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Omata T, Aoyama H, Murayama K, Takayanagi M, Kawaguchi R, Fujimoto R, Takanashi JI. Efficacy of a mitochondrial drug cocktail in preventing acute encephalopathy with biphasic seizures and late reduced diffusion. J Neurol Sci 2024; 466:123245. [PMID: 39303350 DOI: 10.1016/j.jns.2024.123245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 09/12/2024] [Accepted: 09/15/2024] [Indexed: 09/22/2024]
Abstract
Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is difficult to differentiate from prolonged febrile seizures during the acute phase. Mitochondrial dysfunction-induced energy depletion is among the key mechanisms underlying acute encephalopathy. Therefore, this study aimed to examine the efficacy of a "mitochondrial cocktail" in preventing AESD. We retrospectively studied children experiencing status epilepticus associated with fever lasting more than 30 min, focusing on those who received the mitochondrial cocktail between February 2016 and December 2020, and those who did not receive it within 24 h between February 2012 and January 2014. The mitochondrial cocktail contained vitamins B1, C, and E; biotin; coenzyme Q10; and l-carnitine. AESD occurred in 1 of 41 (2.4 %) patients in the administration group and 7 of 39 (17.9 %) patients in the non-administration group. The incidence of AESD was lower in the administration group than in the non-administration group, with a significant difference (p = 0.027). The incidence of encephalopathy, including cases classified as AESD and unclassified, was 7/41 (17.1 %) and 7/39 (17.9 %) in the administration and non-administration groups, respectively, with no significant difference. However, the number of cases with worsening pediatric cerebral performance category scores was significantly lower in the administration group compared to the non-administration group (p = 0.015). In conclusion, early administration of the mitochondrial cocktail may help prevent AESD. Some encephalopathy cases do not progress to a biphasic state or develop AESD. Thus, the mitochondrial cocktail should be administered as early as possible to prevent AESD.
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Affiliation(s)
- Taku Omata
- Department of Pediatrics, Tokyo Women's Medical University, Yachiyo Medical Center, Yachiyo, Japan.
| | - Hiromi Aoyama
- Division of Child Neurology, Chiba Children's Hospital, Chiba, Japan
| | - Kei Murayama
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Masaki Takayanagi
- Department of Physical Therapy, Faculty of Health Care and Medical Sports, Teikyo Heisei University, Chiba, Japan
| | - Risa Kawaguchi
- Division of Child Neurology, Chiba Children's Hospital, Chiba, Japan
| | - Ryo Fujimoto
- Division of Child Neurology, Chiba Children's Hospital, Chiba, Japan
| | - Jun-Ichi Takanashi
- Department of Pediatrics, Tokyo Women's Medical University, Yachiyo Medical Center, Yachiyo, Japan
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Yasukohchi M, Omata T, Ochiai K, Sano K, Murofushi Y, Kimura S, Takase N, Honda T, Yasukawa K, Takanashi JI. Pathomechanism of infantile traumatic brain injury with a biphasic clinical course and late reduced diffusion evaluated by MR spectroscopy. J Neurol Sci 2024; 466:123228. [PMID: 39278172 DOI: 10.1016/j.jns.2024.123228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 08/26/2024] [Accepted: 09/08/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND Infantile traumatic brain injury (TBI) with a biphasic clinical course and late reduced diffusion (TBIRD) has recently been reported as a distinct type of TBI in infancy. However, the pathological and prognostic factors of TBIRD remain unknown. We aimed to compare patients with and without TBIRD and evaluate the pathomechanism of TBIRD using magnetic resonance spectroscopy (MRS). METHODS Ten Japanese patients with TBI were admitted to our hospital and underwent MRS between September 2015 and September 2022 (age range, 3-15 months; median age, 8.5 months). TBIRD was diagnosed in six patients. MRS data were compared among patients with TBIRD, patients without TBIRD, and controls. Neurological prognosis was classified into grades 1 (normal) to 3 (severe). RESULTS In patients with TBIRD, MRS revealed an increase in the glutamine (Gln) level on days 3-29, which subsequently became close to normal. The degree of Gln elevation in the non-TBIRD group was smaller (117-158 % of controls) than that in the TBIRD group (210-337 %) within 14 days. MRS in the TBIRD group showed decreased N-acetyl aspartate (NAA) concentrations. The degree of NAA decrease was more prominent in grade 3 than in grades 1 and 2. NAA levels in the non-TBIRD group were almost normal. CONCLUSIONS Patients with TBI and markedly elevated Gln levels on MRS may develop TBIRD. Neuro-excitotoxicity is a possible pathological mechanism of TBIRD. Decreased NAA levels may be useful for predicting the prognosis of patients with TBIRD.
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Affiliation(s)
- Madoka Yasukohchi
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo-shi, Chiba 276-8524, Japan.
| | - Taku Omata
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo-shi, Chiba 276-8524, Japan.
| | - Kenta Ochiai
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo-shi, Chiba 276-8524, Japan
| | - Kentaro Sano
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo-shi, Chiba 276-8524, Japan
| | - Yuka Murofushi
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo-shi, Chiba 276-8524, Japan
| | - Sho Kimura
- Department of Pediatric Critical Care Medicine, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo-shi, Chiba 276-8524, Japan
| | - Nanako Takase
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo-shi, Chiba 276-8524, Japan
| | - Takafumi Honda
- Department of Pediatric Critical Care Medicine, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo-shi, Chiba 276-8524, Japan.
| | - Kumi Yasukawa
- Department of Pediatric Critical Care Medicine, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo-shi, Chiba 276-8524, Japan.
| | - Jun-Ichi Takanashi
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadashinden, Yachiyo-shi, Chiba 276-8524, Japan.
