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Bhatti KS, Rajagopalan S. Case report: Invasive neuromonitoring in status epilepticus induced hypoxic ischemic brain injury. Front Neurol 2023; 14:1284098. [PMID: 38099068 PMCID: PMC10720614 DOI: 10.3389/fneur.2023.1284098] [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: 08/27/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023] Open
Abstract
Objectives Literature on invasive neuromonitoring and bilateral decompressive craniectomies (BDC) in patients with refractory status epilepticus (RSE)-mediated hypoxic-ischemic brain injury (HIBI) is limited. Neuromonitoring can guide decision making and treatment escalation. Methods and results We report a case of a 17 years-old male who was admitted to our hospital's intensive care unit for RSE. HIBI was detected on neuroimaging on this patient's second day of admission after he developed central diabetes insipidus (DI). Invasive neuromonitoring revealed raised intracranial pressure (ICP) and brain hypoxia as measured by reduced brain tissue oxygen tension (PbtO2). Treatments were escalated in a tiered fashion, including administration of hyperosmolar agents, analgesics, sedatives, and a neuromuscular blocking drug. Eventually, BDC was performed as a salvage therapy as a means of controlling refractory ICP crisis in the setting of diffuse cerebral edema (DCE) following HIBI. Discussion SE-mediated HIBI can result in refractory ICP crisis. Neuromonitoring can help identify secondary brain injury (SBI), guide treatment strategies, including surgical interventions, and may lead to better outcomes.
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Donnan AM, Schneider AL, Russ-Hall S, Churilov L, Scheffer IE. Rates of Status Epilepticus and Sudden Unexplained Death in Epilepsy in People With Genetic Developmental and Epileptic Encephalopathies. Neurology 2023; 100:e1712-e1722. [PMID: 36750385 PMCID: PMC10115508 DOI: 10.1212/wnl.0000000000207080] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 01/05/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The genetic developmental and epileptic encephalopathies (DEEs) comprise a large group of severe epilepsy syndromes, with a wide phenotypic spectrum. Currently, the rates of convulsive status epilepticus (CSE), nonconvulsive status epilepticus (NCSE), and sudden unexplained death in epilepsy (SUDEP) in these diseases are not well understood. We aimed to describe the proportions of patients with frequently observed genetic DEEs who developed CSE, NCSE, mortality, and SUDEP. Understanding the risks of these serious presentations in each genetic DEE will enable earlier diagnosis and appropriate management. METHODS In this retrospective analysis of patients with a genetic DEE, we estimated the proportions with CSE, NCSE, and SUDEP and the overall and SUDEP-specific mortality rates for each genetic diagnosis. We included patients with a pathogenic variant in the genes SCN1A, SCN2A, SCN8A, SYNGAP1, NEXMIF, CHD2, PCDH19, STXBP1, GRIN2A, KCNT1, and KCNQ2 and with Angelman syndrome (AS). RESULTS The cohort comprised 510 individuals with a genetic DEE, in whom we observed CSE in 47% and NCSE in 19%. The highest proportion of CSE occurred in patients with SCN1A-associated DEEs, including 181/203 (89%; 95% CI 84-93) patients with Dravet syndrome and 8/15 (53%; 95% CI 27-79) non-Dravet SCN1A-DEEs. CSE was also notable in patients with pathogenic variants in KCNT1 (6/10; 60%; 95% CI 26-88) and SCN2A (8/15; 53%; 95% CI 27-79). NCSE was common in patients with non-Dravet SCN1A-DEEs (8/15; 53%; 95% CI 27-79) and was notable in patients with CHD2-DEEs (6/14; 43%; 95% CI 18-71) and AS (6/19; 32%; 95% CI 13-57). There were 42/510 (8%) deaths among the cohort, producing a mortality rate of 6.1 per 1,000 person-years (95% CI 4.4-8.3). Cases of SUDEP accounted for 19/42 (48%) deaths. Four genes were associated with SUDEP: SCN1A, SCN2A, SCN8A, and STXBP1. The estimated SUDEP rate was 2.8 per 1,000 person-years (95% CI 1.6-4.3). DISCUSSION We showed that proportions of patients with CSE, NCSE, and SUDEP differ for commonly encountered genetic DEEs. The estimates for each genetic DEE studied will inform early diagnosis and management of status epilepticus and SUDEP and inform disease-specific counseling for patients and families in this high-risk group of conditions.
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Affiliation(s)
- Alice M Donnan
- From the Epilepsy Research Centre (A.M.D., A.L.S., S.R.-H., I.E.S.), Department of Medicine, The University of Melbourne, Austin Health; Melbourne Medical School (L.C.), Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville; The Florey Institute of Neurosciences and Mental Health (L.C., I.E.S.), Melbourne; and Department of Paediatrics (I.E.S.), The University of Melbourne, Royal Children's Hospital, and Murdoch Children's Research Institute, Victoria, Australia
| | - Amy L Schneider
- From the Epilepsy Research Centre (A.M.D., A.L.S., S.R.-H., I.E.S.), Department of Medicine, The University of Melbourne, Austin Health; Melbourne Medical School (L.C.), Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville; The Florey Institute of Neurosciences and Mental Health (L.C., I.E.S.), Melbourne; and Department of Paediatrics (I.E.S.), The University of Melbourne, Royal Children's Hospital, and Murdoch Children's Research Institute, Victoria, Australia
| | - Sophie Russ-Hall
- From the Epilepsy Research Centre (A.M.D., A.L.S., S.R.-H., I.E.S.), Department of Medicine, The University of Melbourne, Austin Health; Melbourne Medical School (L.C.), Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville; The Florey Institute of Neurosciences and Mental Health (L.C., I.E.S.), Melbourne; and Department of Paediatrics (I.E.S.), The University of Melbourne, Royal Children's Hospital, and Murdoch Children's Research Institute, Victoria, Australia
| | - Leonid Churilov
- From the Epilepsy Research Centre (A.M.D., A.L.S., S.R.-H., I.E.S.), Department of Medicine, The University of Melbourne, Austin Health; Melbourne Medical School (L.C.), Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville; The Florey Institute of Neurosciences and Mental Health (L.C., I.E.S.), Melbourne; and Department of Paediatrics (I.E.S.), The University of Melbourne, Royal Children's Hospital, and Murdoch Children's Research Institute, Victoria, Australia
| | - Ingrid E Scheffer
- From the Epilepsy Research Centre (A.M.D., A.L.S., S.R.-H., I.E.S.), Department of Medicine, The University of Melbourne, Austin Health; Melbourne Medical School (L.C.), Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville; The Florey Institute of Neurosciences and Mental Health (L.C., I.E.S.), Melbourne; and Department of Paediatrics (I.E.S.), The University of Melbourne, Royal Children's Hospital, and Murdoch Children's Research Institute, Victoria, Australia.
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Nickels KC, Wirrell EC. Dravet Syndrome: Don't Hesitate, Just Vaccinate! Neurology 2023; 100:171-173. [PMID: 36323523 DOI: 10.1212/wnl.0000000000201531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Katherine C Nickels
- From the Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester MN
| | - Elaine C Wirrell
- From the Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester MN.
