Analysis of the role of viral encephalitis in the development of epileptic seizures and epilepsy

Tetyana Litovchenko,Marianna Markova,Viktoriia Bokatuieva,Vladimir Malakhov,Oleksandr Bilchenko,Vadym Nikonov,Olga Sukhonosova,Olga Dubenko

doi:10.15587/2519-4798.2020.217557

Abstract

The aim – to determine the role of viral lesions of the central nervous system (CNS) in the development of epileptic seizures and epilepsy.Materials and methods: analysis of scientific literature data. The review discusses the role of non-epidemic viral encephalitis and human immunodeficiency virus in the development of acute epileptic seizures and epilepsy; epidemiological data and risk factors.Results. Viral infections are often complicated by acute (early) epileptic seizures and causes the risk of further epilepsy. The mechanisms of development of early and late seizures differ. Except herpetic encephalitis, in which risk of epilepsy in early seizures is up to 60 %, the risk of late seizures in other viral encephalitis hasn't been determined. Timely treatment of viral infections and early seizures reduces the risk of epilepsy. Treatment of epilepsy with infectious lesions of the central nervous system and other types of symptomatic epilepsy is similar, and the antiepileptic drug is determined by the semiology of seizures. The interaction between it and anti-infective drugs can change the concentration in the blood of each of them, which will lead to reduced effectiveness or toxicity. This is especially important for individuals with human immunodeficiency virus infection in whom antiretroviral drugs have significant interactions with antiepileptic drugs. Since epileptic activity of the brain is associated with the severity and complications of the underlying infection, early aggressive therapy prevents the development of late seizures and epilepsy.Conclusions. CNS infections account for 15 % of all newly diagnosed symptomatic epileptic seizures. The 20-year risk of unprovoked seizures and epilepsy after CNS infections ranges from 2.4 % to 22 %. The risk depends on the etiology, location of the lesion and the severity; it is high in herpes-associated encephalitis

Highlights

According to WHO experts, there are more than 50 million people with epilepsy in the world, with 40 million living in low-income and developing countries [1], and about half of them are children
Treatment of epilepsy due to an infectious lesion of the Central nervous system (CNS) is similar to other symptomatic epilepsies, and the antiepileptic drug is selected according to the semiology of seizures
Viral infections are often complicated by epileptic seizures in the acute phase of the disease and lead to an increased risk of developing epilepsy in the future

Summary

Introduction

According to WHO experts, there are more than 50 million people with epilepsy in the world, with 40 million living in low-income and developing countries [1], and about half of them are children. The risk increases significantly with the onset of seizures in the acute period of CNS infections and, especially, with the development of status epilepticus [2]. Acute seizures are common in severe meningitis, viral encephalitis, malaria, and neurocysticercosis, and are associated with increased mortality and morbidity, including the development of epilepsy. Viral encephalitis is a common cause of epileptic seizures, especially in children. EBV is the cause of 5 % of all cases of viral encephalitis, more common in children or in immunosuppressed adults. Chickenpox virus (varicella zoster virus – VZV) is the second most common cause of viral encephalitis, diagnosed in 1:2000 infected individuals with the same frequency in adults and children, with a high risk of mortality – up to 15 % even in immunocompetent patients. Severe neurological consequences and epilepsy rarely develop [2, 16]

Mechanisms of development of epileptic seizures and epilepsy

Findings

Conclusions