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Cui D, Feng J, Yang M, Dong Y, Lian Y. Acute Symptomatic Seizures and Risk of Seizure Recurrence in Patients with Anti-NMDAR, Anti-LGI1, and Anti-GABA BR Encephalitis. Neurol Sci 2024; 45:1609-1617. [PMID: 37940748 DOI: 10.1007/s10072-023-07165-1] [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: 06/03/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
AIMS To analyze the clinical characteristics of acute symptomatic seizures and predict the risk factors for seizure recurrence in patients with anti-N-methyl-D-aspartate receptor (NMDAR), anti-leucine-rich glioma-inactivated 1 (LGI1), and anti-gamma-aminobutyric acid B receptor (GABABR) encephalitis. METHODS In this retrospective study, we included hospitalized patients who had been diagnosed with anti-NMDAR, anti-LGI1, and anti-GABABR encephalitis between November 2014 and April 2021. Binary logistic regression analysis was performed to identify the potential risk factors for seizure recurrence. RESULTS In total, 262 patients with anti-NMDAR, anti-LGI1, and anti-GABABR encephalitis were included, 197 (75.2%) of whom presented with acute symptomatic seizures. During follow-up, 42 patients exhibited seizure recurrence. In anti-NMDAR encephalitis, frontal lobe abnormality on brain magnetic resonance imaging, delayed immunotherapy, early seizures, and focal motor onset were associated with seizure recurrence. CONCLUSIONS Acute symptomatic seizure is a common clinical feature observed in patients with anti-NMDAR, anti-LGI1, and anti-GABABR encephalitis, with 50% of patients presenting with seizures as an initial symptom. The prognosis of patients with acute symptomatic seizures can be improved after receiving immunotherapy. Nevertheless, a minority of patients will experience seizure recurrence; therefore, restarting immunotherapy is recommended.
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Affiliation(s)
- Dingge Cui
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jilun Feng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mu Yang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuanyuan Dong
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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2
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Sun X, Zhao J, Guo C, Zhu X. Early Prediction of Epilepsy after Encephalitis in Childhood Based on EEG and Clinical Features. Emerg Med Int 2023; 2023:8862598. [PMID: 37485251 PMCID: PMC10359137 DOI: 10.1155/2023/8862598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/20/2023] [Accepted: 03/30/2023] [Indexed: 07/25/2023] Open
Abstract
Objective The present study was designed to establish and evaluate an early prediction model of epilepsy after encephalitis in childhood based on electroencephalogram (ECG) and clinical features. Methods 255 patients with encephalitis were randomly divided into training and verification sets and were divided into postencephalitic epilepsy (PE) and no postencephalitic epilepsy (no-PE) according to whether epilepsy occurred one year after discharge. Univariate and multivariate logistic regression analyses were used to screen the risk factors for PE. The identified risk factors were used to establish and verify a model. Results This study included 255 patients with encephalitis, including 209 in the non-PE group and 46 in the PE group. Univariate and multiple logistic regression analysis showed that hemoglobin (OR = 0.968, 95% CI = 0.951-0.958), epilepsy frequency (OR = 0.968, 95% CI = 0.951-0.958), and ECG slow wave/fast wave frequency (S/F) in the occipital region were independent influencing factors for PE (P < 0.05).The prediction model is based on the above factors: -0.031 × hemoglobin -2.113 × epilepsy frequency + 7.836 × occipital region S/F + 1.595. In the training set and the validation set, the area under the ROC curve (AUC) of the model for the diagnosis of PE was 0.835 and 0.712, respectively. Conclusion The peripheral blood hemoglobin, the number of epileptic seizures in the acute stage of encephalitis, and EEG slow wave/fast wave frequencies can be used as predictors of epilepsy after encephalitis.
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Affiliation(s)
- Xiaojuan Sun
- Department of Pediatrics, The Second Affiliated Hospital of Nantong University, Nantong First People's Hospital, Nantong, Jiangsu, China
| | - Jinhua Zhao
- Department of Pediatrics, The Second Affiliated Hospital of Nantong University, Nantong First People's Hospital, Nantong, Jiangsu, China
| | - Chunyun Guo
- Department of Pediatrics, The Second Affiliated Hospital of Nantong University, Nantong First People's Hospital, Nantong, Jiangsu, China
| | - Xiaoxiao Zhu
- Department of Pediatrics, The Second Affiliated Hospital of Nantong University, Nantong First People's Hospital, Nantong, Jiangsu, China
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Valinčiūtė J, Jucevičiūtė N, Balnytė R, Jurkevičienė G, Gelžinienė G. GAD65 Antibody-Associated Epilepsy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1135. [PMID: 37374339 DOI: 10.3390/medicina59061135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/03/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
Autoimmune processes are an increasingly recognized cause of seizures. Antibodies against neuronal surface antigens are implicated in the development of acute symptomatic seizures secondary to autoimmune encephalitis, whereas antibodies against intracellular antigens (anti-glutamic acid decarboxylase (GAD) and onconeural antibodies) are found in cases of autoimmune-associated epilepsy (AAE). AAE is described as isolated drug-resistant epilepsy without any specific magnetic resonance imaging (MRI) or cerebrospinal fluid changes and with a very limited response to immunotherapy. We present a clinical case and a literature review on autoimmune-associated epilepsy to increase awareness of this disease and illustrate its complexity. This is a clinical case of a female with a history of refractory focal epilepsy. The patient had been given several trials of multiple antiepileptic drugs and their combinations without any clear effect. Multiple evaluations including brain MRI, PET, and interictal and ictal electroencephalograms were performed. An APE2 score was calculated with a result of 4 and, in the presence of anti-GAD65 antibodies in the serum, the diagnosis of AAE was confirmed. There was no effect after five sessions of plasma exchange; however, after a course of intravenous immunoglobulin, a positive but temporary clinical effect was noticed: anti-GAD65 levels initially decreased but rebounded to previous levels 6 months later.
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Affiliation(s)
- Justina Valinčiūtė
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Neringa Jucevičiūtė
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Renata Balnytė
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Giedrė Jurkevičienė
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Giedrė Gelžinienė
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
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Guarino M, La Bella S, Santoro M, Caposiena D, Di Lembo E, Chiarelli F, Iannetti G. The Leading Role of Brain and Abdominal Radiological Features in the Work-Up of Anti-NMDAR Encephalitis in Children: An Up-To-Date Review. Brain Sci 2023; 13:brainsci13040662. [PMID: 37190627 DOI: 10.3390/brainsci13040662] [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: 04/02/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis (NMDARe) is the most common cause of nonviral encephalitis, mostly affecting young women and adolescents with a strong female predominance (F/M ratio of around 4:1). NMDARe is characterized by the presence of cerebrospinal fluid (CSF) antibodies against NMDARs, even though its pathophysiological mechanisms have not totally been clarified. The clinical phenotype of NMDARe is composed of both severe neurological and neuropsychiatric symptoms, including generalized seizures with desaturations, behavioral abnormalities, and movement disorders. NMDARe is often a paraneoplastic illness, mainly due to the common presence of concomitant ovarian teratomas in young women. Abdominal ultrasonography (US) is a key imaging technique that should always be performed in suspected patients. The timely use of abdominal US and the peculiar radiological features observed in NMDARe may allow for a quick diagnosis and a good prognosis, with rapid improvement after the resection of the tumor and the correct drug therapy.
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Affiliation(s)
- Miriana Guarino
- Department of Pediatrics, University of Chieti-Pescara "G. D'Annunzio", Via Dei Vestini 5, Ospedale Clinicizzato Chieti (CH), 66100 Chieti, Italy
| | - Saverio La Bella
- Department of Pediatrics, University of Chieti-Pescara "G. D'Annunzio", Via Dei Vestini 5, Ospedale Clinicizzato Chieti (CH), 66100 Chieti, Italy
| | - Marco Santoro
- Department of Radiology, Pescara Public Hospital "Santo Spirito", 65124 Pescara, Italy
| | - Daniele Caposiena
- Department of Radiology, Pescara Public Hospital "Santo Spirito", 65124 Pescara, Italy
| | - Enza Di Lembo
- Department of Internist Ultrasound, Pescara Public Hospital "Santo Spirito", 65124 Pescara, Italy
| | - Francesco Chiarelli
- Department of Pediatrics, University of Chieti-Pescara "G. D'Annunzio", Via Dei Vestini 5, Ospedale Clinicizzato Chieti (CH), 66100 Chieti, Italy
| | - Giovanni Iannetti
- Department of Internist Ultrasound, Pescara Public Hospital "Santo Spirito", 65124 Pescara, Italy
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Hersh N, Ben Zvi H, Goldstein L, Steiner I, Benninger F. Epilepsy following herpes simplex encephalitis - A case series. Epilepsy Res 2023; 192:107137. [PMID: 37060749 DOI: 10.1016/j.eplepsyres.2023.107137] [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] [Revised: 03/25/2023] [Accepted: 04/03/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Herpes simplex encephalitis (HSE) is associated with severe mortality and morbidity. Its incidence is estimated at 1:250 000, and the typical symptomatology of acute disease including headaches, mental state disturbances, confusion, sleepiness, and seizures. The chronic phase of the disease is occasionally characterized by epilepsy and neurological deficits. STUDY RATIONALE The present retrospective single-center study aims to identify risk factors for predicting the development of epilepsy (epileptogenesis) following HSE. METHODS Medical records were screened for patients older than 18 years, hospitalized between January 2005 and September 2019 with a diagnosis of "encephalitis" and "herpes simplex virus, HSV" infection. HSE diagnosis was based on an analysis of the cerebrospinal fluid with positive HSV testing results. RESULTS Twenty-three patients fit our inclusion criteria: fever and behavioral changes, followed by seizures, were reported in 58.3 % of patients. On follow-up (59.7 ± 38.8 months), eight patients (34.8 %) developed epilepsy. Pathological imaging and EEG were correlated with acute symptomatic seizures (ASS). ASS was associated with an 8-fold risk increase to develop post-encephalitis epilepsy (PE). PE was associated with younger age but not with CSF results, imaging, or EEG. CONCLUSION Our retrospective single-center study on PE, following HSE, shows that younger age and ASS were associated with PE. Brain imaging, CSF analysis, and EEG were not associated with the development of epilepsy following HSE.
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Affiliation(s)
- Nir Hersh
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Neurology Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel
| | - Haim Ben Zvi
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - Lilach Goldstein
- Department of Neurology, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Tel Aviv, Israel; Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - Felix Benninger
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel.