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Howell KB, Butcher S, Schneider AL, Russ-Hall S, Muzariri PR, Kerr R, Overmars I, Hayman M, Kornberg AJ, Danchin M, Crawford NW, Scheffer IE. Complications of Influenza A or B Virus Infection in Individuals With SCN1A-Positive Dravet Syndrome. Neurology 2023; 100:e435-e442. [PMID: 36323522 DOI: 10.1212/wnl.0000000000201438] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/06/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To determine the frequency and spectrum of complications of influenza infection in individuals with SCN1A-positive Dravet syndrome (SCN1A-DS). METHODS Individuals with SCN1A-DS were identified in neurologists' care at 2 hospitals in Melbourne, Australia, with additional searches of EEG databases, the Victorian PAEDS FluCan influenza database, and the University of Melbourne Epilepsy Genetics Research Program database. Medical records were searched and families questioned to identify individuals who had an influenza infection; reported infections were confirmed by pathology report. For these individuals, we obtained baseline clinical characteristics and clinical details of the influenza infection. RESULTS Twenty-one of 82 individuals (26%) had 24 documented influenza infections (17 influenza A and 7 influenza B) at age 0.5-25 years (median 4 years). All presented to hospital, 18/24 (75%) for status epilepticus or seizure exacerbations. Recovery was prompt in 18/24 (75%) infections, delayed but complete in 1/24 (4%) and incomplete in 5/24 (21%). One child died from influenza pneumonia, and long-term neurologic sequelae were seen with 4 infections. These individuals were poorly responsive after termination of status epilepticus. Brain imaging in 2 showed cerebral edema and 1 also having imaging features of laminar necrosis. All have ongoing neurologic deficits compared with their baseline, 1 having profound global impairment. DISCUSSION Our data show that patients with SCN1A-DS are highly susceptible to neurologic complications during and severe sequelae after influenza infection, including moderate to severe persistent neurologic impairments and death. Safe administration of the seasonal influenza vaccine should be prioritized for this population.
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Affiliation(s)
- Katherine B Howell
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia.
| | - Sophie Butcher
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Amy L Schneider
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Sophie Russ-Hall
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Pearl R Muzariri
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Rachel Kerr
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Isabella Overmars
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Michael Hayman
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Andrew J Kornberg
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Margie Danchin
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Nigel W Crawford
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
| | - Ingrid E Scheffer
- From the Department of Neurology (K.B.H., S.B., M.H., A.J.K., I.E.S.), The Royal Children's Hospital; Department of Paediatrics (K.B.H., A.J.K., N.W.C., I.E.S.), The University of Melbourne; Murdoch Children's Research Institute (K.B.H., P.R.M., R.K., I.O., A.J.K., M.D., N.W.C., I.E.S.); Department of Medicine (A.L.S., S.R.-H., I.E.S.), Epilepsy Research Centre, Austin Health, The University of Melbourne; Immunisation Service (M.D., N.W.C., I.E.S.), The Royal Children's Hospital; and Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Australia
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The effectiveness of intravenous benzodiazepine for status epilepticus in Dravet syndrome. Brain Dev 2022; 44:319-328. [PMID: 35120772 DOI: 10.1016/j.braindev.2022.01.004] [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: 06/19/2021] [Revised: 12/28/2021] [Accepted: 01/16/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE We aimed to evaluate choice and efficacy of intravenous antiepileptic drugs (AEDs) for status epilepticus (SE) in Dravet syndrome and to find predictable clinical features demonstrating the effectiveness of benzodiazepine (BZD) for SE. METHODS We retrospectively investigated the medical records in patients with Dravet syndrome and evaluated the effectiveness rate of intravenous AEDs and the rate of adverse effects. To find the clinical features of BZD-effective SE, we divided the SE episodes into the following two groups: BZD effective group and BZD non-effective group. The choice of treatment was dependent on physicians' discretion according to the protocol for SE in our institution. RESULTS Sixty-eight SE episodes in 10 patients were assessed. The median age at SE was 31 months. Of 68 episodes, 42 episodes (61.8%) were in the BZD effective group and 26 (38.2%) in the BZD non-effective group. There were no significant differences in clinical features. In the BZD non-effective group, the effective rates of continuous midazolam, phenobarbital, phenytoin/fosphenytoin were 9/9 episodes (100%), 14/17 (82.4%), and 2/5 (40.0%), respectively. Adverse effects were identified in 19/68 episodes (27.9%), including 11/42 episodes in the BZD effective group and 8/26 in the BZD non-effective group, which was no statistical difference between the two groups. Respiratory suppression was found in all 19 episodes and the incidence of endotracheal intubation in the BZD non-effective group (15.4%) was higher than that in the BZD effective group (2.4%) (p = 0.046). CONCLUSION BZD may be used as first choice, and phenobarbital prior to continuous midazolam as second choice for SE with Dravet syndrome. There might be no predictable clinical features showing that BZD will be effective.
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Abstract
PURPOSE OF REVIEW This article reviews the clinical features, typical EEG findings, treatment, prognosis, and underlying molecular etiologies of the more common genetic epilepsy syndromes. Genetic generalized epilepsy, self-limited focal epilepsy of childhood, self-limited neonatal and infantile epilepsy, select developmental and epileptic encephalopathies, progressive myoclonus epilepsies, sleep-related hypermotor epilepsy, photosensitive occipital lobe epilepsy, and focal epilepsy with auditory features are discussed. Also reviewed are two familial epilepsy syndromes: genetic epilepsy with febrile seizures plus and familial focal epilepsy with variable foci. RECENT FINDINGS Recent years have seen considerable advances in our understanding of the genetic factors underlying genetic epilepsy syndromes. New therapies are emerging for some of these conditions; in some cases, these precision medicine approaches may dramatically improve the prognosis. SUMMARY Many recognizable genetic epilepsy syndromes exist, the identification of which is a crucial skill for neurologists, particularly those who work with children. Proper diagnosis of the electroclinical syndrome allows for appropriate treatment choices and counseling regarding prognosis and possible comorbidities.