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Murthy MC, Banerjee B, Acharya U, Shamarao S. Acute Encephalopathy with Biphasic Seizures and Late Reduced Diffusion following SARS-CoV-2 Infection-A Rare Case Report. Indian J Radiol Imaging 2024; 34:181-184. [PMID: 38106861 PMCID: PMC10723947 DOI: 10.1055/s-0043-1775797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a clinicoradiological syndrome first recognized during the influenza pandemic in Japanese population in the late twentieth century. 1 In this article, we presented a rare case report of AESD in a young child due to severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2) who presented with febrile status epilepticus, persistent encephalopathy, and had recurrence of seizures on day 4 of illness with characteristic magnetic resonance imaging findings and a relatively fair outcome.
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Affiliation(s)
- Manasa C. Murthy
- Division of Pediatric Neurology, Manipal Hospital, Hal Airport Road, Bengaluru, Karnataka, India
| | - Bidisha Banerjee
- Division of Pediatric Neurology, Manipal Hospital, Hal Airport Road, Bengaluru, Karnataka, India
| | - Ullas Acharya
- Department of Radiology and Imaging, Manipal Hospital, Bengaluru, Karnataka, India
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Nagase H, Yamaguchi H, Tokumoto S, Ishida Y, Tomioka K, Nishiyama M, Nozu K, Maruyama A. Timing of therapeutic interventions against infection-triggered encephalopathy syndrome: a scoping review of the pediatric literature. Front Neurosci 2023; 17:1150868. [PMID: 37674514 PMCID: PMC10477367 DOI: 10.3389/fnins.2023.1150868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023] Open
Abstract
Our goal was to conduct a scoping review of the literature on the treatment of infection-triggered encephalopathy syndrome/acute encephalopathy in children, focusing on treatment targets and treatment initiation timing. We performed literature searches using PubMed for articles reporting treatments of infection-triggered encephalopathy syndrome/acute encephalopathy. We included articles describing specific treatments for acute encephalopathy with control groups. For the purpose of searching new therapies only experimentally tried in the case series, we also included case series studies without control groups in this review, if the studies contained at least two cases with clear treatment goals. Therapies were classified based on their mechanisms of action into brain protection therapy, immunotherapy, and other therapies. We operationally categorized the timing of treatment initiation as T1 (6-12 h), T2 (12-24 h), T3 (24-48 h), and T4 (>48 h) after the onset of seizures and/or impaired consciousness. Thirty articles were included in this review; no randomized control study was found. Eleven retrospective/historical cohort studies and five case-control studies included control groups with or without specific therapies or outcomes. The targeted conditions and treatment timing varied widely across studies. However, the following three points were suggested to be effective in multiple studies: (1) Careful seizure management and targeted temperature management within 12 h (T1) of onset of febrile seizure/prolonged impaired consciousness without multiple organ failure may reduce the development of acute encephalopathy with biphasic seizures and late reduced diffusion; (2) immunotherapy using corticosteroids, tocilizumab, or plasma exchange within 24 h (T1-T2) of onset of acute necrotizing encephalopathy may reduce sequelae; and (3) anakinra therapy and ketogenic diet demonstrate little evidence of neurologic sequelae reduction, but may reduce seizure frequency and allow for weaning from barbiturates, even when administered weeks (T4) after onset in children with febrile infection-related epilepsy syndrome. Although available studies have no solid evidence in the treatment of infection-triggered encephalopathy syndrome/acute encephalopathy, this scoping review lays the groundwork for future prospective clinical trials.
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Affiliation(s)
- Hiroaki Nagase
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Yamaguchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shoichi Tokumoto
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yusuke Ishida
- Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
- Department of Emergency and General Pediatrics, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Kazumi Tomioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Nishiyama
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Azusa Maruyama
- Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
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Aleshin VA, Graf AV, Artiukhov AV, Ksenofontov AL, Zavileyskiy LG, Maslova MV, Bunik VI. Pentylenetetrazole-Induced Seizures Are Increased after Kindling, Exhibiting Vitamin-Responsive Correlations to the Post-Seizures Behavior, Amino Acids Metabolism and Key Metabolic Regulators in the Rat Brain. Int J Mol Sci 2023; 24:12405. [PMID: 37569781 PMCID: PMC10418815 DOI: 10.3390/ijms241512405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 07/30/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
Epilepsy is characterized by recurrent seizures due to a perturbed balance between glutamate and GABA neurotransmission. Our goal is to reveal the molecular mechanisms of the changes upon repeated challenges of this balance, suggesting knowledge-based neuroprotection. To address this goal, a set of metabolic indicators in the post-seizure rat brain cortex is compared before and after pharmacological kindling with pentylenetetrazole (PTZ). Vitamins B1 and B6 supporting energy and neurotransmitter metabolism are studied as neuroprotectors. PTZ kindling increases the seizure severity (1.3 fold, p < 0.01), elevating post-seizure rearings (1.5 fold, p = 0.03) and steps out of the walls (2 fold, p = 0.01). In the kindled vs. non-kindled rats, the post-seizure p53 level is increased 1.3 fold (p = 0.03), reciprocating a 1.4-fold (p = 0.02) decrease in the activity of 2-oxoglutarate dehydrogenase complex (OGDHC) controlling the glutamate degradation. Further, decreased expression of deacylases SIRT3 (1.4 fold, p = 0.01) and SIRT5 (1.5 fold, p = 0.01) reciprocates increased acetylation of 15 kDa proteins 1.5 fold (p < 0.01). Finally, the kindling abrogates the stress response to multiple saline injections in the control animals, manifested in the increased activities of the pyruvate dehydrogenase complex, malic enzyme, glutamine synthetase and decreased malate dehydrogenase activity. Post-seizure animals demonstrate correlations of p53 expression to the levels of glutamate (r = 0.79, p = 0.05). The correlations of the seizure severity and duration to the levels of GABA (r = 0.59, p = 0.05) and glutamate dehydrogenase activity (r = 0.58, p = 0.02), respectively, are substituted by the correlation of the seizure latency with the OGDHC activity (r = 0.69, p < 0.01) after the vitamins administration, testifying to the vitamins-dependent impact of the kindling on glutamate/GABA metabolism. The vitamins also abrogate the correlations of behavioral parameters with seizure duration (r 0.53-0.59, p < 0.03). Thus, increased seizures and modified post-seizure behavior in rats after PTZ kindling are associated with multiple changes in the vitamin-dependent brain metabolism of amino acids, linked to key metabolic regulators: p53, OGDHC, SIRT3 and SIRT5.