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Liu Q, Wu N, Liu C, Yu H, Sun Y, Wang Y, Yu G, Wang S, Ji T, Liu X, Jiang Y, Cai L. Pediatric epilepsy surgery in patients with Lennox-Gastaut syndrome after viral encephalitis. Front Neurol 2023; 14:1097535. [PMID: 36908602 PMCID: PMC9998939 DOI: 10.3389/fneur.2023.1097535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/20/2023] [Indexed: 03/14/2023] Open
Abstract
Objective To analyse the surgical outcomes of pediatric patients with Lennox-Gastaut syndrome (LGS) secondary to viral encephalitis. Methods We retrospectively analyzed the data of four patients with LGS secondary to viral encephalitis who underwent surgery at the pediatric epilepsy center of Peking University First Hospital from January 2014 to December 2019. Preoperative evaluations included a detailed history, long-term video electroencephalography (VEEG), brain magnetic resonance imaging (MRI), positron emission tomography (PET) and a neuropsychological test. All patients were followed up at 1, 3, and 6 months and then yearly. The surgical outcome was evaluated according to the Engel classification. Results Among the four children, the surgeries were right temporo-parieto-occipital disconnection (case 1), corpus callosotomy (case 2), left temporo-parieto-occipital disconnection (case 3), and left temporal lobectomy (case 4). The pathology was gliosis secondary to viral encephalitis. The median follow-up time was 4 years (3-5 years). At the last follow-up, one case had Engel I, two cases had Engel III, and one case had Engel IV. Conclusions Preliminary observations shows that surgical treatment may be challenging for patients with LGS secondary to viral encephalitis. However, suitable surgical candidacy and approaches have a significant impact on the prognosis of the patients.
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Affiliation(s)
- Qingzhu Liu
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Nan Wu
- Department of Neurosurgery, Tianjin Children's Hospital, Children's Hospital of Tianjin University, Tianjin, China
| | - Chang Liu
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Hao Yu
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Yu Sun
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Yao Wang
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Guojing Yu
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Shuang Wang
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China.,Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Taoyun Ji
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China.,Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xiaoyan Liu
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China.,Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yuwu Jiang
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China.,Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Lixin Cai
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
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Alam AM, Chen JPK, Wood GK, Facer B, Bhojak M, Das K, Defres S, Marson A, Granerod J, Brown D, Thomas RH, Keller SS, Solomon T, Michael BD. Increased volume of cerebral oedema is associated with risk of acute seizure activity and adverse neurological outcomes in encephalitis - regional and volumetric analysis in a multi-centre cohort. BMC Neurol 2022; 22:412. [PMID: 36344954 PMCID: PMC9639313 DOI: 10.1186/s12883-022-02926-5] [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: 07/22/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Seizures can occur unpredictably in patients with acute encephalitis syndrome (AES), and many suffer from poor long-term neurological sequelae. Establishing factors associated with acute seizures risk and poor outcomes could support clinical care. We aimed to conduct regional and volumetric analysis of cerebral oedema on magnetic resonance imaging (MRI) in patients with AES. We assessed the relationship of brain oedema with acute seizure activity and long-term neurological outcome. METHODS In a multi-centre cohort study, adults and children presenting with an AES were recruited in the UK. The clinical and brain MRI data were retrospectively reviewed. The outcomes variables were inpatient acute seizure activity and neurological disability at six-months post-discharge. A poor outcome was defined as a Glasgow outcome score (GOS) of 1-3. We quantified regional brain oedema on MRI through stereological examination of T2-weighted images using established methodology by independent and blinded assessors. Clinical and neuroimaging variables were analysed by multivariate logistic regression to assess for correlation with acute seizure activity and outcome. RESULTS The study cohort comprised 69 patients (mean age 31.8 years; 53.6% female), of whom 41 (59.4%) had acute seizures as inpatients. A higher Glasgow coma scale (GCS) score on admission was a negative predictor of seizures (OR 0.61 [0.46-0.83], p = 0.001). Even correcting for GCS on admission, the presence of cortical oedema was a significant risk factor for acute seizure activity (OR 5.48 [1.62-18.51], p = 0.006) and greater volume of cerebral oedema in these cortical structures increased the risk of acute seizures (OR 1.90 [1.12-3.21], p = 0.017). At six-month post-discharge, 21 (30.4%) had a poor neurological outcome. Herpes simplex virus encephalitis was associated with higher risk of poor outcomes in univariate analysis (OR 3.92 [1.08-14.20], p = 0.038). When controlling for aetiology, increased volume of cerebral oedema was an independent risk factor for adverse neurological outcome at 6 months (OR 1.73 [1.06-2.83], p = 0.027). CONCLUSIONS Both the presence and degree of cerebral oedema on MRIs of patients with AES may help identify patients at risk of acute seizure activity and subsequent long-term morbidity.
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Affiliation(s)
- Ali M Alam
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, UK
- The NIHR Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, UK
| | | | - Greta K Wood
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, UK
- The NIHR Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, UK
| | - Bethany Facer
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Maneesh Bhojak
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Kumar Das
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Sylviane Defres
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, UK
- The NIHR Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, UK
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Trust, Liverpool, UK
| | - Anthony Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Julia Granerod
- Independent Scientific Consultant, formerly of Public Health England, London, UK
| | - David Brown
- UK Heath Security Agency, 61 Colindale Avenue, London, UK
| | - Rhys H Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Simon S Keller
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Tom Solomon
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, UK
- The NIHR Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, UK
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Benedict D Michael
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, UK.
- The NIHR Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, UK.
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK.
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Wesselingh R, Broadley J, Buzzard K, Tarlinton D, Seneviratne U, Kyndt C, Stankovich J, Sanfilippo P, Nesbitt C, D'Souza W, Macdonell R, Butzkueven H, O'Brien TJ, Monif M. Prevalence, risk factors, and prognosis of drug-resistant epilepsy in autoimmune encephalitis. Epilepsy Behav 2022; 132:108729. [PMID: 35623203 DOI: 10.1016/j.yebeh.2022.108729] [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: 02/24/2022] [Revised: 04/10/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the prevalence and biomarkers of drug-resistant epilepsy (DRE) in patients with autoimmune encephalitis (AIE). METHODS Sixty-nine patients with AIE were recruited retrospectively and electroencephalographies (EEGs) were reviewed using a standard reporting proforma. Associations between EEG biomarkers and DRE development at 12 months were examined using logistic regression modeling and were utilized to create a DRE risk score. RESULTS Sixteen percent of patients with AIE developed DRE at 12-month follow-up. The presence of status epilepticus (SE) (OR 11.50, 95% CI [2.81, 51.86], p-value <0.001), temporal lobe focality (OR 9.90, 95% CI [2.60, 50.71], p-value 0.001) and periodic discharges (OR 19.12, 95% CI [3.79, 191.10], p-value 0.001) on the admission EEG were associated with the development of DRE at 12 months. These variables were utilized to create a clinically applicable risk score for the prediction of DRE development. CONCLUSIONS Drug-resistant epilepsy is an infrequent complication of AIE. Electroencephalography changes during the acute illness can predict the risk of DRE at 12 months post-acute AIE. SIGNIFICANCE The identified EEG biomarkers provide the basis to generate a clinically applicable prediction tool which could be used to inform treatment, prognosis, and select patients for acute treatment trials.
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Affiliation(s)
- Robb Wesselingh
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, Alfred Health, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - James Broadley
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, Alfred Health, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Katherine Buzzard
- Department of Neurology, Melbourne Health, 300 Grattan Street, Parkville, Victoria 3050, Australia; Department of Neuroscience, Eastern Health, Level 2, 5 Arnold Street, Box Hill, Victoria 3128, Australia
| | - David Tarlinton
- Department of Immunology and Pathology, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Burnett Building, 89 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Udaya Seneviratne
- Department of Neurosciences, Monash Health, Clayton Road, Clayton, Victoria 3168, Australia
| | - Chris Kyndt
- Department of Neurology, Melbourne Health, 300 Grattan Street, Parkville, Victoria 3050, Australia; Department of Neuroscience, Eastern Health, Level 2, 5 Arnold Street, Box Hill, Victoria 3128, Australia
| | - Jim Stankovich
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Paul Sanfilippo
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Cassie Nesbitt
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, University Hospital of Geelong, Level 2, Kardinia House, Bellerine Street, Geelong, Victoria 3220, Australia
| | - Wendyl D'Souza
- Department of Neurosciences, Building D - Daly Wing, Level 5, St Vincent's Hospital, Fitzroy, Victoria 3065, Australia
| | - Richard Macdonell
- Department of Neurology, Austin Health, Level 6 North Austin Tower, 145 Studley Road, Heidelberg, Victoria 3084, Australia
| | - Helmut Butzkueven
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, Alfred Health, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Terence J O'Brien
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, Alfred Health, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Mastura Monif
- Department of Neurosciences, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, Alfred Health, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Neurology, Melbourne Health, 300 Grattan Street, Parkville, Victoria 3050, Australia.
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9
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Mizoguchi T, Hara M, Hirose S, Nakajima H. Novel qEEG Biomarker to Distinguish Anti-NMDAR Encephalitis From Other Types of Autoimmune Encephalitis. Front Immunol 2022; 13:845272. [PMID: 35242143 PMCID: PMC8885512 DOI: 10.3389/fimmu.2022.845272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/24/2022] [Indexed: 01/15/2023] Open
Abstract
Objective To establish the diagnostic biomarker of electroencephalogram (EEG) to distinguish between anti-N-methyl-d-aspartate receptor encephalitis (NMDARE) and other types of autoimmune encephalitis (other AEs). Methods We reviewed the clinical records of 90 patients with acute encephalitis who were treated in our institution between January 2014 and October 2020. We enrolled the patients who fulfilled the diagnostic criteria for possible AE (pAE) defined by Graus et al. (pAE criteria) and then classified into definite NMDARE and other AEs. We investigated the main syndrome and analyzed all admission EEGs using EEG power value (PV). Statistical significance was tested using the Mann–Whitney U test or Fisher’s exact test. Results Twenty-five patients fulfilled the pAE criteria and were classified into 9 with definite NMDARE (median age: 21 years; 8 women) and 12 with other AEs (median age: 37.5 years; 6 women). Four were eventually excluded. Speech dysfunction (9/9 vs. 4/12, p = 0.005) and movement disorders (6/9 vs. 1/12, p = 0.016) were more frequent in NMDARE than in other AEs. The PV analyses revealed the novel quantitative EEG (qEEG) index, namely, fast slow ratio (FSR) (PV of total beta/PV of total theta + delta). The median FSR (0.139 vs. 0.029, p = 0.004) was higher for NMDARE than other AEs, and the receiver operating characteristic curve area of FSR was 0.86 (95% CI 0.70–1.00). A cutoff value of 0.047 yielded a specificity of 0.75 and a sensitivity of 1.00. Focusing on patients who did not meet the “probable NMDARE criteria” in Graus 2016 (proNMDARE criteria) (n = 10), the pretest probability of NMDAR antibody test was 0.30 (3/10), which increased in patients with an FSR greater than the cutoff (n = 5) to 0.60 (3/5). Conclusions The NMDARE group highlighted speech dysfunction and movement disorders, and a novel qEEG index FSR accurately distinguished the NMDARE patients from other AEs. The FSR is a promising diagnostic marker for NMDARE that indicates the positive results of NMDAR antibodies in patients with AE when combined with the proNMDARE criteria.