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Perulli M, Battista A, Sivo S, Turrini I, Musto E, Quintiliani M, Gambardella ML, Contaldo I, Veredice C, Mercuri EM, Lanza GA, Dravet C, Delogu AB, Battaglia DI. Heart rate variability alterations in Dravet Syndrome: The role of status epilepticus and a possible association with mortality risk. Seizure 2021; 94:129-135. [PMID: 34896816 DOI: 10.1016/j.seizure.2021.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/02/2021] [Accepted: 11/26/2021] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Preliminary data suggest that patients with Dravet Syndrome (DS) have a reduced heart rate variability (HRV). This seems particularly evident in patients who experienced sudden unexpected death in epilepsy (SUDEP). This study aims at confirming these findings in a larger cohort and at defining clinical, genetic or electroencephalographic predictors of HRV impairment in DS patients. METHODS DS patients followed at our Institution performed a 24h-ECG Holter to derive HRV parameters. We used as control population patients with epilepsy (PWEs) and healthy controls (HCs). In DS patients, we assessed the impact of different clinical, neurophysiological and genetic features on HRV alterations through multiple linear regression. After a mean follow-up of 7.4 ± 3.2 years since the HRV assessment, all DS patients were contacted to record death or life-threatening events. RESULTS 56 DS patients had a significantly reduced HRV compared to both HCs and PWEs. A recent history of status epilepticus (SE) was the only significant predictor of lower HRV in the multivariate analysis. At follow-up, only one patient died; her HRV was lower than that of all the controls and was in the low range for DS patients. CONCLUSION We describe for the first time an association between SE and HRV alterations in DS. Further studies on other SCN1A-related phenotypes and other epilepsies with frequent SE will help clarify this finding. Compared to the literature, our cohort showed better HRV and lower mortality. Although limited, this observation reinforces the role of HRV as a biomarker for mortality risk in DS.
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Affiliation(s)
- Marco Perulli
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Battista
- Pediatrics, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Serena Sivo
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ida Turrini
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Musto
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michela Quintiliani
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Luigia Gambardella
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ilaria Contaldo
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Veredice
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eugenio Maria Mercuri
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gaetano Antonio Lanza
- Cardiology, Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze cardiovascolari e pneumologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Charlotte Dravet
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angelica Bibiana Delogu
- Pediatrics, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenica Immacolata Battaglia
- Pediatric Neurology, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.
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Cardenal-Muñoz E, Auvin S, Villanueva V, Cross JH, Zuberi SM, Lagae L, Aibar JÁ. Guidance on Dravet syndrome from infant to adult care: Road map for treatment planning in Europe. Epilepsia Open 2021; 7:11-26. [PMID: 34882995 PMCID: PMC8886070 DOI: 10.1002/epi4.12569] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 11/24/2021] [Accepted: 12/02/2021] [Indexed: 12/22/2022] Open
Abstract
Dravet syndrome (DS) is a severe, rare, and complex developmental and epileptic encephalopathy affecting 1 in 16 000 live births and characterized by a drug‐resistant epilepsy, cognitive, psychomotor, and language impairment, and behavioral disorders. Evidence suggests that optimal treatment of seizures in DS may improve outcomes, even though neurodevelopmental impairments are the likely result of both the underlying genetic variant and the epilepsy. We present an updated guideline for DS diagnosis and treatment, taking into consideration care of the adult patient and nonpharmaceutical therapeutic options for this disease. This up‐to‐date guideline, which is based on an extensive review of the literature and culminates with a new treatment algorithm for DS, is a European consensus developed through a survey involving 29 European clinical experts in DS. This guideline will serve professionals in their clinical practice and, as a consequence, will benefit DS patients and their families.
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Affiliation(s)
- Elena Cardenal-Muñoz
- Dravet Syndrome Foundation Spain, Member of the EpiCARE ePAG Group, Madrid, Spain
| | - Stéphane Auvin
- APHP. Service de Neurologie Pédiatrique, Hôpital Robert Debré, Paris, France.,INSERM NeuroDiderot, Université de Paris, Paris, France.,Institut Universitaire de France (IUF), Paris, France
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Hospital Universitario y Politécnico La Fe, Member of the ERN EpiCARE, Valencia, Spain
| | - J Helen Cross
- Department of Developmental Neurosciences, UCL NIHR BRC Great Ormond Street Institute of Child Health, London, UK.,Department of Neurology, Great Ormond Street Hospital for Children, Member of the ERN EpiCARE, London, UK
| | - Sameer M Zuberi
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Member of the ERN EpiCARE, Glasgow, UK.,Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Lieven Lagae
- Department of Development and Regeneration, KU Leuven, Member of the ERN EpiCARE, Leuven, Belgium
| | - José Ángel Aibar
- Dravet Syndrome Foundation Spain, Member of the EpiCARE ePAG Group, Madrid, Spain
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9
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Andrade DM, Berg AT, Hood V, Knupp KG, Koh S, Laux L, Meskis MA, Miller I, Perry MS, Scheffer IE, Sullivan J, Villas N, Wirrell E. Dravet syndrome: A quick transition guide for the adult neurologist. Epilepsy Res 2021; 177:106743. [PMID: 34624600 DOI: 10.1016/j.eplepsyres.2021.106743] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/02/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Dravet syndrome (DS) is still seen as a "pediatric disease", where patients receive excellent care in pediatric centers, but care is less than optimal in adult health care systems (HCS). This creates a barrier when young adults need to leave the family-centered pediatric system and enter the adult, patient-centered HCS. Here we create a guide to help with the transition from pediatric to adult for patients with DS. METHODS Experts in Dravet syndrome flagged the main barriers in caring for adults with DS and created a 2-page transition summary guide based on their expertise and a literature review. RESULTS The 2-page guide addresses: DS diagnosis in children and adults; clinical manifestations, including the differences in seizures types and frequencies between children and adults with DS; the natural history of intellectual disability, behavior, gait, motor disorders and dysautonomia; a review of optimal treatments (including medications not commonly used in adult epilepsy settings such as stiripentol and fenfluramine), as well as emergency seizure management; avoidance of triggers, preventive measures, and vaccine administration in adults with DS. CONCLUSION Several young adults with DS are still followed by their child neurologist. This 2-page transition guide should help facilitate the transition of patients with DS to the adult HCS and should be given to families as well as adult health care providers that may not be familiar with DS.
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Affiliation(s)
- Danielle M Andrade
- Adult Epilepsy Genetics Program, Division of Neurology, Krembil Brain Institute, Toronto Western Hospital, University of Toronto, Toronto, Canada.
| | - Anne T Berg
- Ann & Robert H. Lurie Children's Hospital of Chicago, Departments of Pediatrics and Neurological Surgery, Northwestern Feinberg School of Medicine, Chicago, USA
| | | | - Kelly G Knupp
- Department of Pediatrics and Neurology, University of Colorado Anschutz Campus, Aurora, CO, USA
| | - Sookyong Koh
- Department of Pediatric Neurology at University of Nebraska Medical Center, Omaha, NE, USA
| | - Linda Laux
- Epilepsy Center, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | | | - Ian Miller
- Department of Neurology, Nicklaus Children's Hospital, Miami, FL, USA
| | - M Scott Perry
- Jane and John Justin Neurosciences Center, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Ingrid E Scheffer
- Epilepsy Research Centre, The University of Melbourne, Austin Health, Royal Children's Hospital, Florey Institute, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Joseph Sullivan
- Department of Neurology & Pediatrics, University of California, San Francisco, CA, USA
| | | | - Elaine Wirrell
- Child and Adolescent Neurology, Mayo Clinic, Rochester, MN, USA
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10
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Gamblin A, Fredrickson VL, Hollon TC, Salzman KL, Couldwell WT. Idiopathic chronic temporal lobe herniation with associated epilepsy. Acta Neurochir (Wien) 2021; 163:2805-2808. [PMID: 34292392 DOI: 10.1007/s00701-021-04926-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/18/2021] [Indexed: 11/30/2022]
Abstract
Herniation of parahippocampal gyrus is usually caused by pressure differentials intracranially, and herniation without known risk factors is extremely rare. We describe a patient with a long history of seizures and a remote status epilepticus event. On magnetic resonance imaging, a presumed left temporal lobe tumor was observed. On neurosurgical consultation, the lesion was identified as a chronic mesial temporal lobe herniation. The patient lacked history that would suggest risk of cerebral herniation. Accurately identifying the patient's chronic temporal lobe herniation radiographically likely saved this patient from unnecessary surgery or biopsy and allowed the patient to receive appropriate conservative care.