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Affiliation(s)
- Vasily A. Aleshin
- A.N. Belozersky Institute of Physicochemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia; (V.A.A.)
- Department of Biochemistry, Sechenov University, Trubetskaya, 8, Bld. 2, 119991 Moscow, Russia
| | - Anastasia V. Graf
- Faculty of Biology, Lomonosov Moscow State University, 119234 Moscow, Russia
- Faculty of Nano-, Bio-, Informational, Cognitive and Socio-Humanistic Sciences and Technologies at Moscow Institute of Physics and Technology, Maximova Street 4, 123098 Moscow, Russia
| | - Artem V. Artiukhov
- A.N. Belozersky Institute of Physicochemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia; (V.A.A.)
- Department of Biochemistry, Sechenov University, Trubetskaya, 8, Bld. 2, 119991 Moscow, Russia
| | - Alexander L. Ksenofontov
- A.N. Belozersky Institute of Physicochemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia; (V.A.A.)
| | - Lev G. Zavileyskiy
- Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, 119991 Moscow, Russia
| | - Maria V. Maslova
- Faculty of Biology, Lomonosov Moscow State University, 119234 Moscow, Russia
| | - Victoria I. Bunik
- A.N. Belozersky Institute of Physicochemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia; (V.A.A.)
- Department of Biochemistry, Sechenov University, Trubetskaya, 8, Bld. 2, 119991 Moscow, Russia
- Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, 119991 Moscow, Russia
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Bunik V. The Therapeutic Potential of Vitamins B1, B3 and B6 in Charcot-Marie-Tooth Disease with the Compromised Status of Vitamin-Dependent Processes. BIOLOGY 2023; 12:897. [PMID: 37508330 PMCID: PMC10376249 DOI: 10.3390/biology12070897] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/11/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023]
Abstract
Understanding the molecular mechanisms of neurological disorders is necessary for the development of personalized medicine. When the diagnosis considers not only the disease symptoms, but also their molecular basis, treatments tailored to individual patients may be suggested. Vitamin-responsive neurological disorders are induced by deficiencies in vitamin-dependent processes. These deficiencies may occur due to genetic impairments of proteins whose functions are involved with the vitamins. This review considers the enzymes encoded by the DHTKD1, PDK3 and PDXK genes, whose mutations are observed in patients with Charcot-Marie-Tooth (CMT) disease. The enzymes bind or produce the coenzyme forms of vitamins B1 (thiamine diphosphate, ThDP) and B6 (pyridoxal-5'-phosphate, PLP). Alleviation of such disorders through administration of the lacking vitamin or its derivative calls for a better introduction of mechanistic knowledge to medical diagnostics and therapies. Recent data on lower levels of the vitamin B3 derivative, NAD+, in the blood of patients with CMT disease vs. control subjects are also considered in view of the NAD-dependent mechanisms of pathological axonal degeneration, suggesting the therapeutic potential of vitamin B3 in these patients. Thus, improved diagnostics of the underlying causes of CMT disease may allow patients with vitamin-responsive disease forms to benefit from the administration of the vitamins B1, B3, B6, their natural derivatives, or their pharmacological forms.
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Affiliation(s)
- Victoria Bunik
- Belozersky Institute of Physicochemical Biology, Department of Biokinetics, Lomonosov Moscow State University, 119234 Moscow, Russia
- Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, 119234 Moscow, Russia
- Department of Biochemistry, Sechenov University, 119048 Moscow, Russia
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Changes in the treatment of pediatric acute encephalopathy in Japan between 2015 and 2021: A national questionnaire-based survey. Brain Dev 2023; 45:153-160. [PMID: 36446696 DOI: 10.1016/j.braindev.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although acute encephalopathy (AE) is the most serious disorder associated with a viral infection in childhood and often causes death or neurological sequelae, standard treatments have not been established. In 2016, the Japanese Society of Child Neurology published the "Guidelines for the Diagnosis and Treatment of Acute Encephalopathy in Childhood 2016" (AE GL 2016). We conducted a questionnaire survey to evaluate the status of the treatment of pediatric AE in 2021 and the changes in treatment before and after the publication of the AE GL 2016. METHODS In October 2021, questionnaires were mailed via the web to members of two mailing lists who were involved in the practice of pediatric neurological disorders. RESULTS Most Japanese physicians (98 %) engaged in the treatment of pediatric AE used the AE GL 2016 as a clinical reference. From 2015 to 2021, the number of institutions that implemented targeted temperature management (TTM), vitamin administration, and continuous electroencephalographic monitoring increased significantly. Regarding the targeted temperature for TTM, the proportion of patients who were treated with normothermia (36.0-37.0 °C) increased from 2015 (55 %) to 2021 (79 %). The use of corticosteroids in patients with AE caused by a cytokine storm, which is recommended in the AE GL 2016, had already been implemented in most institutions by 2015. CONCLUSION The AE GL 2016 could be used to disseminate the knowledge accumulated to date. Evidence of the efficacy and proper indication criteria for the treatment of AE is insufficient and must be further accumulated.
