SEIZURES IN THE POST ENCEPHALITIC/ENCEPHALOPATHIC SETTING IN CHILDREN
Abstract number :
1.237
Submission category :
Year :
2002
Submission ID :
69
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Michele M. Van Hirtum-Das, Wendy G. Mitchell. Division of Neurology, Childrens Hospital Los Angeles, Los Angeles, CA
RATIONALE: To evaluate characteristics and predictors of persistent seizures in children who have suffered an encephalitic/encephalopathic illness.
Objective: At the end of this activity the participants should be able to discuss the development of seizures, characterize seizure type, and describe the common EEG abnormalities in children admitted with encephalitis/encephalopathy.
METHODS: A retrospective review of the medical records of patients admitted with encephalitis/encephalopathy from 12/89 to 12/01 was performed. Data abstracted included: age, gender, presenting features, laboratories, neuroimaging, EEG, and neuropsychologic testing. Time course was categorized as: prodromal (day -30 to admission), early (day 0-7), middle (days 8-30), and late (beyond day 30).
RESULTS: 91 patients were included (60% male), mean age 5.1years (1week-13years). Early seizures were present in 66%: 34% partial, 25% generalized, 7% status epilepticus. Late seizures occurred in 32%: 19% partial, 9% generalized, 2% myoclonic, with the clinical seizure type often evolving over time. EEG was abnormal early in 54 of 65 patients (83%), with diffuse slowing/disorganization in 29%, focal slowing in 20%, focal epileptiform discharges on a normal background in 14%, epileptiform discharges on a slow background in 9%, generalized epileptiform discharges in 5%, and multifocal discharges in 6%. Late EEG abnormalities were found in 74% (25 of 34 patients who had EEG), with diffuse slowing/disorganization present in the majority (35%).
Predictors of late seizures included: middle seizure (r=.822, p[lt].001) and early abnormal EEG (40% vs. 0% of patients with late seizures who had an initial normal EEG, p[lt].001). Age, gender, and CSF WBC did not correlate with late seizure. Neither focal nor bilateral/diffuse neuroimaging abnormality correlated with seizure either early or late.
CONCLUSIONS: In the setting of an acute encephalitis/encephalopathy, children with seizures persisting beyond the first week of hospitalization were more likely to develop a chronic seizure disorder. Serum/CSF laboratory values and neuroimaging findings were not predictive of outcome regarding seizures. EEG abnormalities correlated with the development of late seizures.