorder associated with Group A Streptococcus. Pediatr Infect Dis J. 2013;32(8):834–838. doi: 10.1097/inf.0b013e31829062e2
  22. Pavone P, Rapisarda V, Serra A, et al. Pediatric autoimmune neuropsychiatry disorder associated with group a streptococcal infection: The role of surgical treatment. Int J Immunopathol Pharmacol. 2014;27(3):371–378. doi: 10.1177/039463201402700307
  23. Windfuhr JP. Tonsillectomy remains a questionable option for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). GMS Curr Top Otorhinolaryngol Head Neck Surg. 2016;15:Doc07. doi: 10.3205/cto000134
  24. Blockij AA, Antipenko VV. Hronicheskij tonzillit. Blagoveshchensk: FGBOU VO Amurskaya GMA MZ RF; 2018. (In Russ.)
  25. Isung J, Isomura K, Almqvist C, et al. Association of chronic and acute inflammation of the mucosa-associated lymphoid tissue with psychiatric disorders and suicidal behavior. Transl Psychiatry. 2019;9(1):227. doi: 10.1038/s41398-019-0568-5
  26. Georgiou AN, Voskarides K, Zanos P, Chatzittofis A. Investigating the shared genetic basis and causal relationships between mucosa-associated lymphoid tissue inflammation and psychiatric disorders. Front Psychiatry. 2024;15:1379922. doi: 10.3389/fpsyt.2024.1379922
  27. Chang HC, Lu HY, Guo YC, et al. Depression risk in chronic tonsillitis patients underwent tonsillectomy: a global federated health network analysis. Int J Med Sci. 2024;21(5):949–957. doi: 10.7150/ijms.93977
  28. Tihomirova IA. Somatic and neurological pathology in chronic diseases of the nasal cavity and lymphoepithelial pharyngeal ring in children. Rossijskaya otorinolaringologiya. 2008;(3(34)):13–22. (In Russ.) EDN: JSCYHJ
  29. Belousov AA, Khrabrikov AN. Clinical and psychological features of patients with chronic tonsillitis. Rossijskaya otorinolaringologiya. 2018;(5(96)):14–19. EDN: UCEHJK doi: 10.18692/1810-4800-2018-5-14-19
  30. Gonzalez A, Hyde E, Sangwan N, et al. Migraines are correlated with higher levels of nitrate-, nitrite-, and nitric oxide-reducing oral microbes in the American gut project cohort. mSystems. 2016;1(5):e00105–16. doi: 10.1128/msystems.00105-16

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