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Affiliation(s)
- Tomotaka Mizoguchi
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Hara
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Satoshi Hirose
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hideto Nakajima
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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10
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Gadian J, Eyre M, Konstantoulaki E, Almoyan A, Absoud M, Garrood I, Lim M. Neurological and cognitive outcomes after antibody-negative autoimmune encephalitis in children. Dev Med Child Neurol 2022; 64:649-653. [PMID: 34724211 DOI: 10.1111/dmcn.15101] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/16/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
AIM To characterize the neurological and cognitive outcomes in children with antibody-negative autoimmune encephalitis (Ab-negative AE). METHOD A cohort of children presenting to our institution over a 10-year period with autoimmune encephalitis was identified by structured retrospective review of medical records. Clinical features at presentation and final follow-up were recorded. Neuropsychological testing was performed in a subset of patients. Outcomes after Ab-negative AE were compared with outcomes after N-methyl-D-aspartate receptor antibody encephalitis (NMDARE). RESULTS Forty-four patients (26 females, 18 males, median age 9y 2mo [interquartile range 4y 5mo-11y 8mo], 23 with NMDARE) with a diagnosis of autoimmune encephalitis were included. Postencephalitic epilepsy was more frequent after Ab-negative AE compared to NMDARE (61% vs 14%, p=0.002). Cognitive testing was performed in a subset of patients (n=21; Ab-negative AE=11, NMDARE=10). Full-scale IQ was lower after Ab-negative AE than NMDARE (mean IQ 75 vs 92, p=0.02), primarily because of reduced verbal comprehension index (80 vs 98, p=0.01) and working memory index (77 vs 95, p=0.09). The cognitive function most commonly impaired was executive function (80% [8/10] vs 22% [2/9]). INTERPRETATION Ab-negative AE was associated with poorer cognitive outcomes than NMDARE at 1-year follow-up. Further studies are required to evaluate if immunotherapy can be optimized to improve outcome.
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Affiliation(s)
- Jonathan Gadian
- Evelina London Children's Hospital, Children's Neurosciences Centre, London, UK
| | - Michael Eyre
- Evelina London Children's Hospital, Children's Neurosciences Centre, London, UK.,School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Ele Konstantoulaki
- Evelina London Children's Hospital, Children's Neurosciences Centre, London, UK
| | - Ani Almoyan
- Evelina London Children's Hospital, Children's Neurosciences Centre, London, UK
| | - Michael Absoud
- Evelina London Children's Hospital, Children's Neurosciences Centre, London, UK.,Department Women and Children's Health, School of Life Course Sciences (SoLCS), King's College London, London, UK
| | - Isabel Garrood
- Evelina London Children's Hospital, Children's Neurosciences Centre, London, UK
| | - Ming Lim
- Evelina London Children's Hospital, Children's Neurosciences Centre, London, UK.,Department Women and Children's Health, School of Life Course Sciences (SoLCS), King's College London, London, UK
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11
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Chen DD, Peng XL, Cheng H, Ma JN, Cheng M, Meng LX, Hu Y. Risk factors and a predictive model for the development of epilepsy after Japanese encephalitis. Seizure 2022; 99:105-112. [DOI: 10.1016/j.seizure.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/10/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022] Open
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12
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Ng ACH, Kassiri J, Goez HR, Morneau-Jacob F, Mailo J. Startle Seizures and Diffuse Leukoencephalopathy After Resolution of Herpes Simplex Virus 1 Encephalitis in a Child. Child Neurol Open 2022; 9:2329048X221083761. [PMID: 35360486 PMCID: PMC8961350 DOI: 10.1177/2329048x221083761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/12/2022] [Accepted: 02/03/2022] [Indexed: 11/21/2022] Open
Abstract
We describe a unique clinical presentation of a child after the acute phase of herpes
simplex virus 1 (HSV1) encephalitis. A 17-month-old boy first presented with HSV1
encephalitis and was promptly treated with antiviral medication. Seven months later, he
was re-admitted for startle seizures. Magnetic Resonance Imaging of the brain showed
diffuse confluent leukoencephalopathy. This constellation of symptoms has not been
previously reported in HSV1 encephalitis. In conclusion, we showed that brain injury due
to HSV1 encephalitis can be associated with the development of startle seizures and
diffuse white matter injury in the post-acute phase.
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13
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Liu S, Xiong Z, Wang J, Tang C, Deng J, Zhang J, Guo M, Guan Y, Zhou J, Zhai F, Luan G, Li T. Efficacy and potential predictors of vagus nerve stimulation therapy in refractory postencephalitic epilepsy. Ther Adv Chronic Dis 2022; 13:20406223211066738. [PMID: 35070253 PMCID: PMC8771757 DOI: 10.1177/20406223211066738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Vagus nerve stimulation (VNS) is a therapeutic approach for patients with refractory postencephalitic epilepsy (PEE), which is characterized by drug resistance and disappointing surgical outcomes. However, the efficacy of VNS has not yet been studied in patients with refractory PEE. The present study aimed to demonstrate the efficacy of VNS and evaluate potential clinical predictors in patients with refractory PEE. METHODS We retrospectively collected the outcomes of VNS with at least a 1-year follow-up in all patients with refractory PEE. Subgroups were classified as responders and non-responders according to the efficacy of VNS (⩾50% or < 50% reduction in seizure frequency). Preoperative data were analyzed to screen for potential predictors of VNS responsiveness. RESULTS A total of 42 refractory PEE patients who underwent VNS therapy were enrolled, with an average age of 21.13 ± 9.70 years. Seizure frequency was reduced by more than 50% in 64.25% of patients, and 7.14% of patients achieved seizure-free events after VNS therapy. In addition, the response rates increased over time, with 40.5%, 50.0% and 57.1%, respectively at 6 months, 12 months, and 24 months after VNS therapy. Preoperative duration of epilepsy, monthly seizure frequency, and spatial distribution of interictal epileptic discharges (IEDs) were correlated with responders (p < 0.05) in the univariate analysis. Further multivariate regression analysis demonstrated that refractory PEE patients with high monthly seizure frequency or Focal IEDs (focal or multifocal epileptiform discharges) achieved better efficacy on VNS (p = 0.010, p = 0.003, respectively). CONCLUSION VNS is an effective palliative therapy for patients with refractory PEE. Focal IEDs (focal or multifocal epileptiform discharges) and high seizure frequency were potential preoperative predictors of effectiveness after VNS therapy.
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Affiliation(s)
- Siqi Liu
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Zhonghua Xiong
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Chongyang Tang
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jiahui Deng
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Mengyi Guo
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yuguang Guan
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jian Zhou
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Feng Zhai
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Guoming Luan
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Tianfu Li
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, XiangshanYikesong 50, Haidian District, Beijing 100093, China
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14
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Sonneville R, Jaquet P, Vellieux G, de Montmollin E, Visseaux B. Intensive care management of patients with viral encephalitis. Rev Neurol (Paris) 2021; 178:48-56. [PMID: 34973832 DOI: 10.1016/j.neurol.2021.12.002] [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: 10/08/2021] [Accepted: 12/13/2021] [Indexed: 11/26/2022]
Abstract
Viral encephalitis is a severe syndrome that can lead to encephalopathy, seizures, focal deficits, and neurological sequelae and death. It is mainly caused by neurotropic herpes viruses (i.e., HSV and VZV), although other pathogens may be observed in specific geographic regions or conditions. Recent advances in neuroimaging and molecular biology (PCR, metagenomics) allow for faster and more accurate etiological diagnoses, although their benefits need to be confirmed to provide guidelines for their use and interpretation. Despite intravenous acyclovir therapy and supportive care, outcomes remain poor in about two-thirds of herpes encephalitis patients requiring ICU admission. Randomized clinical trials focusing on symptomatic measures (i.e. early ICU admission, fever control, and treatment of seizures/status epilepticus) or adjunctive immunomodulatory therapies (i.e. steroids, intravenous immunoglobulins) to improve neurologic outcomes have not been conducted in the ICU setting. Large prospective multicenter studies combining clinical, electrophysiological, and neuroimaging data are needed to improve current knowledge on care pathways, long-term outcomes, and prognostication.
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Affiliation(s)
- R Sonneville
- Université de Paris, INSERM UMR1148, team 6, 75018 Paris, France; AP-HP, intensive care medicine, Hôpital Bichat - Claude Bernard, 75018 Paris, France.
| | - P Jaquet
- AP-HP, intensive care medicine, Hôpital Bichat - Claude Bernard, 75018 Paris, France
| | - G Vellieux
- AP-HP, department of Physiology, Hôpital Bichat - Claude Bernard, 75018 Paris, France
| | - E de Montmollin
- Université de Paris, INSERM UMR1148, team 6, 75018 Paris, France; Université de Paris, INSERM UMR1137, team 6, 75018 Paris, France
| | - B Visseaux
- Université de Paris, INSERM UMR1137, team 6, 75018 Paris, France; AP-HP, department of virology, Hôpital Bichat - Claude Bernard, 75018 Paris, France
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15
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Zelano J. Recurrence risk after a first remote symptomatic seizure in adults: Epilepsy or not? Epilepsia Open 2021; 6:634-644. [PMID: 34561959 PMCID: PMC8633470 DOI: 10.1002/epi4.12543] [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: 07/14/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 11/08/2022] Open
Abstract
The ILAE practical definition of epilepsy has a one seizure possibility to diagnose epilepsy after a first seizure if the recurrence risk is very high. The recurrence risk after a first seizure in brain disorders (first remote seizure) is often high, but varies with etiology, so more specific information is needed for clinical practice. This review describes etiology-specific recurrence risks in adults with a first remote seizure in stroke, traumatic brain injury, infections, dementia, multiple sclerosis, and tumors. Most studies are short, single center, and retrospective. Inclusion criteria, outcome ascertainment, and results vary. Few patient categories are clearly above the epilepsy threshold of recurrence risk, and there are surprisingly little data for important etiologies like brain infections. Beside stroke, severe TBI could have a sufficiently high recurrence risk for early epilepsy diagnosis, but more studies are needed, preferably prospective ones. The literature is uninformative regarding which seizures qualify as remote. The clinical implication of the low level of available evidence is that for other etiologies than stroke, seizure recurrence remains the most appropriate indicator of epilepsy for most patients with a first remote seizure. Nonetheless, there are worrying indications of a diagnostic drift, which puts patients with a preexisting brain disorder at risk of misdiagnosis. Although there are drawbacks to an intermediate term like "possible epilepsy," it could perhaps be useful in cases when the recurrence risk is high, but epilepsy criteria are not definitely met after a first remote seizure.