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Affiliation(s)
- Austin Gamblin
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Vance L Fredrickson
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Todd C Hollon
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Karen L Salzman
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
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11
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Li W, Schneider AL, Scheffer IE. Defining Dravet syndrome: An essential pre-requisite for precision medicine trials. Epilepsia 2021; 62:2205-2217. [PMID: 34338318 PMCID: PMC9291974 DOI: 10.1111/epi.17015] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/21/2021] [Accepted: 07/12/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The classical description of Dravet syndrome, the prototypic developmental and epileptic encephalopathy, is of a normal 6-month-old infant presenting with a prolonged, febrile, hemiclonic seizure and showing developmental slowing after age 1 year. SCN1A pathogenic variants are found in >80% of patients. Many patients have atypical features resulting in diagnostic delay and inappropriate therapy. We aimed to provide an evidence-based definition of SCN1A-Dravet syndrome in readiness for precision medicine trials. METHODS Epilepsy patients were recruited to the University of Melbourne Epilepsy Genetics Research Program between 1995 and 2020 by neurologists from around the world. Patients with SCN1A pathogenic variants were reviewed and only those with Dravet syndrome were included. Clinical data, including seizure and developmental course, were analyzed in all patients with SCN1A-Dravet syndrome. RESULTS Two hundred and five patients were studied at a median age of 8.5 years (range 10 months to 60 years); 25 were deceased. The median seizure-onset age was 5.7 months (range 1.5-20.6 months). Initial seizures were tonic-clonic (52%) and hemiclonic (35%), with only 55% being associated with fever. Only 34% of patients presented with status epilepticus (seizure lasting ≥30 minutes). Median time between first and second seizure was 30 days (range 4 hours to 8 months), and seven patients (5%) had at least 6 months between initial seizures. Median ages at onset of second and third seizure types were 9.1 months (range 3 months-25.4 years) and 15.5 months (range 4 months-8.2 years), respectively. Developmental slowing occurred prior to 12 months in 27%. SIGNIFICANCE An evidence-based definition of SCN1A-Dravet syndrome is essential for early diagnosis. We refine the spectrum of Dravet syndrome, based on patterns of seizure onset, type, and progression. Understanding of the full spectrum of SCN1A-Dravet syndrome presentation is essential for early diagnosis and optimization of treatment, especially as precision medicine trials become available.
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Affiliation(s)
- Wenhui Li
- Children's Hospital of Fudan University, Shanghai, China.,Department of Medicine, Austin Health, Epilepsy Research Centre, University of Melbourne, Heidelberg, Vic., Australia
| | - Amy L Schneider
- Department of Medicine, Austin Health, Epilepsy Research Centre, University of Melbourne, Heidelberg, Vic., Australia
| | - Ingrid E Scheffer
- Department of Medicine, Austin Health, Epilepsy Research Centre, University of Melbourne, Heidelberg, Vic., Australia.,Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia.,Murdoch Children's Research Institute and Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, Vic., Australia
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12
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Different Outcomes of Acute Encephalopathy after Status Epilepticus in Patients with Dravet Syndrome. How to Avoid Them? Comment on De Liso et al. Fatal Status Epilepticus in Dravet Syndrome. Brain Sci. 2020, 10, 889. Brain Sci 2021; 11:brainsci11060792. [PMID: 34208473 PMCID: PMC8235089 DOI: 10.3390/brainsci11060792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/08/2021] [Indexed: 11/28/2022] Open
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13
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Miller I, Scheffer IE, Gunning B, Sanchez-Carpintero R, Gil-Nagel A, Perry MS, Saneto RP, Checketts D, Dunayevich E, Knappertz V. Dose-Ranging Effect of Adjunctive Oral Cannabidiol vs Placebo on Convulsive Seizure Frequency in Dravet Syndrome: A Randomized Clinical Trial. JAMA Neurol 2021; 77:613-621. [PMID: 32119035 PMCID: PMC7052786 DOI: 10.1001/jamaneurol.2020.0073] [Citation(s) in RCA: 144] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Clinical evidence supports effectiveness of cannabidiol for treatment-resistant seizures in Dravet syndrome, but this trial is the first to evaluate the 10-mg/kg/d dose. Objective To evaluate the efficacy and safety of a pharmaceutical formulation of cannabidiol, 10 and 20 mg/kg/d, vs placebo for adjunctive treatment of convulsive seizures in patients with Dravet syndrome. Design, Setting, and Participants This double-blind, placebo-controlled, randomized clinical trial (GWPCARE2) recruited patients from April 13, 2015, to November 10, 2017, with follow-up completed on April 9, 2018. Of 285 patients screened from 38 centers in the United States, Spain, Poland, the Netherlands, Australia, and Israel, 86 were excluded, and 199 were randomized. Patients were aged 2 to 18 years with a confirmed diagnosis of Dravet syndrome and at least 4 convulsive seizures during the 4-week baseline period while receiving at least 1 antiepileptic drug. Data were analyzed from November 16 (date of unblinding) to December 13 (date of final outputs), 2018, based on intention to treat and per protocol. Interventions Patients received cannabidiol oral solution at a dose of 10 or 20 mg/kg per day (CBD10 and CBD20 groups, respectively) or matched placebo in 2 equally divided doses for 14 weeks. All patients, caregivers, investigators, and individuals assessing data were blinded to group assignment. Main Outcomes and Measures The primary outcome was change from baseline in convulsive seizure frequency during the treatment period. Secondary outcomes included change in all seizure frequency, proportion with at least a 50% reduction in convulsive seizure activity, and change in Caregiver Global Impression of Change score. Results Of 198 eligible patients (mean [SD] age, 9.3 [4.4] years; 104 female [52.5%]), 66 were randomized to the CBD10 group, 67 to the CBD20 group, and 65 to the placebo group, and 190 completed treatment. The percentage reduction from baseline in convulsive seizure frequency was 48.7% for CBD10 group and 45.7% for the CBD20 group vs 26.9% for the placebo group; the percentage reduction from placebo was 29.8% (95% CI, 8.4%-46.2%; P = .01) for CBD10 group and 25.7% (95% CI, 2.9%-43.2%; P = .03) for the CBD20 group. The most common adverse events were decreased appetite, diarrhea, somnolence, pyrexia, and fatigue. Five patients in the CBD20 group discontinued owing to adverse events. Elevated liver transaminase levels occurred more frequently in the CBD20 (n = 13) than the CBD10 (n = 3) group, with all affected patients given concomitant valproate sodium. Conclusions and Relevance Adjunctive cannabidiol at doses of 10 and 20 mg/kg/d led to similar clinically relevant reductions in convulsive seizure frequency with a better safety and tolerability profile for the 10-mg/kg/d dose in children with treatment-resistant Dravet syndrome. Dose increases of cannabidiol to greater than 10 mg/kg/d should be tailored to individual efficacy and safety. Trial Registration ClinicalTrials.gov Identifier: NCT02224703.
