Postencephalitic epilepsy and drug‐resistant epilepsy after infectious and antibody‐associated encephalitis in childhood: Clinical and etiologic risk factors |
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| 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 |
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| Affiliation: | 1. Neuroimmunology Group, Institute for Neuroscience and Muscle Research at The Kids Research Institute, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia;2. TY Nelson Department of Neurology and Neurosurgery, Children's Hospital at Westmead, Sydney, New South Wales, Australia;3. Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom;4. Department of Medical Imaging, Children's Hospital at Westmead, Sydney, New South Wales, Australia;5. NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia;6. Department of Statistics, Children's Hospital at Westmead, Sydney, New South Wales, Australia;7. Evelina London Children's Hospital, London, United Kingdom |
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| 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. |
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| Keywords: | Encephalitis Infection Autoimmune Epilepsy Outcome |
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