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Affiliation(s)
- Johan Zelano
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Gothenburg, Sweden
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16
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Chen SS, Zhang YF, Di Q, Shi JP, Wang LL, Lin XJ, Yu N. Predictors and prognoses of epilepsy after anti-neuronal antibody-positive autoimmune encephalitis. Seizure 2021; 92:189-194. [PMID: 34551365 DOI: 10.1016/j.seizure.2021.09.007] [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: 03/24/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE This study aimed to investigate the incidence and predictors of epilepsy after anti-neuronal antibody-positive autoimmune encephalitis (AIE). The clinical outcomes of patients with epilepsy after AIE were also explored. METHODS A total of 111 AIE patients were retrospectively evaluated. Post-AIE epilepsy (PAEE) was defined as at least one unprovoked seizure occurring six or more months after discharge from hospital. RESULTS The incidence of acute symptomatic seizures was 80.2% (89/111) in our AIE patients. Furthermore, of the 89 AIE patients with seizures, 29 (32.6%) presented with seizures as the initial symptom. Overall, 44 out of 111 AIE patients (39.6%) had unprovoked seizures after six months, meeting our definition of PAEE. The independent risk factors for PAEE incidence included an initial presentation with new-onset refractory status epilepticus (NORSE), delayed immunotherapy treatment, the complication of a lung infection during admission, the requirement for mechanical ventilation during hospitalization, parietal lesions observed in magnetic resonance imaging (MRI), and focal slow waves on electroencephalographic (EEG) monitoring. CONCLUSIONS Early initiation of immunotherapy and lung infection treatment may reduce the risk of conversion of symptomatic seizures to chronic epilepsy in the acute phase of AIE. In general, PAEE patients could have a good prognosis if treated properly and in a timely fashion.
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Affiliation(s)
- Shan-Shan Chen
- Department of Neurology, The Nanjing Brain Hospital Affiliated Nanjing Medical University, 210029 Nanjing, China
| | - Yan-Fang Zhang
- Department of Neurology, The Nanjing Brain Hospital Affiliated Nanjing Medical University, 210029 Nanjing, China
| | - Qing Di
- Department of Neurology, The Nanjing Brain Hospital Affiliated Nanjing Medical University, 210029 Nanjing, China
| | - Jing-Ping Shi
- Department of Neurology, The Nanjing Brain Hospital Affiliated Nanjing Medical University, 210029 Nanjing, China
| | - Ling-Ling Wang
- Department of Neurology, The Nanjing Brain Hospital Affiliated Nanjing Medical University, 210029 Nanjing, China
| | - Xing-Jian Lin
- Department of Neurology, The Nanjing Brain Hospital Affiliated Nanjing Medical University, 210029 Nanjing, China.
| | - Nian Yu
- Department of Neurology, The Nanjing Brain Hospital Affiliated Nanjing Medical University, 210029 Nanjing, China.
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17
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Sun Y, Chen J, Fang T, Wan L, Shi X, Wang J, Li Z, Wang J, Cui Z, Xu X, Ling Z, Zou L, Yang G. Vagus Nerve Stimulation Therapy for the Treatment of Seizures in Refractory Postencephalitic Epilepsy: A Retrospective Study. Front Neurosci 2021; 15:685685. [PMID: 34489622 PMCID: PMC8418307 DOI: 10.3389/fnins.2021.685685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/31/2021] [Indexed: 11/23/2022] Open
Abstract
Background Vagus nerve stimulation (VNS) has been demonstrated to be safe and effective for patients with refractory epilepsy, but there are few reports on the use of VNS for postencephalitic epilepsy (PEE). This retrospective study aimed to evaluate the efficacy of VNS for refractory PEE. Methods We retrospectively studied 20 patients with refractory PEE who underwent VNS between August 2017 and October 2019 in Chinese PLA General Hospital and Beijing Children’s Hospital. VNS efficacy was evaluated based on seizure reduction, effective rate (percentage of cases with seizure reduction ≥ 50%), McHugh classification, modified Early Childhood Epilepsy Severity Scale (E-Chess) score, and Grand Total EEG (GTE) score. The follow-up time points were 3, 6, and 12 months after VNS. Pre- and postoperative data were compared and analyzed. Results The median [interquartile range (IQR)] seizure reduction rates at 3, 6, and 12 months after VNS were 23.72% (0, 55%), 46.61% (0, 79.04%), and 67.99% (0, 93.78%), respectively. The effective rates were 30% at 3 months, 45% at 6 months, and 70% at 12 months. E-chess scores before the operation and at 3, 6, and 12 months after the operation were 10 (10, 10.75), 9 (9, 10), 9 (9, 9.75), and 9 (8.25, 9) (P < 0.05), respectively. GTE scores before surgery and at 12 months after the operation were 11 (9, 13) and 9 (7, 11) (P < 0.05), respectively. The mean intensity of VNS current was 1.76 ± 0.39 (range: 1.0–2.5) mA. No intraoperative complications or severe post-operative adverse effects were reported. Conclusions Our study shows that VNS can reduce the frequency and severity of seizure in patients with refractory PEE. VNS has a good application prospect in patients with refractory PEE.
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Affiliation(s)
- Yulin Sun
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jian Chen
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Tie Fang
- Department of Functional Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lin Wan
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiuyu Shi
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jing Wang
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhichao Li
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jiaxin Wang
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhiqiang Cui
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Xin Xu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Zhipei Ling
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Liping Zou
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Guang Yang
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China.,Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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18
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Husari KS, Cervenka MC. Ketogenic Diet Therapy for the Treatment of Post-encephalitic and Autoimmune-Associated Epilepsies. Front Neurol 2021; 12:624202. [PMID: 34220664 PMCID: PMC8242936 DOI: 10.3389/fneur.2021.624202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 05/19/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction: Acute Encephalitis is associated with a high risk of acute symptomatic seizures, status epilepticus, and remote symptomatic epilepsy. Ketogenic diet therapies (KDT) have been established as a feasible and safe adjunctive management of refractory- and super-refractory status epilepticus. However, the role of KDT in the chronic management of Post-encephalitic epilepsy (PE) and autoimmune-associated epilepsy (AE) is unknown. This study aims to investigate the use of KDT in patients with PE and AE. Methods: A retrospective single-center case series examining adult patients with PE and AE treated with the modified Atkins diet (MAD), a KDT commonly used by adults with drug-resistant epilepsy. Results: Ten patients with PE and AE who were treated with adjunctive MAD were included. Four patients had either confirmed or presumed viral encephalitis, five patients had seronegative AE, and one patient had GAD65 AE. The median latency between starting MAD and onset of encephalitis was 6 years (IQR: 1–10). The median duration of MAD was 10 months (IQR: 3.75–36). Three patients (30%) became seizure-free, one patient (10%) achieved 90% seizure freedom, and three patients (30%) achieved a 50–75% reduction in their baseline seizure frequency, while three patients (30%) had no significant benefit. Overall, seven patients (70%) achieved ≥50% seizure reduction. Conclusion: In addition to its established role in the treatment of RSE, KDT may be a safe and feasible option for the treatment of chronic PE and AE, particularly in those with prior history of SE. Prospective studies are warranted to explore the efficacy of KDT in management of patients with PE and AE.
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Affiliation(s)
- Khalil S Husari
- Department of Neurology, Johns Hopkins Comprehensive Epilepsy Center, Johns Hopkins University, Baltimore, MD, United States
| | - Mackenzie C Cervenka
- Department of Neurology, Johns Hopkins Comprehensive Epilepsy Center, Johns Hopkins University, Baltimore, MD, United States
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19
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Mithani F, Poursheykhi M, Ma B, Smith RG, Hsu SH, Gotur D. New-Onset Seizures in Three COVID-19 Patients: A Case Series. J Clin Neurophysiol 2021; 38:e5-e10. [PMID: 33315693 DOI: 10.1097/wnp.0000000000000783] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SUMMARY Neurological manifestations of coronavirus disease 2019 most commonly present in severe cases and range from mild complications, such as headache and dizziness, to severe complications, such as encephalopathy and acute cerebrovascular disease. Seizures, however, are an underreported neurological manifestation of this disease. We present three critically ill coronavirus disease 2019 patients with EEG monitoring who developed new-onset seizures and encephalopathy up to three-and-a-half weeks after symptom onset. There are several speculated etiologies for the development of new-onset seizures; however, the pathogenic mechanism remains unknown. Testing of coronavirus disease 2019 in the cerebrospinal fluid in addition to extensive research on neurological manifestations is warranted.
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Affiliation(s)
- Farhan Mithani
- Texas A&M Health Science Center College of Medicine, Bryan, Texas, U.S.A
| | - Meryim Poursheykhi
- Department of Neurology, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Brandy Ma
- Department of Neurology, Houston Methodist Hospital, Houston, Texas, U.S.A
- Weill Cornell Medical College, New York City, New York, U.S.A
| | - Robert G Smith
- Department of Neurology, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Steven H Hsu
- Weill Cornell Medical College, New York City, New York, U.S.A
- Department of Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A.; and
- Texas A&M University, College Station, Texas, U.S.A
| | - Deepa Gotur
- Weill Cornell Medical College, New York City, New York, U.S.A
- Department of Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A.; and
- Texas A&M University, College Station, Texas, U.S.A
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20
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Hon KLE, Leung AK, Au CC, Torres AR. Autoimmune Encephalitis in Children: From Suspicion to Diagnosis. Cureus 2021; 13:e13307. [PMID: 33732562 PMCID: PMC7955954 DOI: 10.7759/cureus.13307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/15/2020] [Indexed: 11/13/2022] Open
Abstract
There are several well-described and studied autoimmune diseases that affect different organ systems, and a limited number of these affect the central nervous system. Autoimmune encephalitis represents a disease with a wide spectrum of clinical manifestations and different levels of severity, from mild cognitive impairment to complex encephalopathy. Immune-mediated encephalitis refers to a diverse and rare group of conditions in children associated with nonspecific symptomatology, altered mental state, and recalcitrant seizures. Infectious etiology must be excluded. Immune-mediated encephalitis syndromes could be associated with paraneoplastic or primarily autoimmune mechanisms. The newest scientific advantages have concluded that autoimmune encephalitis may be further divided into different groups of diseases depending on the immune response; examples are antibodies to cell surface proteins, antibodies to intracellular synaptic proteins, T-cell response with antibodies to intracellular antigens, among others. Treatment consists of supportive therapy, ranging from supplemental oxygen, fluid restriction to mechanical circulatory support. Specific treatment includes immunoglobulin infusion, plasmapheresis, and pulse steroid treatment. Prognosis is poor if specific treatment is not timely instituted. The diagnosis of autoimmune encephalitis could be challenging to clinicians due to its diverse clinical features, which can mimic a variety of other pathologic processes. Screening for cancer and proper management that includes immune therapy are fundamental, although some patients will need immune suppression for weeks or months as autoimmune encephalitis may relapse; therefore, follow-up is always necessary.