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Affiliation(s)
- Ian Miller
- Department of Neurology, Nicklaus Children's Hospital, Miami, Florida
| | - Ingrid E Scheffer
- Epilepsy Research Centre, The University of Melbourne at Austin Health and the Royal Children's Hospital, Melbourne, Victoria, Australia.,Florey Institute, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Rocio Sanchez-Carpintero
- Pediatric Neurology Unit, Clínica Universidad de Navarra, Navarra Institute for Health Research, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Antonio Gil-Nagel
- Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | - M Scott Perry
- Jane and John Justin Neurosciences Center, Cook Children's Medical Center, Ft Worth, Texas
| | - Russell P Saneto
- Neuroscience Institute, Division of Pediatric Neurology, Department of Neurology, Seattle Children's Hospital and University of Washington, Seattle
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14
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Ninan S, Thompson P, Gershon T, Ford N, Mills W, Jewells V, Thorne L, Saunders K, Bouldin T, Smedberg JR, Miller MB, Wu E, Tilly A, Sites J, Lercher D, Clement K, Walker T, Shea P, Joyner B, Smith R. Fatal Pediatric COVID-19 Case With Seizures and Fulminant Cerebral Edema. Child Neurol Open 2021; 8:2329048X211022532. [PMID: 34179214 PMCID: PMC8207268 DOI: 10.1177/2329048x211022532] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/12/2021] [Accepted: 05/16/2021] [Indexed: 12/22/2022] Open
Abstract
The novel coronavirus, SARS-CoV-2, can present with a wide range of neurological manifestations, in both adult and pediatric populations. We describe here the case of a previously healthy 8-year-old girl who presented with seizures, encephalopathy, and rapidly progressive, diffuse, and ultimately fatal cerebral edema in the setting of acute COVID-19 infection. CSF analysis, microbiological testing, and neuropathology yielded no evidence of infection or acute inflammation within the central nervous system. Acute fulminant cerebral edema (AFCE) is an often fatal pediatric clinical entity consisting of fever, encephalopathy, and new-onset seizures followed by rapid, diffuse, and medically-refractory cerebral edema. AFCE occurs as a rare complication of a variety of common pediatric infections and a CNS pathogen is identified in only a minority of cases, suggesting a para-infectious mechanism of edema. This report suggests that COVID-19 infection can precipitate AFCE, and highlights the need for high suspicion and early recognition thereof.
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Affiliation(s)
- Siddharth Ninan
- Department of Neurology, University of North Carolina at Chapel Hill, NC, USA
| | - Peyton Thompson
- Department of Pediatrics, Division of Infectious Diseases, University of North Carolina at Chapel Hill, NC, USA
| | - Timothy Gershon
- Department of Pediatrics, Division of Infectious Diseases, University of North Carolina at Chapel Hill, NC, USA
| | - Natalie Ford
- Department of Pediatrics, University of North Carolina at Chapel Hill, NC, USA
| | - William Mills
- Department of Pediatrics, Division of Emergency Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Valerie Jewells
- Department of Radiology, University of North Carolina at Chapel Hill, NC, USA
| | - Leigh Thorne
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Katherine Saunders
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Thomas Bouldin
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Jason R. Smedberg
- Clinical Microbiology Laboratory, McLendon Clinical Laboratories, UNC Medical Center, Chapel Hill, NC
| | - Melissa B. Miller
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, NC, USA
- Clinical Microbiology Laboratory, McLendon Clinical Laboratories, UNC Medical Center, Chapel Hill, NC
| | - Eveline Wu
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, University of North Carolina at Chapel Hill, NC, USA
| | - Alyssa Tilly
- Departments of Medicine and Pediatrics, Palliative Care Program, University of North Carolina at Chapel Hill, NC, USA
| | - Jeremy Sites
- Department of Pediatrics, Division of Critical Care, University of North Carolina at Chapel Hill, NC, USA
| | - Daniel Lercher
- Department of Pediatrics, Division of Critical Care, University of North Carolina at Chapel Hill, NC, USA
| | - Katherine Clement
- Department of Pediatrics, Division of Critical Care, University of North Carolina at Chapel Hill, NC, USA
| | - Tracie Walker
- Department of Pediatrics, Division of Critical Care, University of North Carolina at Chapel Hill, NC, USA
| | - Paul Shea
- Department of Pediatrics, Division of Critical Care, University of North Carolina at Chapel Hill, NC, USA
| | - Benny Joyner
- Department of Pediatrics, Division of Critical Care, University of North Carolina at Chapel Hill, NC, USA
| | - Rebecca Smith
- Department of Pediatrics, Division of Critical Care, University of North Carolina at Chapel Hill, NC, USA
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15
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Deng X, He F, Zhang C, Yin F, Peng J. Etiology of Non-Traumatic Seizures in Children Admitted to PICU: An Eight-Year Retrospective Study. Int J Gen Med 2020; 13:1285-1290. [PMID: 33273847 PMCID: PMC7705251 DOI: 10.2147/ijgm.s283036] [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: 10/13/2020] [Accepted: 11/17/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Seizure is a serious neurological symptom in the pediatric intensive care unit (PICU), yet data on etiologies of non-traumatic childhood seizures in China are scarce. We aimed to investigate the etiological trends of seizures in children admitted to the PICU in our tertiary center. Patients and Methods We performed a retrospective analysis of all patients (aged 29 days to 14 years) with non-traumatic seizures, admitted to the PICU of Xiangya Hospital from 2010 to 2017. Etiological analysis was performed to compare data between 2010–2013 and 2014–2017. Results The study included 318 patients (male: female = 1.27:1) with mean age of 5.4 ± 4.0 years. The most frequent causes observed were CNS infections (109/318, 34.3%), unknown reason epilepsy (96/318, 30.2%), and immune (56/318, 17.6%). Comparison of the 2010–2013 and 2014–2017 periods revealed a significant decrease in the percentage of CNS infections [48.8% (59/121) vs 25.4% (50/197), p < 0.001] and a significant increase in the incidence of unknown reason epilepsy [(24/121, 19.8%) vs (72/197, 36.5%), p < 0.001] and immune causes [(12/121, 9.9%) vs (44/197, 22.3%), p = 0.005]. Conclusion CNS infections were the most common cause of seizures during 2010–2013, while non-infectious diseases such as epilepsy and immune disorders represented the leading causes during 2014–2017. Continuous improvement in medical technology and understanding of disease patterns would greatly improve early diagnosis and therapeutic management of such conditions.
