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Sakuma H, Takanashi JI, Muramatsu K, Kondo H, Shiihara T, Suzuki M, Okanari K, Kasai M, Mitani O, Nakazawa T, Omata T, Shimoda K, Abe Y, Maegaki Y, Murayama K, Murofushi Y, Nagase H, Okumura A, Sakai Y, Tada H, Mizuguchi M. Severe pediatric acute encephalopathy syndromes related to SARS-CoV-2. Front Neurosci 2023; 17:1085082. [PMID: 36922927 PMCID: PMC10008884 DOI: 10.3389/fnins.2023.1085082] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/07/2023] [Indexed: 03/08/2023] Open
Abstract
Background and objectives To clarify whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection cause acute encephalopathy in children and which are the most common syndromes that cause them and what are the outcomes. Methods A nationwide web-based survey among all members of the Japanese Society of Child Neurology to identify pediatric patients aged < 18 years who developed acute encephalopathy in Japan between 1 January 2020 and 31 May 2022 associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection confirmed by polymerase chain reaction or antigen tests using pharyngeal swabs. Acute encephalopathy was defined as acute onset of impaired consciousness lasting > 24 h or an altered mental state; neurological symptoms arising within 2 weeks of onset of COVID-19 or multisystem inflammatory syndrome in children (MIS-C)/pediatric inflammatory multisystem syndrome (PIMS); evidence of SARS-CoV-2 infection; and reasonable exclusion of other diseases. Patients were divided into the known clinico-radiological acute encephalopathy syndrome group and unexplained or unclassifiable acute encephalopathy group. Outcomes were assessed by pediatric cerebral performance category (PCPC) score at hospital discharge. Results Of the 3,802 society members, 217 representing institutions responded, and 39 patients with suspected acute encephalopathy were reported, of which 31 met inclusion criteria. Of these patients, 14 were diagnosed with known clinico-radiological acute encephalopathy syndromes, with acute encephalopathy with biphasic seizures and late reduced diffusion (five patients) being the most common. Five developed acute encephalopathy associated with MIS-C/PIMS. Among 31 patients, 9 (29.0%) had severe sequelae or died (PCPC ≥ 4). Two of three patients with encephalopathy with acute fulminant cerebral edema and two with hemorrhagic shock and encephalopathy syndrome died. The PCPC scores were higher in the known clinico-radiological acute encephalopathy syndrome group than in the unexplained or unclassifiable acute encephalopathy group (P < 0.01). Discussion Acute encephalopathy related to SARS-CoV-2 infection was demonstrated to be more severe than that caused by other viruses in Japan. Acute encephalopathy syndromes characterized by specific neuroradiological findings was associated with poor clinical outcomes.
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Affiliation(s)
- Hiroshi Sakuma
- Department of Brain and Neurosciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Jun-Ichi Takanashi
- Department of Pediatrics and Pediatric Neurology, Tokyo Women's Medical University Yachiyo Medical Center, Tokyo, Japan
| | | | - Hidehito Kondo
- Department of Pediatrics, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Takashi Shiihara
- Department of Neurology, Gunma Children's Medical Center, Gunma, Japan
| | - Motomasa Suzuki
- Department of Pediatric Neurology, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Kazuo Okanari
- Department of Pediatrics, Oita Prefectural Hospital, Oita, Japan
| | - Mariko Kasai
- Department of Pediatrics, Saitama Citizens Medical Center, Saitama, Japan
| | - Osamu Mitani
- Department of Pediatrics, Fukuyama City Hospital, Hiroshima, Japan
| | - Tomoyuki Nakazawa
- Department of Pediatrics, Tokyo Metropolitan Toshima Hospital, Tokyo, Japan
| | - Taku Omata
- Division of Child Neurology, Chiba Children's Hospital, Chiba, Japan
| | - Konomi Shimoda
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuichi Abe
- Division of Neurology, National Center for Child Health and Development, Tokyo, Japan
| | - Yoshihiro Maegaki
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Kei Murayama
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Yuka Murofushi
- Department of Pediatrics and Pediatric Neurology, Tokyo Women's Medical University Yachiyo Medical Center, Tokyo, Japan
| | - Hiroaki Nagase
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyōgo, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroko Tada