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Affiliation(s)
- Kam Lun Ellis Hon
- Pediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong, HKG
| | | | - Cheuk Chung Au
- Pediatric Intensive Care Unit, Hong Kong Children's Hospital, Hong Kong, HKG
| | - Alcy R Torres
- Pediatrics, Boston University School of Medicine, Boston, USA
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Ni G, Lin W, Cai X, Qin J, Feng L, Zhu S, Zhou L, Chen Z. Associations between seizures and MRI in patients with anti-NMDAR encephalitis. Acta Neurol Scand 2020; 142:460-465. [PMID: 32533702 DOI: 10.1111/ane.13298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/22/2020] [Accepted: 06/06/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Seizures are a prominent feature of anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis. Nearly half of brain magnetic resonance image (MRI) results are abnormal. The aim of our study was to evaluate the associations between seizures and brain MRI results in patients with anti-NMDAR encephalitis. METHODS Patients with anti-NMDAR encephalitis were enrolled between January 2015 and December 2018. The patients included were divided into normal and abnormal MRI groups. Seizure outcomes and modified Rankin Scale scores at the 1-year follow-up were assessed. Seizure characteristics and outcomes were compared between groups. RESULTS Of 35 patients with anti-NMDAR encephalitis, 28 patients (80%) had reported seizures in the acute phase. Patients with abnormal MRI findings more frequently had focal seizures than patients with normal MRI findings (72.7% vs 17.6%, P < .01). The incidence of patients treated with 2 or more antiepileptic drugs was higher in the normal MRI group than in the abnormal MRI group (100% vs 45.4%, P < .01). The onset-immunotherapy time was shorter in the abnormal MRI group than in the normal MRI group (P < .05). There were no statistically significant differences in seizure outcomes between the normal and abnormal MRI groups (P > .05). CONCLUSIONS Focal seizures were most common in patients with abnormal MRI lesions. In the acute stage of the disease, the abnormal MRI group was more likely than the normal MRI group to achieve seizure control. Abnormal MRI findings did not affect the overall good prognosis of patients with anti-NMDAR encephalitis with seizures.
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Affiliation(s)
- Guanzhong Ni
- Department of Neurology The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases National Key Clinical Department and Key Discipline of Neurology Guangzhou China
| | - Wanrong Lin
- Department of Neurology The Seventh Affiliated Hospital Sun Yat‐sen University Shenzhen China
| | - Xiaodong Cai
- Department of Neurology The Sixth Affiliated Hospital Sun Yat‐sen University Guangzhou China
| | - Jiaming Qin
- Department of Pulmonary and Critical Care Medicine The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
| | - Li Feng
- Department of Neurology The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases National Key Clinical Department and Key Discipline of Neurology Guangzhou China
| | - Shaofang Zhu
- Department of Neurology The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases National Key Clinical Department and Key Discipline of Neurology Guangzhou China
| | - Liemin Zhou
- Department of Neurology The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases National Key Clinical Department and Key Discipline of Neurology Guangzhou China
- Department of Neurology The Seventh Affiliated Hospital Sun Yat‐sen University Shenzhen China
| | - Ziyi Chen
- Department of Neurology The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
- Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases National Key Clinical Department and Key Discipline of Neurology Guangzhou China
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Jaafar F, Haddad L, Koleilat N, Sharara-Chami R, Shbarou R. Super refractory status epilepticus secondary to anti-GAD antibody encephalitis successfully treated with aggressive immunotherapy. Epilepsy Behav Rep 2020; 14:100396. [PMID: 33305253 PMCID: PMC7710630 DOI: 10.1016/j.ebr.2020.100396] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 11/29/2022] Open
Abstract
Antibodies against glutamic acid decarboxylase are reported in association with a number of neurological conditions including limbic encephalitis. We report a case of anti-GAD-antibody associated encephalitis presenting with super-refractory status epilepticus. We describe the clinical course, management, and the outcome. In addition, we review the presentation and outcomes of reported cases of anti-GAD encephalitis. Similar to the reported cases of anti-GAD encephalitis, our case was refractory to treatment with conventional antiseizure medication. Treatment with intravenous immune globulin (IVIG), high dose corticosteroids, and plasmapheresis had partial response, but escalation of treatment to the use of tocilizumab was associated with significant clinical improvement.
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Key Words
- AED, antiepileptic drug
- Autoimmune encephalitis
- CSF, cerebrospinal fluid
- EEG, electroencephalogram
- GABA, gamma-aminobutyric acid
- GAD, glutamic acid decarboxylase
- Glutamic acid decarboxylase antibodies
- IVIG, intravenous immunoglobulin
- Limbic encephalitis
- MDZ, midazolam
- MP, methylprednisolone
- MRI, magnetic resonance imaging
- NMDA, N-methyl-d-aspartate
- PCR, polymerase chain reaction
- PLEX, plasma exchange
- RNA, ribonucleic acid
- Status epilepticus
- Tocilizumab
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Affiliation(s)
- Fatima Jaafar
- Division of Child Neurology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Laith Haddad
- Division of Child Neurology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadia Koleilat
- Division of Child Neurology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Sharara-Chami
- Division of Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rolla Shbarou
- Division of Child Neurology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Li F, Zhong M, Zhou X, Li H. Postencephalitis epilepsy in children: Diurnal rhythm of seizures is related to clinical characteristics. Epilepsy Behav 2020; 111:106887. [PMID: 32698107 DOI: 10.1016/j.yebeh.2019.106887] [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: 05/05/2019] [Revised: 12/19/2019] [Accepted: 12/19/2019] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objective of the study was to summarize the relationship between the clinical features of children with postencephalitis epilepsy and the diurnal rhythm of seizures. METHODS We collected a retrospective review of 44 patients between 0 and 14 years, who were diagnosed with postencephalitis epilepsy. Patients were divided into three groups by their seizures in day/night or wakefulness/sleep state. RESULTS Most epileptic seizures of patients of age 3 years or younger occurred during the daytime, and the other occurred most frequently at night. Most epileptic seizures of boys occurred during the wakefulness state, and girls occurred most frequently in sleep. Seizures of patients with the first seizure in the daytime occurred more frequently during the daytime and the wakefulness state; on the contrary, the first seizure in the nighttime occurred more frequently during the nighttime and the sleep state. Tonic seizure occurred more often during the nighttime and in sleep; epileptic spasm occurred more frequently during the daytime and wakefulness. Most seizures of temporal origin occurred in the awakening. The seizures of patient occurred more often during the wakefulness state; the prognosis was worse. Patients with the peak of seizures in the daytime, the level of the physiological development were poorer. CONCLUSIONS The diurnal rhythm of seizures is different in patients with postencephalitis epilepsy with different clinical characteristics (age, gender, time of first seizure, seizure pattern, electroencephalography (EEG), prognosis, and physiological development). Our results may assist in seizure prediction, individualized treatment patterns, and prognosis prediction.
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Affiliation(s)
- Fangming Li
- Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Mingyan Zhong
- Southern Medical University, College of Basic Medicine, Guangzhou, Guangdong, China
| | - Xizhong Zhou
- Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hong Li
- Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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Steriade C, Jehi L, Krishnan B, Morita-Sherman M, Moosa ANV, Hantus S, Chauvel P. Perisylvian vulnerability to postencephalitic epilepsy. Clin Neurophysiol 2020; 131:1702-1710. [PMID: 32504929 PMCID: PMC7879563 DOI: 10.1016/j.clinph.2020.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Postencephalitic epilepsy is often resistant to antiseizure medications, leading to evaluation for epilepsy surgery. Characterizing its localization carries implications for optimal surgical approach. We aimed to determine whether a prior history of encephalitis is associated with specific epileptogenic networks among patients with drug resistant epilepsy undergoing stereotactic EEG (SEEG). METHODS We conducted a retrospective cohort study of drug resistant epilepsy, with and without a prior history of encephalitis. We analyzed SEEG recordings to identify patterns of seizure onset and organization. Seventeen patients with a history of encephalitis (of infectious etiology in two subjects) were identified from a database of patients undergoing SEEG and were compared to seventeen drug-resistant epilepsy controls without a history of encephalitis matched for confounding variables including pre-implantation hypotheses, epilepsy duration, age, and sex. RESULTS Independent bilateral seizures were noted in 65% of the postencephalitic epilepsy cohort. We identified four SEEG-ictal patterns in patients with a prior history of encephalitis: (1) anteromesial temporal onset (24%), (2) anteromesial temporal onset with early spread to the perisylvian region (29%), (3) perisylvian (59%) and (4) synchronized anteromesial temporal and perisylvian (29%) onsets. Patterns 3 and 4, with perisylvian involvement at onset, were unique to the encephalitis group (p = 0.0003 and 0.04 respectively) and exhibited a "patchwork" organization. None of the encephalitis patients vs 5/7 matched controls had Engel I outcome (p = 0.0048). CONCLUSIONS Postencephalitic epilepsies involve anteromesial temporal and perisylvian networks, often in a bilateral independent manner. Unique ictal patterns involving the perisylvian regions was identified in the encephalitis group, but not in the matched control group. SIGNIFICANCE These findings may reflect a selective vulnerability of the perisylvian regions to epilepsy resulting from encephalitis, significantly mitigating the chances of success with SEEG-guided temporal resections.
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Affiliation(s)
- Claude Steriade
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA; New York University Langone Comprehensive Epilepsy Center, New York University, New York, NY, USA.
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Balu Krishnan
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Ahsan N V Moosa
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Stephen Hantus
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Patrick Chauvel
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
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Predictors of Outcome in Clinically Diagnosed Viral Encephalitis Patients: A 5-Year Prospective Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2832418. [PMID: 32724798 PMCID: PMC7366193 DOI: 10.1155/2020/2832418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/20/2020] [Indexed: 12/12/2022]
Abstract
Background Viral encephalitis is the most common infectious disease of the central nervous system and is associated with high morbidity, mortality, and disability. The objective of this study was to analyze the clinical characteristics, auxiliary examinations, therapeutic management, and outcomes of patients clinically diagnosed with viral encephalitis and identify the outcome predictors. Methods We conducted a prospective observational study by collecting information from patients clinically diagnosed with viral encephalitis at the First Affiliated Hospital of Chongqing Medical University and Yongchuan Hospital of Chongqing Medical University from January 2013 to December 2018. Univariate and multivariate analyses were performed to identify factors that influenced good patient outcomes (mRS < 3) and poor patient outcomes (mRS ≥ 3) at discharge. Results In total, 216 patients were enrolled in the study. The multivariate analysis suggested that the following factors were associated with a poor outcome: Glasgow Coma Scale (GCS) score (OR 0.154, 95% CI (0.078-0.302), and P < 0.001), focal neurological deficits (OR 9.403, 95% CI (1.581-55.928), and P = 0.014), and total length of hospital stay (OR 1.119, 95% CI (1.002-1.250), and P = 0.045). However, neurological intensive care unit (NICU) treatment, status epilepticus, and abnormal electroencephalogram (EEG) findings did not influence the prognosis of patients. Conclusion Our study suggests that low GCS scores at admission, focal neurological deficits at admission, and a prolonged total hospital stay are predictors of a poor outcome at discharge in clinically diagnosed viral encephalitis patients. Whether early and effective neurological rehabilitation can improve the prognosis of viral encephalitis patients with focal neurological deficits remains to be confirmed in further studies.