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Affiliation(s)
- Xiaolu Deng
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Fang He
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Ciliu Zhang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Fei Yin
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Jing Peng
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, People's Republic of China
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16
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De Liso P, Pironi V, Mastrangelo M, Battaglia D, Craiu D, Trivisano M, Specchio N, Nabbout R, Vigevano F. Fatal Status Epilepticus in Dravet Syndrome. Brain Sci 2020; 10:brainsci10110889. [PMID: 33238377 PMCID: PMC7700506 DOI: 10.3390/brainsci10110889] [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: 10/21/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 01/21/2023] Open
Abstract
Dravet Syndrome (DS) is burdened by high epilepsy-related premature mortality due to status epilepticus (SE). We surveyed centres within Europe through the Dravet Italia Onlus and EpiCARE network (European Reference Network for Rare and Complex Epilepsies). We collated responses on seven DS SCN1A+ patients who died following refractory SE (mean age 6.9 year, range 1.3–23.4 year); six were on valproate, clobazam, and stiripentol. All patients had previous SE. Fatal SE was always triggered by fever: either respiratory infection or one case of hexavalent vaccination. SE lasted between 80 min and 9 h and all patients received IV benzodiazepines. Four patients died during or within hours of SE; in three patients, SE was followed by coma with death occurring after 13–60 days. Our survey supports the hypothesis that unresponsive fever is a core characteristic feature of acute encephalopathy. We highlight the need for management protocols for prolonged seizures and SE in DS.
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Affiliation(s)
- Paola De Liso
- Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Full Member of European Reference Network EpiCARE, 00165 Rome, Italy; (P.D.L.); (V.P.); (M.T.); (N.S.)
| | - Virginia Pironi
- Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Full Member of European Reference Network EpiCARE, 00165 Rome, Italy; (P.D.L.); (V.P.); (M.T.); (N.S.)
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health, Institute of Pediatrics, Policlinico Universitario Gemelli Foundation, Catholic University of Rome, 00168 Rome, Italy
| | | | - Domenica Battaglia
- Department of Child Neurology and Psychiatry, Policlinico Universitario Gemelli Foundation, Catholic University of Rome, 00153 Rome, Italy;
| | - Dana Craiu
- Department of Neurology, Paediatric Neurology, Psychiatry, Neurosurgery, “Carol Davila” University of Medicine of Bucharest, Full Member of European Reference Network EpiCARE, 050474 Bucharest, Romania;
| | - Marina Trivisano
- Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Full Member of European Reference Network EpiCARE, 00165 Rome, Italy; (P.D.L.); (V.P.); (M.T.); (N.S.)
| | - Nicola Specchio
- Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Full Member of European Reference Network EpiCARE, 00165 Rome, Italy; (P.D.L.); (V.P.); (M.T.); (N.S.)
| | - Rima Nabbout
- Centre for Rare Epilepsies, Department of Paediatric Neurology, Necker-Enfants Malades Hospital, Imagine Institute, INSERMU1163, Paris Descartes University, Full Member of European Reference Network EpiCARE, 75006 Paris, France;
| | - Federico Vigevano
- Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Full Member of European Reference Network EpiCARE, 00165 Rome, Italy; (P.D.L.); (V.P.); (M.T.); (N.S.)
- Correspondence:
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17
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Dibué M, Spoor JKH, Dremmen M, von Saß CF, Hänggi D, Steiger HJ, Ryvlin P, Kamp MA. Sudden death in epilepsy: There is room for intracranial pressure. Brain Behav 2020; 10:e01838. [PMID: 32949224 PMCID: PMC7667321 DOI: 10.1002/brb3.1838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/18/2020] [Accepted: 08/26/2020] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Sudden unexpected death in patients with epilepsy (SUDEP) remains a poorly understood entity, and it is unclear whether the same pathomechanisms underlie all sudden deaths occurring in patients with epilepsy. One aspect not included in current models of SUDEP is the role of increased intracranial pressure (ICP) which can be observed immediately upon seizure activity in neurosurgical practice. METHODS We conducted a systematic review of the occurrence of edema in patients with epilepsy reported to have died of sudden death who underwent brain autopsy or postmortem brain imaging and discuss how increased ICP may contribute to clinical features of SUDEP. RESULTS 19 eligible studies comprising a total of 623 patients were identified. Edema-mostly mild or moderate-was reported in 17% of cases and 74% of studies. 1% (n = 6) of the overall cases were clearly identified as having Dravet syndrome or an SCN1A mutation. In these patients, edema was found in 4 (67%) of cases. CONCLUSION Edema is regularly found in patients with epilepsy classified to have died from SUDEP. We argue that seizures preceding SUDEP may in certain cases elicit acute edema which may represent an additional contributing factor in the cascade of events leading to sudden death of patients with epilepsy. Furthermore, we hypothesize that mild edema may especially progress to severe edema in patients with sodium channel mutations which may represent an important mechanism to investigate in the context of understanding the significantly elevated risk of SUDEP in patients with SCN1A mutations.
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Affiliation(s)
- Maxine Dibué
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Jochem K H Spoor
- Department of Neurosurgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marjolein Dremmen
- Department of Radiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Daniel Hänggi
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Hans-Jakob Steiger
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Centre Hospitalo-Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Marcel A Kamp
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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Menezes LFS, Sabiá Júnior EF, Tibery DV, Carneiro LDA, Schwartz EF. Epilepsy-Related Voltage-Gated Sodium Channelopathies: A Review. Front Pharmacol 2020; 11:1276. [PMID: 33013363 PMCID: PMC7461817 DOI: 10.3389/fphar.2020.01276] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/31/2020] [Indexed: 12/29/2022] Open
Abstract
Epilepsy is a disease characterized by abnormal brain activity and a predisposition to generate epileptic seizures, leading to neurobiological, cognitive, psychological, social, and economic impacts for the patient. There are several known causes for epilepsy; one of them is the malfunction of ion channels, resulting from mutations. Voltage-gated sodium channels (NaV) play an essential role in the generation and propagation of action potential, and malfunction caused by mutations can induce irregular neuronal activity. That said, several genetic variations in NaV channels have been described and associated with epilepsy. These mutations can affect channel kinetics, modifying channel activation, inactivation, recovery from inactivation, and/or the current window. Among the NaV subtypes related to epilepsy, NaV1.1 is doubtless the most relevant, with more than 1500 mutations described. Truncation and missense mutations are the most observed alterations. In addition, several studies have already related mutated NaV channels with the electrophysiological functioning of the channel, aiming to correlate with the epilepsy phenotype. The present review provides an overview of studies on epilepsy-associated mutated human NaV1.1, NaV1.2, NaV1.3, NaV1.6, and NaV1.7.