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Yang MT, Chou IC, Wang HS. Role of vitamins in epilepsy. Epilepsy Behav 2023; 139:109062. [PMID: 36577336 DOI: 10.1016/j.yebeh.2022.109062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/27/2022]
Abstract
Epilepsy is a chronic neurological disorder that presents as recurrent, unprovoked seizures. Pharmacotherapy is the main treatment for epilepsy, but at least 30% of patients with epilepsy have pharmacoresistant epilepsy. Therefore, non-pharmacological treatments are still required. In addition to electrophysiological aberrations contributing to epileptogenesis and pathophysiology in epilepsy, neuroinflammation, oxidative stress, and metabolic derangement have been investigated as drug targets in the treatment of epilepsy. Vitamins have antioxidant, anti-inflammatory, and immunomodulatory effects, which can be beneficial for the treatment of epilepsy. Herein, we comprehensively review the role of vitamins in epilepsy. Certain epilepsies are vitamin-dependent or vitamin-responsive. Most studies on vitamins in epilepsy are of low evidence level or limited to animal studies. Nevertheless, vitamin supplementation should be considered in epilepsy therapy. Additionally, certain anti-seizure medications may alter the serum levels of certain vitamins. Monitoring the serum levels of vitamins and supplementing vitamins when needed are suggested during the follow-up of patients with epilepsy.
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Affiliation(s)
- Ming-Tao Yang
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Chemical Engineering and Materials Science, Yuan Ze University, Taoyuan, Taiwan.
| | - I-Ching Chou
- Division of Pediatrics Neurology, China Medical University Children's Hospital, Taichung, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Huei-Shyong Wang
- Division of Pediatric Neurology, Chang Gung Children's Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Chi H, Chang L, Chao YC, Lin DS, Yang HW, Fang LC, Lin CH, Ho CS, Yang KD. Pathogenesis and Preventive Tactics of Immune-Mediated Non-Pulmonary COVID-19 in Children and Beyond. Int J Mol Sci 2022; 23:14157. [PMID: 36430629 PMCID: PMC9696849 DOI: 10.3390/ijms232214157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/05/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022] Open
Abstract
The COVID-19 pandemic has evolved to immune escape and threatened small children and the elderly with a higher severity and fatality of non-pulmonary diseases. These life-threatening non-pulmonary COVID-19 diseases such as acute necrotizing encephalopathies (ANE) and multisystem inflammatory syndrome in children (MIS-C) are more prevalent in children. However, the mortality of multisystem inflammatory syndrome in adults (MIS-A) is much higher than that of MIS-C although the incidence of MIS-A is lower. Clarification of immunopathogenesis and genetic susceptibility of inflammatory non-pulmonary COVID-19 diseases would provide an appropriate guide for the crisis management and prevention of morbidity and fatality in the ongoing pandemic. This review article described three inflammatory non-pulmonary COVID-19 diseases including (1) meningoencephalitis (ME), (2) acute necrotizing encephalopathies (ANE), and (3) post-infectious multisystem inflammatory syndrome in children (MIS-C) and in adults (MIS-A). To prevent these life-threatening non-pulmonary COVID-19 diseases, hosts carrying susceptible genetic variants should receive prophylactic vaccines, avoid febrile respiratory tract infection, and institute immunomodulators and mitochondrial cocktails as early as possible.
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Affiliation(s)
- Hsin Chi
- MacKay Children’s Hospital, Taipei 103, Taiwan
- Department of Medicine, MacKay Medical College, Sanzhi, New Taipei City 252, Taiwan
| | - Lung Chang
- Department of Medicine, MacKay Medical College, Sanzhi, New Taipei City 252, Taiwan
- Departments of Pediatrics and Medical Research, MacKay Memorial Hospital, TamSui, New Taipei City 251, Taiwan
| | - Yen-Chun Chao
- MacKay Children’s Hospital, Taipei 103, Taiwan
- Department of Medicine, MacKay Medical College, Sanzhi, New Taipei City 252, Taiwan
| | - Dar-Shong Lin
- Department of Medicine, MacKay Medical College, Sanzhi, New Taipei City 252, Taiwan
- Departments of Pediatrics and Medical Research, MacKay Memorial Hospital, TamSui, New Taipei City 251, Taiwan
| | - Horng-Woei Yang
- Departments of Pediatrics and Medical Research, MacKay Memorial Hospital, TamSui, New Taipei City 251, Taiwan
| | - Li-Chih Fang
- MacKay Children’s Hospital, Taipei 103, Taiwan
- Department of Medicine, MacKay Medical College, Sanzhi, New Taipei City 252, Taiwan
| | - Chia-Hsueh Lin
- Departments of Pediatrics and Medical Research, MacKay Memorial Hospital, TamSui, New Taipei City 251, Taiwan
| | - Che-Sheng Ho
- MacKay Children’s Hospital, Taipei 103, Taiwan
- Department of Medicine, MacKay Medical College, Sanzhi, New Taipei City 252, Taiwan
| | - Kuender D. Yang
- MacKay Children’s Hospital, Taipei 103, Taiwan
- Departments of Pediatrics and Medical Research, MacKay Memorial Hospital, TamSui, New Taipei City 251, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Microbiology & Immunology, National Defense Medical Center, Taipei 114, Taiwan
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10
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Nakajima Y, Kobayashi S, Tanoue H, Ishihara S, Kamiya A, Kawata N, Asakura M, Suzuki D, Obana N, Hayashi K, Kawaguchi T, Noda M, Oba K, Katori T, Kageyama T, Ogasawara M. Cerebral blood flow abnormalities with central sparing on arterial spin labeling in mild encephalopathy associated with excitotoxicity: a case report. BMC Neurol 2022; 22:403. [PMID: 36324091 PMCID: PMC9628096 DOI: 10.1186/s12883-022-02942-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 10/27/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) and mild encephalopathy associated with excitotoxicity (MEEX) are the most frequent acute encephalopathies in pediatric patients in Japan. AESD typically presents with biphasic seizures and delayed reduced diffusion in the subcortical area, called bright tree appearance (BTA), on radiological examination. In patients with AESD, arterial spin labeling (ASL) shows decreased cerebral blood flow (CBF) in the hyperacute stage and increased CBF in the acute stage, suggesting the usefulness of ASL for the early diagnosis of AESD. Additionally, proton magnetic resonance spectroscopy (MRS) shows elevated glutamate (Glu) and glutamine (Gln) in AESD. MEEX is a group of mild encephalopathies with transient elevation of Gln on MRS similar to that in AESD; however, MEEX does not include any clinical biphasic course or abnormalities, including BTA on diffusion-weighted imaging. Although the usefulness of ASL for AESD has been reported, there are no reports for patients with MEEX. In this study, we report our experience with a 4-year-old girl diagnosed with MEEX who showed unique findings on ASL. CASE PRESENTATION The patient was a 4-year-old girl admitted to the emergency room with febrile status epilepticus. Considering the possibility of AESD, vitamin therapy was initiated. ASL-MR imaging (MRI) of the brain performed on the second day showed increased blood flow in the frontal, temporal, and occipital regions with spared central sulcus, which indicated AESD with central sparing. The patient was diagnosed with AESD, and the treatment included pulse steroid therapy and immunoglobulin therapy from day 3. The patient remained mildly unconscious but gradually became conscious by day 7 with no seizures. Brain MRI performed on day 8 did not show any characteristic AESD findings, such as BTA. Furthermore, MRS showed elevated Gln, which, along with the clinical course, led to the diagnosis of MEEX. The patient was discharged on day 16 without obvious sequelae. CONCLUSIONS ASL may be useful in the early diagnosis of MEEX as well as AESD, facilitating early intervention.