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Steriade C, Britton J, Dale RC, Gadoth A, Irani SR, Linnoila J, McKeon A, Shao X, Venegas V, Bien CG. Acute symptomatic seizures secondary to autoimmune encephalitis and autoimmune‐associated epilepsy: Conceptual definitions. Epilepsia 2020; 61:1341-1351. [DOI: 10.1111/epi.16571] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/10/2020] [Accepted: 05/12/2020] [Indexed: 12/12/2022]
Affiliation(s)
| | - Jeffrey Britton
- Division of Epilepsy Department of Neurology Mayo Clinic Rochester MN USA
| | - Russell C. Dale
- The Children's Hospital at Westmead Kids Neuroscience Centre University of Sydney Sydney NSW Australia
| | - Avi Gadoth
- Department of Neurology Encephalitis Center Tel‐Aviv Medical Center Tel‐Aviv Israel
| | - Sarosh R. Irani
- Oxford Autoimmune Neurology Group Nuffield Department of Clinical Neurosciences University of Oxford Oxford UK
| | - Jenny Linnoila
- Department of Neurology Massachusetts General Hospital Boston MA USA
| | - Andrew McKeon
- Department of Neurology and Immunology Mayo Clinic Rochester MN USA
| | - Xiao‐Qiu Shao
- Department of Neurology Beijing Tiantan HospitalChina National Clinical Research Center for Neurological DiseasesCapital Medical University Beijing China
| | - Viviana Venegas
- Unit of Neuropediatrics Advanced Center of Epilepsy Clinica Alemana de Santiago Chile
- Unit of Neurophysiology Instituto de Neurocirugía Asenjo Santiago Chile
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Antiepileptic drugs for acute encephalitic patients presented with seizure. Epilepsy Res 2020; 164:106347. [PMID: 32442843 DOI: 10.1016/j.eplepsyres.2020.106347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/08/2020] [Accepted: 04/22/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this study was to clarify the pattern and efficacy of antiepileptic drugs (AEDs) in acute encephalitis and discuss how long AEDs should be used after the acute phase. METHODS Patients with acute encephalitis who presented with seizure were enrolled. The clinical features were systematically gathered, and the information about AEDs and seizures was obtained by a clinical follow-up and (or) a telephone interview based on a structured form. RESULTS A total of 327 patients were enrolled, and the mean follow-up period was 63.8 (14-123) months. The risk of seizure relapse was estimated as 43.6% five years after the acute phase and the first three months was the peak time for relapse. Univariate analysis showed that status epilepticus, more than one seizure, cerebral spinal fluid protein level, abnormal MRI finding, temporal lobe involvement, and epileptiform discharge were related to seizure relapse. But only more than one seizure (OR = 2.80 (95% CI 1.29-6.09), p = 0.009) and temporal lobe involvement (5.34 (2.68-10.64), p < 0.001) remain predictive on multivariate regression analysis. For patients with only one seizure and no temporal lobe involvement, the risk of seizure relapse was similar between those with or without AED (2/29 vs. 4/28, p = 0.423). For the rest, the risks of relapse were similar among those who took sodium valproate and levetiracetam. SIGNIFICANCE For patients with only one seizure and no temporal lobe involvement, AEDs may not be strictly needed. The first three months after acute phase was the peak time for relapse and AEDs may should be used during this period. Both sodium valproate and levetiracetam could be selected.
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Wesselingh R, Butzkueven H, Buzzard K, Tarlinton D, O'Brien TJ, Monif M. Seizures in autoimmune encephalitis: Kindling the fire. Epilepsia 2020; 61:1033-1044. [DOI: 10.1111/epi.16515] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Robb Wesselingh
- Department of Neurosciences Central Clinical School Faculty of Medicine, Nursing, and Health Sciences Monash University Melbourne Victoria Australia
- Department of Neurology Alfred Health Melbourne Victoria Australia
| | - Helmut Butzkueven
- Department of Neurosciences Central Clinical School Faculty of Medicine, Nursing, and Health Sciences Monash University Melbourne Victoria Australia
- Department of Neurology Alfred Health Melbourne Victoria Australia
| | - Katherine Buzzard
- Department of Neurology Melbourne Health Parkville Victoria Australia
- Department of Neurology Eastern Health Box Hill Victoria Australia
| | - David Tarlinton
- Department of Immunology Central Clinical School Faculty of Medicine, Nursing, and Health Sciences Monash University Melbourne Victoria Australia
| | - Terence J. O'Brien
- Department of Neurosciences Central Clinical School Faculty of Medicine, Nursing, and Health Sciences Monash University Melbourne Victoria Australia
- Department of Neurology Alfred Health Melbourne Victoria Australia
| | - Mastura Monif
- Department of Neurosciences Central Clinical School Faculty of Medicine, Nursing, and Health Sciences Monash University Melbourne Victoria Australia
- Department of Neurology Alfred Health Melbourne Victoria Australia
- Department of Neurology Melbourne Health Parkville Victoria Australia
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Kaczmarska A, José-López R, Czopowicz M, Lazzerini K, Leblond G, Stalin C, Gutierrez-Quintana R. Postencephalitic epilepsy in dogs with meningoencephalitis of unknown origin: Clinical features, risk factors, and long-term outcome. J Vet Intern Med 2020; 34:808-820. [PMID: 31990104 PMCID: PMC7096646 DOI: 10.1111/jvim.15687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/10/2019] [Indexed: 12/27/2022] Open
Abstract
Background Although the presence of seizures in dogs with meningoencephalitis of unknown origin (MUO) has been associated with shorter survival times, data regarding the prevalence and risk factors for postencephalitic epilepsy (PEE) is lacking. Objectives To describe the clinical features, prevalence, risk factors, and long‐term outcome of PEE in dogs with MUO. Animals Sixty‐one dogs with presumptive diagnosis of MUO based on the clinicopathological and diagnostic imaging findings. Methods Retrospective study. Cases were identified by search of hospital medical records for dogs with suspected or confirmed MUO. Medical records of dogs meeting inclusion criteria were reviewed. Signalment, seizure history, clinicopathologic, and magnetic resonance imaging (MRI) findings were recorded. Results Among 61 dogs at risk of PEE, 14 (23%) dogs developed PEE. Three of 14 dogs with PEE (21%) developed drug‐resistant epilepsy. Dogs with PEE were younger (P = .03; ORadjusted = 0.75; 95% confidence interval [CI], 0.58‐0.98) and had significantly shorter survival times (log‐rank test P = .04) when compared to dogs that did not develop epilepsy. The risk factors associated with the development of PEE were the presence of acute symptomatic seizures (ASS; P = .04; ORadjusted = 4.76; 95% CI, 1.11‐20.4) and MRI lesions in the hippocampus (P = .04; ORadjusted = 4.75; 95% CI, 1.07‐21.0). Conclusions and Clinical Importance Dogs with MUO and seizures at the early stage of the disease (ASS) seem to be at a higher risk of developing PEE.
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Affiliation(s)
- Adriana Kaczmarska
- Small Animal Hospital, School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Roberto José-López
- Small Animal Hospital, School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Michał Czopowicz
- Laboratory of Veterinary Epidemiology and Economics, Faculty of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Kali Lazzerini
- Small Animal Hospital, School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Guillaume Leblond
- Small Animal Hospital, School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Catherine Stalin
- Small Animal Hospital, School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
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Liu Y, Zhou W. Clinical features and surgical treatment of epilepsy after viral encephalitis. BRAIN SCIENCE ADVANCES 2019. [DOI: 10.1177/2096595819896177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Encephalitis is an acute inflammatory process of the brain parenchyma, which is often caused by viral infection. It is an vital cause of acute symptomatic seizures and subsequent epilepsy. The incidence of unprovoked and recurrent seizures after previous infections of the central nervous system is high and accounts for 1%~5% of the cases of epilepsy. Viral encephalitis (VE) is directly caused by viral infection. The occurrence of seizures after VE is associated with poor prognosis. In survivors of VE, among other neurological sequelae, the risk of developing epilepsy is increased 10-fold. The risk of severe neurological sequelae after VE is particularly high in very young children. Studies on seizure occurrence, possible underlying mechanisms, clinical characteristics, and clinical treatment (especially surgical treatment) of VE have yielded only limited detailed data. We reviewed the most recent literature on the clinical features and surgical treatment of post-VE epilepsy.
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Affiliation(s)
- Yiou Liu
- Department of Epilepsy Center, Tsinghua University Yuquan Hospital, Beijing 100040, China
| | - Wenjing Zhou
- Department of Epilepsy Center, Tsinghua University Yuquan Hospital, Beijing 100040, China
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Sriwastava S, Srinivas M, Kanna A, Yarraguntla K, Jowkar A, George E. Anti-glutamic acid decarboxylase antibody (GAD) syndromes may have more aggressive disease course in African Americans and early onset of presentation compare to Caucasians group. eNeurologicalSci 2019; 17:100208. [PMID: 31646204 PMCID: PMC6804399 DOI: 10.1016/j.ensci.2019.100208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/07/2019] [Indexed: 01/06/2023] Open
Abstract
Anti-Glutamic acid decarboxylase antibodies (GAD) are increasingly diagnosed in the clinic and this antibody related syndromes can manifest commonly as autoimmune encephalitis, Stiff person syndrome and cerebellar ataxia. However, it is unclear if the race has role in age of incidence, presentation and severity of symptoms of anti-GAD associated conditions. In our cohort of 40 patients who were anti-GAD positive, we observed that the age at which the anti-GAD titers turned out to be positive was significantly lower in African Americans (AA) compared to Caucasians (Cau) irrespective of the type of conditions. However, the age at symptoms onset didn't differ significantly different between these groups. Furthermore, AA anti-GAD positive patients had seizures as their initial presentation that was significantly higher in incidence compared to Cau indicating that AA have more aggressive form of autoimmune phenomenon for reasons unknown. Future studies to explore the variations in autoimmune process and their phenotypes may aid in understanding anti-GAD syndromes differently between these racial groups.