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Affiliation(s)
- Luis Felipe Santos Menezes
- Laboratório de Neurofarmacologia, Departamento de Ciências Fisiológicas, Universidade de Brasília, Brasília, Brazil
| | - Elias Ferreira Sabiá Júnior
- Laboratório de Neurofarmacologia, Departamento de Ciências Fisiológicas, Universidade de Brasília, Brasília, Brazil
| | - Diogo Vieira Tibery
- Laboratório de Neurofarmacologia, Departamento de Ciências Fisiológicas, Universidade de Brasília, Brasília, Brazil
| | - Lilian Dos Anjos Carneiro
- Faculdade de Medicina, Centro Universitário Euro Americano, Brasília, Brazil.,Faculdade de Medicina, Centro Universitário do Planalto Central, Brasília, Brazil
| | - Elisabeth Ferroni Schwartz
- Laboratório de Neurofarmacologia, Departamento de Ciências Fisiológicas, Universidade de Brasília, Brasília, Brazil
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Noebels JL. Predicting the impact of sodium channel mutations in human brain disease. Epilepsia 2020; 60 Suppl 3:S8-S16. [PMID: 31904123 PMCID: PMC6953257 DOI: 10.1111/epi.14724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 12/21/2022]
Abstract
Genetic alteration of the sodium channel provides a remarkable opportunity to understand how epilepsy and its comorbidities arise from a molecular disease of excitable membranes, and a chance to create a better future for children with epileptic encephalopathy. In a single cell, the channel reliably acts as a voltage-sensitive switch, enabling axon impulse firing, whereas at a network level, it becomes a variable rheostat for regulating dynamic patterns of neuronal oscillations, including those underlying cognitive development, seizures, and even premature lethality. Despite steady progress linking genetic variation of the channels with distinctive clinical syndromes, our understanding of the intervening biologic complexity underlying each of them is only just beginning. More research on the functional contribution of individual channel subunits to specific brain networks and cellular plasticity in the developing brain is needed before we can reliably advance from precision diagnosis to precision treatment of inherited sodium channel disorders.
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Affiliation(s)
- Jeffrey L Noebels
- Blue Bird Circle Developmental Neurogenetics Laboratory, Departments of Neurology, Neuroscience, and Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
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20
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Cross JH, Caraballo RH, Nabbout R, Vigevano F, Guerrini R, Lagae L. Dravet syndrome: Treatment options and management of prolonged seizures. Epilepsia 2019; 60 Suppl 3:S39-S48. [DOI: 10.1111/epi.16334] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/10/2019] [Accepted: 08/11/2019] [Indexed: 12/22/2022]
Affiliation(s)
- J. Helen Cross
- University College London National Institute for Health Research Biomedical Research Centre Great Ormond Street Institute of Child Health London UK
- Great Ormond Street Hospital for Children London UK
| | - Roberto H. Caraballo
- Department of Neurology J. P. Garrahan Hospital, Capital Federal Buenos Aires Argentina
| | - Rima Nabbout
- Référence centre for rare épilepsies, department of pediatric neurology necker enfants malades hospital, aphp, Paris Descartes university Paris France
- Imagine institute insermU1163Paris France
| | - Federico Vigevano
- Pediatric Neurology Unit Bambino Gesù Children's Hospital Rome Italy
| | - Renzo Guerrini
- Pediatric Neurology Unit A. Meyer Children's HospitalUniversity of Florence Florence Italy
| | - Lieven Lagae
- Department of Pediatric Neurology UZ Leuven Leuven Belgium
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21
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Yu W, Zhu Y, Li Q, Tian X, Zhang P, Lü Y. A clinical and pathological study in patients with sudden unexpected death in Epilepsy. ACTA EPILEPTOLOGICA 2019. [DOI: 10.1186/s42494-019-0007-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Sudden unexpected death of epilepsy (SUDEP) is a severe outcome of epilepsy. This study aimed to report the clinical and pathological findings in patients with SUDEP.
Methods
The record of patients with sudden death was screened. When the reason of death matched with the definition of SUDEP, the clinical and pathological data were analyzed. Eleven patients with SUDEP were included in the study.
Results
Eight patients died after a generalized tonic-clonic seizure, seizures were induced by emotional changes in five patients, four cases were found dead in bed. Carbamazepine was prescribed in six patients. The autopsy showed brain edema and pulmonary edema in all eleven patients. Loss of neurons and gliosis were presented in some brains of SUDEP subjects. The main pathological changes in SUDEP include brain edema, pulmonary edema, loss of neurons and gliosis.
Conclusions
Risk factors for SUDEP in the study are generalized tonic-clonic seizure, emotional disturbance and carbamazepine treatment.
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Myers KA, Lightfoot P, Patil SG, Cross JH, Scheffer IE. Stiripentol efficacy and safety in Dravet syndrome: a 12-year observational study. Dev Med Child Neurol 2018; 60:574-578. [PMID: 29473155 DOI: 10.1111/dmcn.13704] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2018] [Indexed: 11/29/2022]
Abstract
AIM To assess long-term safety and efficacy of stiripentol as an antiepileptic medication for people with Dravet syndrome. METHOD A prospective, observational open-label study (2003-2015) of the efficacy and long-term safety of stiripentol in patients with Dravet syndrome and ongoing seizures. Frequency of generalized tonic-clonic seizures, focal seizures, status epilepticus, and adverse events were recorded. RESULTS Forty-one patients started stiripentol, with median age at enrolment 5 years 7 months (range 11mo-22y) and median duration of treatment 37 months (range 2-141mo). Twenty out of 41 patients had greater than or equal to 50% long-term reduction in frequency of generalized tonic-clonic seizures. Frequency of focal seizures was decreased by greater than or equal to 50% in 11 out of 23 patients over the long-term. Frequency of status epilepticus was decreased by 50% or more in 11 out of 26 patients. The most common adverse events were anorexia, weight loss, sedation, and behavioural changes. One patient had worsening of absence and myoclonic seizures. Another developed recurrent pancreatitis on concurrent valproate. INTERPRETATION Stiripentol improves long-term seizure frequency in approximately 50% of patients with Dravet syndrome, when used as part of unrestricted polytherapy. Long-term use appears safe. In more than 40% of patients, episodes of status epilepticus markedly decrease after stiripentol initiation. What this paper adds Frequency of status epilepticus is reduced in 40% of patients with Dravet syndrome after stiripentol initiation. Stiripentol is effective for generalized tonic-clonic and focal seizures. Stiripentol can be safely used with a range of antiepileptic drugs.
