Clinical characteristics and treatment outcomes of pediatric patients with postencephalitic epilepsy characterized by epileptic spasms.

Lin Wan, Zhichao Li, Yulin Sun, Guang Yang, Yuan Zhang, Xiuyu Shi, Jing Wang, Liping Zou

Journal: Seizure 2021;84():116-121

PMID: 33341688

Free Full Text on Elsevier Science View on PubMed

Abstract

PURPOSE

Viral encephalitis (VE) or bacterial meningoencephalitis (BME) in early childhood may cause brain injury and neurological sequelae, including epilepsy. Postencephalitic epilepsy (PEE) characterized by epileptic spasms (ES) is a rare but serious condition; there is an urgent need to develop new methods to evaluate the characteristics of these children and select appropriate treatments.

METHODS

We conducted an observational study of 20 patients (11 males, 9 females) who experienced ES after VE or BME at the Chinese PLA General Hospital. Patients were followed up for over 12 months, and outcomes were analyzed.

RESULTS

The median ages at the onset of encephalitis and ES were 5.5 and 11.5 months, respectively. The median age at follow-up was 35.5 months. Sixteen (80 %) patients developed drug-resistant epilepsy (DRE), including all 12 patients with VE and 4 of 8 patients with BME. Epileptiform discharges were detected on electroencephalography, including 15 patients with hypsarrhythmia and 5 without. Fifteen of the patients were treated with a 14-day intravenous infusion of adrenocorticotropic hormone (ACTH) at a dose 2.5 U/kg (≤25 U); 12 showed a short-term response but 10 experienced recurrence. Three patients received vigabatrin, and none of these patients responded to treatment. Six patients started a ketogenic diet (KD); five failed to respond and the outcome was not known in one. Four patients were treated by vagus nerve stimulation (VNS), and all showed a partial response.

CONCLUSION

Children with PEE characterized by ES are more likely to develop DRE. The prognosis was worse for patients with VE compared to those with BME. Clarifying the efficacies of treatments involving ACTH (low-dose), KD, vigabatrin, and VNS will require further investigation.

Address: Medical School of Chinese PLA, Beijing, China; Department of Pediatrics, the First Medical Center, Chinese PLA General Hospital, Beijing, China. Electronic address: [email protected].; Medical School of Chinese PLA, Beijing, China; Department of Pediatrics, the First Medical Center, Chinese PLA General Hospital, Beijing, China. Electronic address: [email protected].; Medical School of Chinese PLA, Beijing, China; Department of Pediatrics, the First Medical Center, Chinese PLA General Hospital, Beijing, China. Electronic address: [email protected].; Department of Pediatrics, the First Medical Center, Chinese PLA General Hospital, Beijing, China. Electronic address: [email protected].; Ping An Healthcare Technology, Beijing, China. Electronic address: [email protected].; Department of Pediatrics, the First Medical Center, Chinese PLA General Hospital, Beijing, China. Electronic address: [email protected].; Department of Pediatrics, the First Medical Center, Chinese PLA General Hospital, Beijing, China. Electronic address: [email protected].; Department of Pediatrics, the First Medical Center, Chinese PLA General Hospital, Beijing, China. Electronic address: [email protected].

DOI: 10.1016/j.seizure.2020.12.004