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Chronic post-encephalitic epilepsy following Japanese encephalitis: Clinical features, neuroimaging data, and outcomes. Seizure 2019; 72:49-53. [PMID: 31600677 DOI: 10.1016/j.seizure.2019.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/17/2019] [Accepted: 09/20/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Japanese encephalitis (JE), the main cause of viral encephalitis in Asia, usually presents with acute symptomatic seizures; however, there have been very few systematic reports regarding late unprovoked seizures and epilepsy. We aimed to describe the clinical features and outcomes of post-encephalitic epilepsy following JE. METHODS Patients with epilepsy with a previous confirmed diagnosis of JE visiting West China Hospital from 2013 to 2019 were enrolled in the observational case-controlled study. Patients with epilepsy with a history of other non-specific viral encephalitis were enrolled as controls. For all enrolled subjects, disease related information was recorded. RESULTS Forty-eight patients with JE (20 males; median age, 21.0 years; average epilepsy duration, 8.55 years) were identified. The median duration from JE to the first unprovoked seizure was 7.73 years, which significantly differed from that of the controls (7.73 vs. 2.69 years, respectively; p = 4.59 × 10-6). Most patients had focal epilepsy, and 29 (78.38%) were drug resistant. Among 45 patients with available neuroimaging data, three in fourth had no obvious abnormality, and the temporal lobe and hippocampus (22.22%) were the most affected brain regions. Six patients had surgery, and three achieved class-one seizure-free status. CONCLUSION The latency to the first unprovoked seizure was longer in patients with JE than controls. Regarding chronic epilepsy, three in four had structural abnormalities, and the long-term outcomes of post-encephalitic epilepsy following JE were poor. Surgery remains an option for drug-resistant epilepsy.
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Liu YO, Zhou WJ, Hong B, Zhao T, Wang YF. Surgical outcomes in patients with epilepsy after viral encephalitis: contribution of SEEG study. BMC Neurol 2019; 19:165. [PMID: 31315594 PMCID: PMC6636038 DOI: 10.1186/s12883-019-1396-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/08/2019] [Indexed: 11/16/2022] Open
Abstract
Background Nowadays, few surgery analysis has been reported in cases of epilepsy after viral encephalitis(VE). Herein, this study was to evaluate the efficacy of surgery and capability of stereoelectroencephalography (SEEG) in the definition of the epileptogenic zone (EZ) after VE, and also to explore the relationship between the SEEG features and the surgical outcomes. Methods We retrospectively analyzed 10 surgically treated patients that identified to suffer from epilepsy secondary to VE using SEEG, and investigated the SEEG features associated with surgical outcomes in these patients. Besides visual analysis, we used the epileptogenicity index (EI), a semi-quantitative and supplementary tool to evaluate the validity of SEEG in the context of VE. Results Among the 10 operated patients, 3 of them became completely seizure-free. The patients who got totally seizure free or significant improvement, the seizure onset was located either in the antero-mesial temporal structures or focal gyrus; patients who got worthwhile improvement or no improvement, the seizure started from multiple brain lobes. The number of electrodes classified as epileptogenic visually involved were closely correlated with EI positive onses.Anatomic areas defined and shown as EZ on MRI by visual assessment were also defined as epileptogenic by the EI in these cases. Conclusion Apart from exploring the surgical outcome related to epilepsy after VE, we also bring insight into the relationship between the SEEG features and surgical outcome with the application of the supplementary methods.
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Affiliation(s)
- Yi-Ou Liu
- Department of Epilepsy Center, Division of Neurology, Tsinghua University Yuquan Hospital, Beijing, China
| | - Wen-Jing Zhou
- Department of Epilepsy Center, Division of Neurology, Tsinghua University Yuquan Hospital, Beijing, China.
| | - Bo Hong
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Tong Zhao
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Yue-Feng Wang
- Department of Pathology, Tsinghua University Yuquan Hospital, Beijing, China
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Liu Y, Zhou W. Clinical features and surgical treatment of epilepsy after viral encephalitis. BRAIN SCIENCE ADVANCES 2019. [DOI: 10.26599/bsa.2019.9050002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Steriade C, Moosa ANV, Hantus S, Prayson RA, Alexopoulos A, Rae-Grant A. Electroclinical features of seizures associated with autoimmune encephalitis. Seizure 2018; 60:198-204. [PMID: 30031297 DOI: 10.1016/j.seizure.2018.06.021] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/22/2018] [Accepted: 06/24/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We sought to characterize the electroclinical features of seizures associated with autoimmune encephalitis and their relevance to outcome. METHODS 19 patients with seizures and autoimmune encephalitis were identified from a database of 100 patients (2008-2017) with autoimmune neurological disorders. Clinical and electroclinical characteristics were collected. Persistent seizures at last follow-up were then correlated with electroclinical features. RESULTS Status epilepticus (53%) and early intractability to AEDs (median time to second AED 9.5 days) marked the onset of refractory seizures (median number of AEDs 3). Seizure semiology (abdominal (16%), psychic (42%), olfactory (6%) auras), interictal temporal epileptiform discharges (42%), and ictal onset in the temporal region (63%) mirrored radiologic involvement of the medial temporal regions (on MRI in 74% and/or FDG-PET in 75%). In addition, multimodal auras, with somatosensory (26%), autonomic (26%), gustatory (11%), and visual (16%), features were seen in 82% of patients with focal aware seizures, invoking broader involvement of the perisylvian regions. A change in seizure semiology and EEG findings was often seen. Electroclinical features were similar regardless of antibody type, with the exception of the association of faciobrachial dystonic seizures with LGI1 antibodies. Eight patients had medically intractable seizures at last follow-up and were more likely than patients with seizure remission to have generalized tonic-clonic seizures and temporal lobe involvement on the basis of semiological features, interictal EEG and MRI changes. CONCLUSIONS Seizures associated with autoimmune encephalitis exhibit common electroclinical features which show dynamic evolution over time. We propose a role for the temporo-perisylvian regions in their generation.
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Affiliation(s)
- Claude Steriade
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Ahsan N V Moosa
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Stephen Hantus
- Epilepsy Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Richard A Prayson
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Alexander Rae-Grant
- Mellen Center for Multiple Sclerosis, Cleveland Clinic Foundation, Cleveland, OH, USA
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Dagiasi I, Vall V, Kumlien E, Burman J, Zelano J. Treatment of epilepsy in multiple sclerosis. Seizure 2018; 58:47-51. [PMID: 29656097 DOI: 10.1016/j.seizure.2018.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/13/2018] [Accepted: 04/01/2018] [Indexed: 10/17/2022] Open
Abstract
PURPOSE The prevalence of epilepsy is increased in multiple sclerosis (MS), but information on AED treatment and seizure outcome is scarce. We describe epilepsy characteristics including the use of AEDs and proportion of seizure-free patients at two tertiary hospitals in Sweden. METHOD We retrospectively studied electronic medical records of all patients with a diagnosis of MS and seizures at Sahlgrenska university hospital and Uppsala university hospital. Clinical data were reviewed until 2017. RESULTS We identified a total of 62 MS patients with at least one seizure. Median age at the first seizure (before or after MS) was 41 years (range 0-80). The most common MS disease course at the first seizure was secondary progressive MS, the neurological disability was considerable, and most patients had several MRI lesions at their first seizure. The first EEG demonstrated epileptiform discharges in 38% and unspecific pathology in 40%. Current seizure status could be determined for 37 patients. Out of these, 46% had been seizure free for more than one year at last follow-up. The majority of patients (65%) were on monotherapy at last follow-up. Carbamazepine was the most commonly used first AED, with a retention rate of 52%. No individual AED was associated with a particularly high rate of seizure freedom. The most common reason for discontinuation of the first AED was side-effects. CONCLUSION Seizure freedom rates were low, perhaps indicating a need for higher ambitions in management. Side effects of AEDs may be a particular concern when treating epilepsy in patients with MS.
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Affiliation(s)
- Ioanna Dagiasi
- Department of clinical neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden; NÄL Hospital Trollhättan, Sweden
| | - Victor Vall
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Eva Kumlien
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Joachim Burman
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Johan Zelano
- Department of clinical neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden.
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Liu X, Yan B, Wang R, Li C, Chen C, Zhou D, Hong Z. Seizure outcomes in patients with anti-NMDAR encephalitis: A follow-up study. Epilepsia 2017; 58:2104-2111. [PMID: 29098690 DOI: 10.1111/epi.13929] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Xu Liu
- Department of Neurology; West China Hospital; Sichuan University; Chengdu Sichuan China
| | - Bo Yan
- Department of Neurology; West China Hospital; Sichuan University; Chengdu Sichuan China
| | - Rui Wang
- Department of Neurology; West China Hospital; Sichuan University; Chengdu Sichuan China
| | - Chen Li
- Department of Neurology; West China Hospital; Sichuan University; Chengdu Sichuan China
| | - Chu Chen
- Department of Neurology; West China Hospital; Sichuan University; Chengdu Sichuan China
| | - Dong Zhou
- Department of Neurology; West China Hospital; Sichuan University; Chengdu Sichuan China
| | - Zhen Hong
- Department of Neurology; West China Hospital; Sichuan University; Chengdu Sichuan China
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Morita M, Fujimoto A, Okanishi T, Nishimura M, Sato K, Kanai S, Enoki H. Vagus nerve stimulation therapy improved refractory epilepsy secondary to acute encephalitis with refractory, repetitive partial seizures (AERRPS). INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2017. [DOI: 10.1016/j.inat.2017.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Seo JW, Yang EJ, Kim SH, Choi IH. An inhibitory alternative splice isoform of Toll-like receptor 3 is induced by type I interferons in human astrocyte cell lines. BMB Rep 2016; 48:696-701. [PMID: 26077030 PMCID: PMC4791326 DOI: 10.5483/bmbrep.2015.48.12.106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Indexed: 01/15/2023] Open
Abstract
Toll-like receptor 3 (TLR3) recognizes viral double-stranded RNA. It stimulates pro-inflammatory cytokine and interferon production. Here we reported the expression of a novel isoform of TLR3 in human astrocyte cell lines whose message is generated by alternative splicing. The isoform represents the N-terminus of the protein. It lacks many of the leucine-rich repeat domains, the transmembrane domain, and the intracellular Toll/interleukin-1 receptor domain of TLR3. Type I interferons (interferon-α and interferon-β) induced the expression of this isoform. Exogenous overexpression of this isoform inhibited interferon regulatory factor 3, signal transducers and activators of transcription 1, and Inhibitor of kappa B α signaling following stimulation. This isoform of TLR3 also inhibited the production of chemokine interferon-γ-inducible protein 10. Our study clearly demonstrated that the expression of this isoform of TLR3 was a negative regulator of signaling pathways and that it was inducible by type I interferons. We also found that this isoform could modulate inflammation in the brain. [BMB Reports 2015; 48(12): 696-701]
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Affiliation(s)
- Jin-Won Seo
- Department of Microbiology, Institute for Immunology and Immunological Diseases, and Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Eun-Jeon Yang
- Department of Microbiology, Institute for Immunology and Immunological Diseases, and Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Se Hoon Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul 03722, Korea
| | - In-Hong Choi
- Department of Microbiology, Institute for Immunology and Immunological Diseases, and Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea
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Sonneville R, Mariotte E, Neuville M, Minaud S, Magalhaes E, Ruckly S, Cantier M, Voiriot G, Radjou A, Smonig R, Soubirou JF, Mourvillier B, Bouadma L, Wolff M, Timsit JF. Early-onset status epilepticus in patients with acute encephalitis. Medicine (Baltimore) 2016; 95:e4092. [PMID: 27472682 PMCID: PMC5265819 DOI: 10.1097/md.0000000000004092] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Status epilepticus (SE) is a common complication of acute encephalitis, but its determinants and prognostic value in this setting are not known.Risk factors for early-onset SE (within 48 hours of intensive care unit [ICU] admission) in consecutive adult patients with all-cause encephalitis admitted to the medical ICU of a university hospital (1991-2013) were evaluated by multivariate logistic regression analysis. To examine the prognostic value of SE, patients were classified into 3 groups: no SE, nonrefractory SE (NRSE), and refractory SE (RSE). Poor neurologic outcome was defined by a modified Rankin score of 4 to 6.Among the 290 patients, 58 (20%, 95% CI: 15%-25%) developed early-onset SE, comprising 44 patients with NRSE and 14 patients with RSE. Coma (adjusted odds ratio [OR]: 3.1, 95% CI: 1.5-6.3), cortical lesions on neuroimaging (adjusted OR: 3.7, 95% CI: 1.8-7.8), and nonneurologic organ failure(s) (adjusted OR: 13.6, 95% CI: 4.9-37.7) were found to be independent risk factors for SE. By contrast, a bacterial etiology had a protective effect (adjusted OR: 0.3, 95% CI: 0.1-0.7). Age, body temperature, and blood sodium levels were not independently associated with SE. Poor neurologic outcomes were observed at day 90 in respectively 23% (95% CI: 17%-28%), 23% (95% CI: 10%-35%), and 71% (95% CI: 48%-95%) of no SE, NRSE, and RSE patients (P < 0.01). After adjusting for confounders, RSE, but not NRSE, remained independently associated with 90-day mortality (adjusted OR: 6.0, 95% CI: 1.5-23.3).Coma, cortical involvement on neuroimaging, and nonneurologic organ failure(s) are independent risk factors for SE in patients with acute encephalitis. Conversely, a bacterial etiology is associated with a lower risk of SE.These findings may help identify patients who may benefit from prophylactic antiepileptic drugs.
