Postencephalitic epilepsy and drug-resistant epilepsy after infectious and antibody-associated encephalitis in childhood: Clinical and etiologic risk factors.

Abstract

To define the risk factors for postencephalitic epilepsy (PE) and drug-resistant epilepsy (DRE) in childhood following infectious and autoimmune encephalitis, we included 147 acute encephalitis patients with a median follow-up of 7.3 years (range 2-15.8 years). PE was defined as the use of antiepileptic drugs (AEDs) for ≥24 months, and DRE was defined as the persistence of seizures despite ≥2 appropriate AEDs at final follow-up. PE and DRE were diagnosed in 31 (21%) and 15 (10%) of patients, respectively. The features during acute encephalitis predictive of DRE (presented as odds ratio [OR] with confidence intervals [CIs]) were status epilepticus (OR 10.8, CI 3.4-34.3), visual disturbance (6.4, 1.4-29.9), focal seizures (6.2, 1.9-20.6), magnetic resonance imaging (MRI) hippocampal/amygdala involvement (5.0, 1.7-15.4), intensive care admission (4.7, 1.4-15.4), use of >3 AEDs (4.5, 1.2-16.1), MRI gadolinium enhancement (4.1, 1.2-14.2), any seizure (3.9, 1.1-14.4), and electroencephalography (EEG) epileptiform discharges (3.9, 1.3-12.0). On multivariable regression analysis, only status epilepticus remained predictive of DRE in all models. DRE was common in herpes simplex virus (3/9, 33%) and unknown (8/40, 20%) encephalitis, but absent in acute disseminated encephalomyelitis (ADEM) (0/32, 0%), enterovirus (0/18), and anti-N-methyl-d-aspartate receptor-NMDAR encephalitis (0/9). We have identified risk factors for DRE and demonstrated "high-risk," and "low-risk" etiologies.

• Authors: Sekhar C Pillai, Shekeeb S Mohammad, Yael Hacohen, Esther Tantsis, Kristina Prelog, Elizabeth H Barnes, Deepak Gill, Ming J Lim, Fabienne Brilot, Angela Vincent, Russell C Dale
• Journal: Epilepsia (Epilepsia) Vol. 57 Issue 1 Pg. e7-e11 (Jan 2016) ISSN: 1528-1167 [Electronic] United States
• PMID: 26592968 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

Chemical References

• Autoantibodies
• CNTNAP2 protein, human
• Membrane Proteins
• Nerve Tissue Proteins
• Potassium Channels, Voltage-Gated
• Receptors, N-Methyl-D-Aspartate
• Glutamate Decarboxylase

Topics

• Adolescent
• Autoantibodies (blood)
• Child
• Child, Preschool
• Cohort Studies
• Drug Resistant Epilepsy (etiology)
• Electroencephalography
• Encephalitis (complications, immunology)
• Epilepsy (blood, etiology)
• Female
• Glutamate Decarboxylase (immunology)
• Humans
• Male
• Membrane Proteins (immunology)
• Nerve Tissue Proteins (immunology)
• Potassium Channels, Voltage-Gated (immunology)
• ROC Curve
• Receptors, N-Methyl-D-Aspartate (immunology)
• Risk Factors