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Affiliation(s)
- Yuki Nakajima
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Shinya Kobayashi
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Hideki Tanoue
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Sayaka Ishihara
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Ayako Kamiya
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Nanako Kawata
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Mari Asakura
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Daichi Suzuki
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Natsuko Obana
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Kenta Hayashi
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Takahiro Kawaguchi
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Masahiro Noda
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Kunihiro Oba
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Tatsuo Katori
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Tsutomu Kageyama
- grid.410795.e0000 0001 2220 1880Center for Emergency Preparedness and Response, National Institute of Infectious Diseases, Tokyo, Japan
| | - Masashi Ogasawara
- grid.415825.f0000 0004 1772 4742Department of Pediatrics, Showa General Hospital, Tokyo, Japan ,grid.419280.60000 0004 1763 8916Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1 Ogawahigashi, Kodaira, Tokyo, Japan
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11
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Yaworski A, Alobaidi R, Liu N, Mailo J, Kassiri J. Pediatric Encephalopathy and Complex Febrile Seizures. Clin Pediatr (Phila) 2022; 61:493-498. [PMID: 35352986 PMCID: PMC9163768 DOI: 10.1177/00099228221084422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amanda Yaworski
- Division of Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta and Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Rashid Alobaidi
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta and Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Natarie Liu
- Division of Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta and Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Janette Mailo
- Division of Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta and Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Janani Kassiri
- Division of Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta and Stollery Children’s Hospital, Edmonton, AB, Canada,Janani Kassiri, Division of Neurology, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta and Stollery Children’s Hospital, 3-478, ECHA, 11405 87 Ave. NW, Edmonton, AB T6G 1C9, Canada.
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12
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Miyamoto Y, Okanishi T, Maeda M, Kawaguchi T, Kanai S, Saito Y, Maegaki Y. Involuntary movements as a prognostic factor for acute encephalopathy with biphasic seizures and late reduced diffusion. Brain Dev 2022; 44:122-130. [PMID: 34656360 DOI: 10.1016/j.braindev.2021.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is characterized by biphasic seizures and white matter lesions with reduced diffusion, which are often accompanied by involuntary movements. The neurological outcomes of AESD vary from normal to mild or severe sequelae, including intellectual disability, paralysis, and epilepsy. The present study aimed to clarify the prognostic factors of AESD, including involuntary movements. METHODS We enrolled 29 patients with AESD admitted to Tottori University Hospital from 1991 to 2020 and retrospectively analyzed their clinical data. Neurological outcomes were assessed by the Pediatric Cerebral Performance Category score and cerebral paralysis as neurological sequelae. RESULTS Of the 29 patients, 12 had favorable outcomes and 17 had unfavorable outcomes. Univariate analysis revealed that the presence of underlying diseases, a decline in Glasgow Coma Scale (GCS) score 12-24 h after early seizures, and involuntary movements were associated with unfavorable outcomes. In multivariate analysis, a decline in GCS score and involuntary movements were associated with unfavorable outcomes. The sensitivities and specificities of underlying diseases, a decline of ≥ 3 points in GCS score 12-24 h after early seizures, and involuntary movements for unfavorable outcomes were 53% and 92%, 92% and 65%, and 59% and 92%, respectively. CONCLUSIONS The appearance of involuntary movements may be associated with unfavorable outcomes of AESD. The prognostic factors identified herein are comparable with previously known prognostic factors of consciousness disturbances after early seizures.
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Affiliation(s)
- Yosuke Miyamoto
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, Tottori 683-8504, Japan; Department of Pediatrics, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Tohru Okanishi
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, Tottori 683-8504, Japan.