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Affiliation(s)
- Romain Sonneville
- Univ Paris Diderot, Sorbonne Paris Cité, Assistance Publique–Hôpitaux de Paris, Hôpital Bichat–Claude-Bernard, Service de Réanimation Médicale et des Maladies Infectieuses, rue Henri-Huchard, Paris Cedex, France
- Correspondence: Romain Sonneville, Univ Paris Diderot, Sorbonne Paris Cité, Assistance Publique–Hôpitaux de Paris, Hôpital Bichat–Claude-Bernard, Service de Réanimation Médicale et des Maladies Infectieuses, 46 rue Henri Huchard, 75877 Paris Cedex, France (e-mail: )
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Pillai SC, Mohammad SS, Hacohen Y, Tantsis E, Prelog K, Barnes EH, Gill D, Lim MJ, Brilot F, Vincent A, Dale RC. Postencephalitic epilepsy and drug-resistant epilepsy after infectious and antibody-associated encephalitis in childhood: Clinical and etiologic risk factors. Epilepsia 2015; 57:e7-e11. [PMID: 26592968 DOI: 10.1111/epi.13253] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
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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Affiliation(s)
- Sekhar C Pillai
- 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.,TY Nelson Department of Neurology and Neurosurgery, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Shekeeb S Mohammad
- 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
| | - Yael Hacohen
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Esther Tantsis
- 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.,TY Nelson Department of Neurology and Neurosurgery, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Kristina Prelog
- Department of Medical Imaging, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Elizabeth H Barnes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.,Department of Statistics, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Deepak Gill
- TY Nelson Department of Neurology and Neurosurgery, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Ming J Lim
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.,Evelina London Children's Hospital, London, United Kingdom
| | - Fabienne Brilot
- 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
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Russell C Dale
- 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.,TY Nelson Department of Neurology and Neurosurgery, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Singh TD, Fugate JE, Hocker S, Wijdicks EFM, Aksamit AJ, Rabinstein AA. Predictors of outcome in HSV encephalitis. J Neurol 2015; 263:277-289. [DOI: 10.1007/s00415-015-7960-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 10/25/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
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Löscher W, Hirsch LJ, Schmidt D. The enigma of the latent period in the development of symptomatic acquired epilepsy - Traditional view versus new concepts. Epilepsy Behav 2015; 52:78-92. [PMID: 26409135 DOI: 10.1016/j.yebeh.2015.08.037] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 08/30/2015] [Indexed: 01/21/2023]
Abstract
A widely accepted hypothesis holds that there is a seizure-free, pre-epileptic state, termed the "latent period", between a brain insult, such as traumatic brain injury or stroke, and the onset of symptomatic epilepsy, during which a cascade of structural, molecular, and functional alterations gradually mediates the process of epileptogenesis. This review, based on recent data from both animal models and patients with different types of brain injury, proposes that epileptogenesis and often subclinical epilepsy can start immediately after brain injury without any appreciable latent period. Even though the latent period has traditionally been the cornerstone concept representing epileptogenesis, we suggest that the evidence for the existence of a latent period is spotty both for animal models and human epilepsy. Knowing whether a latent period exists or not is important for our understanding of epileptogenesis and for the discovery and the trial design of antiepileptogenic agents. The development of antiepileptogenic treatments to prevent epilepsy in patients at risk from a brain insult is a major unmet clinical need.
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Affiliation(s)
- Wolfgang Löscher
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, 30559 Hannover, Germany; Center for Systems Neuroscience, 30559 Hannover, Germany.
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Lin KL, Lin JJ, Hsia SH, Chou ML, Hung PC, Wang HS. Effect of Antiepileptic Drugs for Acute and Chronic Seizures in Children with Encephalitis. PLoS One 2015; 10:e0139974. [PMID: 26444013 PMCID: PMC4596539 DOI: 10.1371/journal.pone.0139974] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 09/18/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Encephalitis presents with seizures in the acute phase and increases the risk of late unprovoked seizures and epilepsy. This study aimed to evaluate the effect of antiepileptic drugs in pediatric patients with acute seizures due to encephalitis and epilepsy. PATIENTS AND METHODS Cases of acute pediatric encephalitis between January 2000 and December 2010 were reviewed. Clinical data, including onset at age, seizure type, seizure frequency, effects of antiepileptic drugs, and prognosis were analyzed. RESULTS During the study period, 1038 patients (450 girls, 588 boys) were enrolled. Among them, 44.6% (463) had seizures in the acute phase, 33% had status epilepticus, and 26% (251) developed postencephalitic epilepsy. At one year of follow-up, 205 of the 251 patients with postencephalitic epilepsy were receiving antiepileptic drugs while 18% were seizure free even after discontinuing the antiepileptic drugs. Among those with postencephalitic epilepsy, 67% had favorable outcomes and were using <2 anti-epileptic drugs while 15% had intractable seizures and were using ≥ 2 antiepileptic drugs. After benzodiazepines, intravenous phenobarbital was preferred over phenytoin as treatment of postencephalitic seizures in the acute phase. For refractory status epilepticus, high-dose topiramate combined with intravenous high-dose phenobarbital or high-dose lidocaine had less side effects. CONCLUSIONS Children with encephalitis have a high rate of postencephalitic epilepsy. Phenobarbital and clonazepam are the most common drugs used, alone or in combination, for postencephalitic epilepsy.
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Affiliation(s)
- Kuang-Lin Lin
- Division of Pediatric Neurology, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Chang Gung Children’s Hospital Study Group for Children with Encephalitis/Encephalopathy Related Status Epilepticus and Epilepsy (CHEESE), Taoyuan, Taiwan
- * E-mail:
| | - Jainn-Jim Lin
- Division of Pediatric Neurology, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Chang Gung Children’s Hospital Study Group for Children with Encephalitis/Encephalopathy Related Status Epilepticus and Epilepsy (CHEESE), Taoyuan, Taiwan
- Division of Pediatric Critical Care and Emergency Medicine, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shao-Hsuan Hsia
- Chang Gung Children’s Hospital Study Group for Children with Encephalitis/Encephalopathy Related Status Epilepticus and Epilepsy (CHEESE), Taoyuan, Taiwan
- Division of Pediatric Critical Care and Emergency Medicine, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Min-Liang Chou
- Division of Pediatric Neurology, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Chang Gung Children’s Hospital Study Group for Children with Encephalitis/Encephalopathy Related Status Epilepticus and Epilepsy (CHEESE), Taoyuan, Taiwan
| | - Po-Cheng Hung
- Division of Pediatric Neurology, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Chang Gung Children’s Hospital Study Group for Children with Encephalitis/Encephalopathy Related Status Epilepticus and Epilepsy (CHEESE), Taoyuan, Taiwan
| | - Huei-Shyong Wang
- Division of Pediatric Neurology, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Chang Gung Children’s Hospital Study Group for Children with Encephalitis/Encephalopathy Related Status Epilepticus and Epilepsy (CHEESE), Taoyuan, Taiwan
| | - CHEESE Study Group
- Chang Gung Children’s Hospital Study Group for Children with Encephalitis/Encephalopathy Related Status Epilepticus and Epilepsy (CHEESE), Taoyuan, Taiwan
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Lin YJ, Lo C, Cheng SJ, Chou CL, Hseuh IH. Recurrent nonconvulsive status epilepticus in a patient with progressive left hemispheric leukoencephalopathy after a remote viral meningoencephalitis. Epilepsy Behav 2015; 49:178-83. [PMID: 26139418 DOI: 10.1016/j.yebeh.2015.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/09/2015] [Accepted: 05/12/2015] [Indexed: 01/28/2023]
Abstract
Nonconvulsive status epilepticus (NCSE), defined as changes in behavior and/or mental processes from baseline with continuous epileptiform discharges, remains a diagnostic and treatment challenge. Here, we present a 68-year-old female who developed 3 episodes of NCSE 10 years after a viral meningoencephalitis which gradually progressed to left hemispheric leukoencephalopathy. In this case, we hypothesize that immune-mediated mechanisms and perhaps genetic predisposition played a role in epileptogenesis, and these will be discussed. This article is part of a Special Issue entitled "Status Epilepticus".
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Affiliation(s)
- Ya-Ju Lin
- Department of Neurology, MacKay Memorial Hospital, No. 92, Sec 2, Zhong-shan North Road, Taipei 104, Taiwan.
| | - Chiening Lo
- Department of Neurology, National Cheng Kung University Hospital Dou-Liou Branch, No. 345, Jhuangjing Road, Dou-Liou City, Yun-Lin County 640, Taiwan.
| | - Sho-Jen Cheng
- Department of Radiology, MacKay Memorial Hospital, No. 92, Sec 2, Zhong-shan North Road, Taipei 104, Taiwan.
| | - Chao-Liang Chou
- Department of Neurology, MacKay Memorial Hospital, No. 92, Sec 2, Zhong-shan North Road, Taipei 104, Taiwan.
| | - I-Hung Hseuh
- Department of Neurology, MacKay Memorial Hospital, No. 92, Sec 2, Zhong-shan North Road, Taipei 104, Taiwan.
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