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Affiliation(s)
- Kenneth A Myers
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - Paul Lightfoot
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - Shekhar G Patil
- Apollo Paediatric Centre, Apollo Hospital, Navi Mumbai, India
| | - J Helen Cross
- UCL Institute of Child Health & Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ingrid E Scheffer
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
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Tian X, Ye J, Zeng Q, Zhang J, Yang X, Liu A, Yang Z, Liu X, Wu X, Zhang Y. The clinical outcome and neuroimaging of acute encephalopathy after status epilepticus in Dravet syndrome. Dev Med Child Neurol 2018; 60:566-573. [PMID: 29573403 DOI: 10.1111/dmcn.13727] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2018] [Indexed: 12/01/2022]
Abstract
AIM To analyze the clinical outcome and neuroimaging over a long duration follow-up in the currently largest series of acute encephalopathy after status epilepticus in patients with Dravet syndrome. METHOD Clinical and neuroimaging data of patients with Dravet syndrome with a history of acute encephalopathy (coma >24h) after status epilepticus from February 2005 to December 2016 at Peking University First Hospital were reviewed retrospectively. RESULTS Thirty-five patients (15 males, 20 females) with a history of acute encephalopathy were enrolled from a total of 624 patients with Dravet syndrome (5.6%). The median onset age of acute encephalopathy was 3 years 1 month. The duration of status epilepticus varied between 40 minutes to 12 hours. Thirty-four patients had a high fever when status epilepticus occurred, and only one had a normal temperature. Coma lasted from 2 to 20 days. Twelve patients died and 23 survived with massive neurological regression. The median follow-up time was 2 years 1 month. Neuroimaging of 20 out of 23 survivors during the recovery phase showed diverse degrees of cortical atrophy with or without subcortical lesions. INTERPRETATION Acute encephalopathy after status epilepticus is more prone to occur in patients with Dravet syndrome who had a high fever. The mortality rate is high in severe cases. Survivors are left with severe neurological sequelae but often with either no seizure or low seizure frequency. WHAT THIS PAPER ADDS Acute encephalopathy is more prone to occur in patients with Dravet syndrome with a high fever. The mortality rate is high for acute encephalopathy after status epilepticus in patients with Dravet syndrome. Survivors have neurological sequelae.
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Affiliation(s)
- Xiaojuan Tian
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jintang Ye
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Qi Zeng
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jing Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xiaoling Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Aijie Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Zhixian Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xiaoyan Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xiru Wu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yuehua Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
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Dravet C. Acute encephalopathy after febrile status epilepticus: an underdiagnosed, misunderstood complication of Dravet syndrome. Dev Med Child Neurol 2018; 60:534. [PMID: 29655225 DOI: 10.1111/dmcn.13778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Myers KA, Scheffer IE, Archer JS. Hemiconvulsion-hemiplegia-epilepsy evolving to contralateral hemi-Lennox-Gastaut-like phenotype. Brain Dev 2018; 40:425-428. [PMID: 29459061 DOI: 10.1016/j.braindev.2018.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/10/2018] [Accepted: 01/18/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hemiconvulsion-hemiplegia-epilepsy (HHE) involves infantile-onset acute hemiconvulsive febrile status epilepticus with subsequent unilateral cerebral atrophy and hemiparesis. Chronic epilepsy later develops, typically involving refractory focal seizures; however, the underlying pathophysiology of this epilepsy is not well understood. PATIENT We present a boy who had a typical acute presentation of HHE at 23 months, but an unusual evolution to chronic epilepsy in which the initially unaffected hemisphere was significantly abnormal. His initial acute presentation was right-sided hemiconvulsive febrile status epilepticus, with subsequent left cerebral hemiatrophy and hemiparesis affecting the right face, arm and leg. Focal seizures began at 5 years and were refractory to medical treatment. At 9 years, video EEG monitoring showed a striking pattern of interictal slow spike-wave and paroxysmal fast activity, maximal over the right, initially unaffected, hemisphere. He had primarily focal tonic seizures involving left-sided stiffening, also appearing to originate from the right hemisphere. Following left functional hemispherotomy he became seizure-free and parents reported improved cognitive function, attention and quality of life. DISCUSSION This boy had classic features of Lennox-Gastaut syndrome, but expressed almost exclusively over the right hemisphere, which was initially unaffected in his acute presentation of HHE. His evolution to "hemi-Lennox-Gastaut-like phenotype" illustrates the importance of monitoring chronic epilepsy in patients with HHE; early surgical intervention might prevent pathologic recruitment of bilateral secondary networks leading to the refractory seizures and cognitive impairment associated with Lennox-Gastaut syndrome.
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Affiliation(s)
- Kenneth A Myers
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia; Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Division of Child Neurology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Ingrid E Scheffer
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia; The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia; Department of Neurology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - John S Archer
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia; The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
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Büren C, Kamp MA, Munoz-Bendix C, Steiger HJ, Windolf J, Dibué-Adjei M. Can the combination of hyperthermia, seizures and ion channel dysfunction cause fatal post-ictal cerebral edema in patients with SCN1A mutations? EPILEPSY & BEHAVIOR CASE REPORTS 2017; 9:29-32. [PMID: 29692967 PMCID: PMC5913039 DOI: 10.1016/j.ebcr.2017.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/13/2017] [Accepted: 12/18/2017] [Indexed: 10/31/2022]
Abstract
A 21-year-old male with an SCN1A mutation died of cerebral herniation 3 h after a seizure occurring during physical activity. Cases of fatal cerebral edema in patients with SCN1A mutations after fever and status epilepticus have been recently reported raising the question whether sodium channel dysfunction may contribute to cerebral edema and thereby contribute to the increased premature mortality in Dravet Syndrome. We report on our patient and discuss whether the combination of hyperthermia and ion channel dysfunction may not only trigger seizures but also a fatal pathophysiological cascade of cerebral edema and herniation leading to cardiorespiratory collapse.
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Affiliation(s)
- Carina Büren
- Department for Trauma- and Hand Surgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Moorenstraße 5, D-40225 Düsseldorf, Germany
| | - Marcel Alexander Kamp
- Department for Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Moorenstraße 5, D-40225 Düsseldorf, Germany
| | - Christopher Munoz-Bendix
- Department for Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Moorenstraße 5, D-40225 Düsseldorf, Germany
| | - Hans-Jakob Steiger
- Department for Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Moorenstraße 5, D-40225 Düsseldorf, Germany
| | - Joachim Windolf
- Department for Trauma- and Hand Surgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Moorenstraße 5, D-40225 Düsseldorf, Germany
| | - Maxine Dibué-Adjei
- Department for Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Moorenstraße 5, D-40225 Düsseldorf, Germany.,LivaNova Deutschland GmbH (a LivaNova PLC-owned subsidiary), Lindberghstr 25, D-80939 Munich, Germany
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Verrotti A, Ambrosi M, Pavone P, Striano P. Pediatric status epilepticus: improved management with new drug therapies? Expert Opin Pharmacother 2017; 18:789-798. [PMID: 28481700 DOI: 10.1080/14656566.2017.1323873] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Alberto Verrotti
- Department of Pediatrics, San Salvatore Hospital, University of L’Aquila, L’Aquila, Italy
| | - Michela Ambrosi
- Department of Pediatrics, San Salvatore Hospital, University of L’Aquila, L’Aquila, Italy
| | - Piero Pavone
- Acute and Emergency Paediatric and General Paediatric Operative Unit, Policlinico Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, DINOGMI-Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, “G. Gaslini” Institute, Genova, Italy
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