| | - Masanori Maeda
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, Tottori 683-8504, Japan; Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Tatsuya Kawaguchi
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, Tottori 683-8504, Japan
| | - Sotaro Kanai
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, Tottori 683-8504, Japan
| | - Yoshiaki Saito
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, Tottori 683-8504, Japan; Division of Child Neurology, Saiseikai Yokohama City Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa 230-8765, Japan
| | - Yoshihiro Maegaki
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, Tottori 683-8504, Japan
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13
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Ichinose F, Nakamura T, Kira R, Furuno K, Ishii S, Takamura K, Hashiguchi M, Inoue T, Senju A, Ichimiya Y, Sakakibara T, Sugiyama N, Naitou T, Higuchi N, Togawa M, Torii KI, Toda S, Iwamatsu H, Sato T, Tsurui S, Tanaka H, Motobayashi M, Abe A, Kawaguchi A, Matsuo M. Incidence and risk factors of acute encephalopathy with biphasic seizures in febrile status epilepticus. Brain Dev 2022; 44:36-43. [PMID: 34362595 DOI: 10.1016/j.braindev.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To clarify the incidence and risk factors of acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) in pediatric patients with febrile status epilepticus (FSE). METHODS We retrospectively surveyed patients with FSE (≥20 min and ≥40 min) who were younger than 6 years by mailing a questionnaire to 1123 hospitals in Japan. The survey period was 2 years. We then collected clinical data on patients with prolonged febrile seizures (PFS) ≥40 min and those with AESD, and compared clinical data between the PFS and AESD groups. RESULTS The response rate for the primary survey was 42.3%, and 28.0% of hospitals which had applicable cases responded in the secondary survey. The incidence of AESD was 4.3% in patients with FSE ≥20 min and 7.1% in those with FSE ≥40 min. In the second survey, a total of 548 patients had FSE ≥40 min (AESD group, n = 93; PFS group, n = 455). Univariate analysis revealed significant between-group differences in pH, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, creatine kinase, NH3, procalcitonin (PCT), uric acid, blood urea nitrogen, creatinine (Cr), and lactate. Multivariate analysis using stratified values showed that high PCT was an only risk factor for AESD. A prediction score of ≥3 was indicative of AESD, as determined using the following indexes: HCO3- < 20 mmol/L (1 point), Cl <100 mEq/L (1 point), Cr ≥0.35 mg/dL (1 point), glucose ≥200 mg/dL (1 point), and PCT ≥1.7 pg/mL (2 points). The scoring system had sensitivity of 84.2% and specificity of 81.0%. CONCLUSION Incidence data and prediction scores for AESD will be useful for future intervention trials for AESD.
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Affiliation(s)
- Fumio Ichinose
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan.
| | - Takuji Nakamura
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan; Department of Pediatrics, National Hospital Organization Ureshino Medical Center, Saga, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Kenji Furuno
- Department of General Medicine, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Shigeki Ishii
- Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Kazunari Takamura
- Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Marina Hashiguchi
- Department of Pediatrics, Japan Organization of Occupational Health and Safety, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Takushi Inoue
- Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Ayako Senju
- Department of Pediatrics, Kitakyushu General Hospital, Fukuoka, Japan
| | - Yuko Ichimiya
- Department of Pediatrics, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Nobuyoshi Sugiyama
- Department of Pediatrics, School of Medicine, Tokai University, Kanagawa, Japan
| | - Tomomi Naitou
- Department of Pediatrics, Saiseikai Kawaguchi General Hospital, Saitama, Japan
| | - Naoya Higuchi
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan; Department of Pediatrics, Saga Prefectural Medical Center Koseikan, Saga, Japan
| | - Masami Togawa
- Department of Pediatrics, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Ken-Ichi Torii
- Department of Pediatrics, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan
| | - Soichiro Toda
- Department of Pediatrics, Kameda Medical Center, Chiba, Japan
| | - Hiroko Iwamatsu
- Department of Pediatrics, Oita Prefectural Hospital, Oita, Japan
| | - Tatsuharu Sato
- Department of Pediatrics, Nagasaki University Hospital, Nagasaki, Japan
| | - Satoshi Tsurui
- Department of Pediatrics, Seirei Numazu Hospital, Shizuoka, Japan
| | - Hidenori Tanaka
- Department of Pediatrics, Komaki City Hospital, Aichi, Japan
| | - Mitsuo Motobayashi
- Department of Pediatric Neurology, Nagano Children's Hospital, Nagano, Japan
| | - Akiko Abe
- Department of Pediatrics, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Atsushi Kawaguchi
- Education and Research Center for Community Medicine, Saga University, Saga, Japan
| | - Muneaki Matsuo
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan
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14
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Maeda M, Okanishi T, Miyamoto Y, Hayashida T, Kawaguchi T, Kanai S, Saito Y, Maegaki Y. Predicting the Onset of Acute Encephalopathy With Biphasic Seizures and Late Reduced Diffusion by Using Early Laboratory Data. Front Neurol 2021; 12:730535. [PMID: 34790160 PMCID: PMC8591104 DOI: 10.3389/fneur.2021.730535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) often causes various neurological sequelae, necessitating early and objective differentiation of AESD from a febrile seizure (FS). Therefore, we developed a scoring system that predicts AESD onset using only early laboratory data. Methods: We selected patients with AESD or FS admitted to the Tottori University Hospital between November 2005 and September 2020 and collected laboratory data from onset to discharge in patients with FS and from onset to the second neurological events in patients with AESD. Results: We identified 18 patients with AESD and 181 patients with FS. In comparison with patients with FS, patients with AESD showed statistically significant increases in ammonia (NH3), blood sugar (BS), and serum creatinine (Cr) levels, and the white blood cell (WBC) count, and a significant decrease in pH at <3 h from onset. We set the cut-off values and adjusted the weight of each of these parameters based on data obtained <3 h from onset and proposed a scoring system for predicting AESD. This system showed 91% sensitivity and 94% specificity for distinguishing AESD from FS. These accuracies were only slightly improved by the addition of information related to consciousness and seizure duration (sensitivity, 91%; specificity, 96%). Conclusion: NH3, BS, and Cr levels, WBC count, and pH were significantly different between patients with AESD and patients with FS at <3 h from seizure onset. This scoring system using these data may enable the prediction of AESD onset for patients under sedation or without precise clinical information.