- Department of Brain and Neurosciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.,Division of Pediatrics, Chibaken Saiseikai Narashino Hospital, Chiba, Japan
| | - Masashi Mizuguchi
- Department of Pediatrics, National Rehabilitation Center for Children with Disabilities, Tokyo, Japan
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Oguri M, Saito Y, Fukuda C, Kishi K, Yokoyama A, Lee S, Torisu H, Toyoshima M, Sejima H, Kaji S, Hamano SI, Okanishi T, Tomita Y, Maegaki Y. Distinguishing Acute Encephalopathy with Biphasic Seizures and Late Reduced Diffusion from Prolonged Febrile Seizures by Acute Phase EEG Spectrum Analysis. Yonago Acta Med 2016; 59:1-14. [PMID: 27046946 PMCID: PMC4816744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 12/14/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND To differentiate the features of electroencephalography (EEG) after status epileptics in febrile children with final diagnosis of either febrile seizure (FS) or acute encephalopathy for an early diagnosis. METHODS We retrospectively collected data from 68 children who had status epilepticus and for whom EEGs were recorded within 120 h. These included subjects with a final diagnosis of FS (n = 20), epileptic status (ES; n = 11), acute encephalopathy with biphasic seizures and late reduced diffusion (AESD; n = 18), mild encephalopathy with a reversible splenial lesion (MERS; n = 7), other febrile encephalopathies (n = 10), hypoxic-ischemic encephalopathy (n = 1), and intracranial bleeding (n = 1). Initially, all EEGs were visually assessed and graded, and correlation with outcome was explored. Representative EEG epochs were then selected for quantitative analyses. Furthermore, data from AESD (n = 7) and FS (n = 16) patients for whom EEG was recorded within 24 h were also compared. RESULTS Although milder and most severe grades of EEG correlated with neurological outcome, the outcome of moderate EEG severity group was variable and was not predictable from usual inspection. Frequency band analysis revealed that solid delta power was not significantly different among the five groups (AESD, MERS, FS, ES and control), and that MERS group showed the highest theta band power. The ratios of delta/alpha and (delta + theta)/(alpha + beta) band powers were significantly higher in the AESD group than in other groups. The alpha and beta band powers in EEGs within 24 h from onset were significantly lower in the AESD group. The band powers and their ratios showed earlier improvement towards 24 h in FS than in AESD. CONCLUSION Sequential EEG recording up to 24 h from onset appeared to be helpful for distinction of AESD from FS before emergence of the second phase of AESD.
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Affiliation(s)
- Masayoshi Oguri
- Department of Child Neurology, Institute of Neurological Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Yoshiaki Saito
- Department of Child Neurology, Institute of Neurological Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Chisako Fukuda
- †Department of Pathobiological Science and Technology, School of Life Sciences, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Kazuko Kishi
- ‡Department of Pediatrics, Shimane University Hospital, Izumo 693-8501, Japan
| | - Atsushi Yokoyama
- Department of Child Neurology, Institute of Neurological Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan; §Department of Pediatrics, Shimane Prefectural Center Hospital, Izumo 693-8555, Japan
| | - Sooyoung Lee
- ||Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; ¶Department of Critical care Medicine, Fukuoka Children's Hospital, Fukuoka 813-0017, Japan
| | - Hiroyuki Torisu
- ||Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; *Section of Pediatrics, Department of Medicine, Fukuoka Dental College, Fukuoka 814-0193, Japan
| | - Mitsuo Toyoshima
- ††Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8544, Japan
| | - Hitoshi Sejima
- ‡‡Department of Pediatrics, Matsue Red-Cross Hospital, Matsue 690-8506, Japan
| | - Shunsaku Kaji
- §§Department of Pediatrics, Tsuyama Chuo Hospital, Tsuyama 708-0841, Japan
| | - Shin-Ichiro Hamano
- ||||Division of Neurology, Saitama Children's Medical Center, Saitama 339-8551, Japan
| | - Toru Okanishi
- ¶¶Division of Child Neurology, Seirei-Hamamatsu General Hospital, Hamamatsu 430-8558, Japan
| | - Yutaka Tomita
- **Department of Laboratory Medicine, Kyoto Min-iren Central Hostpial, Kyoto 604-8453, Japan
| | - Yoshihiro Maegaki
- Department of Child Neurology, Institute of Neurological Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
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