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Affiliation(s)
- Masanori Maeda
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan.,Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Tohru Okanishi
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yosuke Miyamoto
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan.,Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuya Hayashida
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan.,Department of Pediatrics, Nagasaki University, Nagasaki, Japan
| | - Tatsuya Kawaguchi
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Sotaro Kanai
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yoshiaki Saito
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan.,Division of Child Neurology, Saiseikai Yokohama City Tobu Hospital, Yokohama, Japan
| | - Yoshihiro Maegaki
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
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15
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Nishiyama M, Ishida Y, Yamaguchi H, Tokumoto S, Tomioka K, Hongo H, Toyoshima D, Maruyama A, Kurosawa H, Tanaka R, Nozu K, Iijima K, Nagase H. Prediction of AESD and neurological sequelae in febrile status epilepticus. Brain Dev 2021; 43:616-625. [PMID: 33563484 DOI: 10.1016/j.braindev.2021.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/19/2020] [Accepted: 01/22/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The clinical prediction rule (CPR) for acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) was developed with an area under the receiver operating characteristic curve (AUC) of 0.95 - 0.96. Our objective was to verify the AESD CPR in a new cohort and compare the utilities of three CPRs of acute encephalopathy: the Tada, Yokochi, and Nagase criteria. METHODS We reviewed the clinical data and medical charts of 580 consecutive patients (aged < 18 years) with febrile convulsive status epilepticus lasting for ≥ 30 min in 2002 - 2017 and measured the performance of the CPRs in predicting AESD and sequelae. RESULTS The CPRs predicted AESD with an AUC of 0.84 - 0.88. The Tada criteria predicted AESD with a positive predictive value (PPV) of 0.25 and a negative predictive value (NPV) of 0.99. The Yokochi criteria predicted AESD with a PPV and NPV of 0.20 and 0.95, respectively, after 12 h. The Nagase criteria predicted AESD with a PPV and NPV of 0.14 and 1.00, respectively, after 6 h. The PPVs of the Tada, Yokochi, and Nagase criteria for sequelae were 0.28, 0.28, and 0.17, respectively; the corresponding NPVs were 0.97, 0.95, and 0.98, respectively. CONCLUSIONS The effectiveness of the AESD CPR in a new cohort was lower than that in the derivation study. CPRs are not sufficient as diagnostic tests, but they are useful as screening tests. The Nagase criteria are the most effective for screening among the three CPRs due to their high NPV and swiftness.
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Affiliation(s)
- Masahiro Nishiyama
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan.
| | - Yusuke Ishida
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Hiroshi Yamaguchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Shoichi Tokumoto
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan; Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Kazumi Tomioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Hiroto Hongo
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Daisaku Toyoshima
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Azusa Maruyama
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Hiroshi Kurosawa
- Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Ryojiro Tanaka
- Department of Emergency and General Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Hiroaki Nagase
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
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16
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Mizuguchi M, Ichiyama T, Imataka G, Okumura A, Goto T, Sakuma H, Takanashi JI, Murayama K, Yamagata T, Yamanouchi H, Fukuda T, Maegaki Y. Guidelines for the diagnosis and treatment of acute encephalopathy in childhood. Brain Dev 2021; 43:2-31. [PMID: 32829972 DOI: 10.1016/j.braindev.2020.08.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/04/2020] [Accepted: 08/04/2020] [Indexed: 12/16/2022]
Abstract
The cardinal symptom of acute encephalopathy is impairment of consciousness of acute onset during the course of an infectious disease, with duration and severity meeting defined criteria. Acute encephalopathy consists of multiple syndromes such as acute necrotizing encephalopathy, acute encephalopathy with biphasic seizures and late reduced diffusion and clinically mild encephalitis/encephalopathy with reversible splenial lesion. Among these syndromes, there are both similarities and differences. In 2016, the Japanese Society of Child Neurology published 'Guidelines for the Diagnosis and Treatment of Acute Encephalopathy in Childhood', which made recommendations and comments on the general aspects of acute encephalopathy in the first half, and on individual syndromes in the latter half. Since the guidelines were written in Japanese, this review article describes extracts from the recommendations and comments in English, in order to introduce the essence of the guidelines to international clinicians and researchers.
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Affiliation(s)
- Masashi Mizuguchi
- Committee for the Compilation of Guidelines for the Diagnosis and Treatment of Acute Encephalopathy in Childhood, Japanese Society of Child Neurology, Tokyo, Japan; Department of Developmental Medical Sciences, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Takashi Ichiyama
- Committee for the Compilation of Guidelines for the Diagnosis and Treatment of Acute Encephalopathy in Childhood, Japanese Society of Child Neurology, Tokyo, Japan; Division of Pediatrics, Tsudumigaura Medical Center for Children with Disabilities, Yamaguchi, Japan
| | - George Imataka
- Committee for the Compilation of Guidelines for the Diagnosis and Treatment of Acute Encephalopathy in Childhood, Japanese Society of Child Neurology, Tokyo, Japan; Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan
| | - Akihisa Okumura
- Committee for the Compilation of Guidelines for the Diagnosis and Treatment of Acute Encephalopathy in Childhood, Japanese Society of Child Neurology, Tokyo, Japan; Department of Pediatrics, Aichi Medical University, Aichi, Japan
| | - Tomohide Goto
- Committee for the Compilation of Guidelines for the Diagnosis and Treatment of Acute Encephalopathy in Childhood, Japanese Society of Child Neurology, Tokyo, Japan; Division of Neurology, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Hiroshi Sakuma
- Committee for the Compilation of Guidelines for the Diagnosis and Treatment of Acute Encephalopathy in Childhood, Japanese Society of Child Neurology, Tokyo, Japan; Department of Brain and Neurosciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Jun-Ichi Takanashi
- Committee for the Compilation of Guidelines for the Diagnosis and Treatment of Acute Encephalopathy in Childhood, Japanese Society of Child Neurology, Tokyo, Japan; Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan
| | - Kei Murayama
- Committee for the Compilation of Guidelines for the Diagnosis and Treatment of Acute Encephalopathy in Childhood, Japanese Society of Child Neurology, Tokyo, Japan; Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Takanori Yamagata
- Committee for the Compilation of Guidelines for the Diagnosis and Treatment of Acute Encephalopathy in Childhood, Japanese Society of Child Neurology, Tokyo, Japan; Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Hideo Yamanouchi
- Committee for the Compilation of Guidelines for the Diagnosis and Treatment of Acute Encephalopathy in Childhood, Japanese Society of Child Neurology, Tokyo, Japan; Department of Pediatrics, Comprehensive Epilepsy Center, Saitama Medical University, Saitama, Japan
| | - Tokiko Fukuda
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan; Committee for the Integration of Guidelines, Japanese Society of Child Neurology, Tokyo, Japan
| | - Yoshihiro Maegaki
- Committee for the Integration of Guidelines, Japanese Society of Child Neurology, Tokyo, Japan; Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
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17
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Ramji S, McCullagh G, Ram D, Vassallo G, Pavaine J. T2-highlighted U-fibres and rapid parenchymal volume loss in AESD: An under-recognised subtype of paediatric acute encephalopathy syndromes. J Neuroradiol 2020; 47:458-463. [DOI: 10.1016/j.neurad.2019.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/28/2019] [Accepted: 09/24/2019] [Indexed: 12/23/2022]
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18
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Akiyama T, Toda S, Kimura N, Mogami Y, Hanaoka Y, Tokorodani C, Ito T, Miyahara H, Hyodo Y, Kobayashi K. Vitamin B6 in acute encephalopathy with biphasic seizures and late reduced diffusion. Brain Dev 2020; 42:402-407. [PMID: 32107100 DOI: 10.1016/j.braindev.2020.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/27/2020] [Accepted: 02/12/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The initial presentation of acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is indistinguishable from that of complex febrile seizures (FS), which poses a great diagnostic challenge for clinicians. Excitotoxicity is speculated to be the pathogenesis of AESD. Vitamin B6 (VB6) is essential for the biosynthesis of gamma-aminobutyric acid, an inhibitory neurotransmitter. The aim of this study is to investigate our hypothesis that VB6 deficiency in the brain may play a role in AESD. METHODS We obtained cerebrospinal fluid (CSF) samples from pediatric patients with AESD after early seizures and those with FS. We measured pyridoxal 5'-phosphate (PLP) and pyridoxal (PL) concentrations in the CSF samples using high-performance liquid chromatography with fluorescence detection. RESULTS The subjects were 5 patients with AESD and 17 patients with FS. Age did not differ significantly between AESD and FS. In AESD, CSF PLP concentration was marginally lower (p = 0.0999) and the PLP-to-PL ratio was significantly (p = 0.0417) reduced compared to those in FS. CONCLUSIONS Although it is impossible to conclude that low PLP concentration and PLP-to-PL ratio are causative of AESD, this may be a risk factor for developing AESD. When combined with other markers, this finding may be useful in distinguishing AESD from FS upon initial presentation.
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Affiliation(s)
- Tomoyuki Akiyama
- Department of Child Neurology, Okayama University Hospital, Okayama, Japan; Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Soichiro Toda
- Department of Pediatrics, Kameda Medical Center, Chiba, Japan
| | - Nobusuke Kimura
- Department of Pediatrics, Japanese Red Cross Otsu Hospital, Shiga, Japan
| | - Yukiko Mogami
- Department of Pediatric Neurology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Yoshiyuki Hanaoka
- Department of Child Neurology, Okayama University Hospital, Okayama, Japan
| | - Chiho Tokorodani
- Department of Pediatrics, Kochi Health Sciences Center, Kochi, Japan
| | - Tomoshiro Ito
- Department of Pediatrics, Sapporo City General Hospital, Hokkaido, Japan
| | - Hiroyuki Miyahara
- Department of Pediatrics, Kurashiki Central Hospital, Okayama, Japan
| | - Yuki Hyodo
- Department of Child Neurology, Okayama University Hospital, Okayama, Japan; Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Katsuhiro Kobayashi
- Department of Child Neurology, Okayama University Hospital, Okayama, Japan; Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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19
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Hayakawa I, Okubo Y, Nariai H, Michihata N, Matsui H, Fushimi K, Yasunaga H. Recent treatment patterns and variations for pediatric acute encephalopathy in Japan. Brain Dev 2020; 42:48-55. [PMID: 31522789 DOI: 10.1016/j.braindev.2019.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/15/2019] [Accepted: 08/22/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Treatments for pediatric acute encephalopathy are largely empiric with limited evidence to support. This study investigated recent trends in clinical practice patterns for pediatric acute encephalopathy at a national level. METHOD Discharge records were extracted for children with acute encephalopathy for the fiscal years 2010-2015 using a national inpatient database in Japan. We ascertained the secular trends in medications, diagnostic and therapeutic procedures, healthcare costs, in-hospital mortality, and length of hospital stays (LOS), using mixed effect linear or logistic regression models. We also ascertained variations and clustering of the practice patterns across different hospitals using hierarchical cluster analyses. RESULTS A total of 4692 eligible inpatients were identified. From 2010 to 2015, we observed increasing trends in hospitalization costs, corticosteroid and edaravone use and a decreasing trend in LOS. Despite changes in treatments, the rates of home respiratory support and in-hospital mortality were constant during the study period. Hierarchical cluster analyses showed that 6 hospital groups showed largely different therapeutic strategies to the same disease regardless of mortality rates. Hospitals with more intensive treatment practices were likely to have higher mortality, while hospitals with less intensive treatment practices were likely to have the lower mortality. However, hospitals in one group (group 1) had less intensive treatment practice even though they had the highest mortality. CONCLUSIONS We provided novel insights into the recent trends in treatments for pediatric acute encephalopathy. Therapeutic strategies varied between hospitals, suggesting the importance of pursuing evidence-based treatment strategy and promoting standardized practices to pediatric acute encephalopathy.
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Affiliation(s)
- Itaru Hayakawa
- Division of Neurology, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Okubo
- Department of Epidemiology, UCLA Fielding School of Public Health, LA, CA, USA; Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan.
| | - Hiroki Nariai
- Division of Pediatric Neurology, Department of Pediatrics, UCLA Medical Center, LA, CA, USA
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
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