Antiepileptic Drug Treatment Following Status Epilepticus Secondary to Posterior Reversible Encephalopathy Syndrome in the Pediatric Population (P04.175)

Abstract

Objective: Studies on antiepileptic drug (AED) treatment following status epilepticus (SE) related to posterior reversible encephalopathy syndrome (PRES) in the pediatric population are lacking. We report two cases of SE in teenage girls with PRES secondary to hypertension from post-infectious glomerulonephritis treated with a course of levetiracetam. Background PRES is a clinical syndrome of headache, altered mental status, seizures, and vision loss associated with brain MRI characteristics of symmetrical white matter edema in the posterior cerebral hemispheres. Design/Methods: Initial presentation, clinical course, diagnostic test results, and AED management from two teenage girls with SE secondary to PRES and post-infectious glomerulonephritis are described. Results: Two teenage girls were treated with antibiotics for pharyngitis as outpatients. Both girls developed headache, vomiting, and presented in SE. The thirteen (13) year old girl also experienced vision loss and hypertensive urgency while the fourteen (14) year old girl had a retropharyngeal abscess and subsequently developed hypertension. Labs revealed hematuria, elevated creatinine, hyperkalemia, and low C3 consistent with poststreptococcal glomerulonephritis. Infection was established by elevated DNase B and ASO in the former case and culture in the latter. CSF studies were benign. Brain MRI studies showed cortical and subcortical T2/FLAIR prolongation in the occipital, parietal, and temporal lobes bilaterally. Acute SE resolved with benzodiazepines and hypertension controlled with amlodipine. In follow up, the 14 year old patient had a recurrent seizure four weeks following the initial SE, but complete imaging resolution at six weeks. Both patients were managed with a 3-6 month course of levetiracetam. Conclusions: Guidelines on continued AED treatment following PRES are unclear. This case of a breakthrough seizure following initial presentation of SE and PRES reflects the potential need for continued AED treatment. SE as the first presentation of PRES may dictate future risk of seizures and larger studies are needed to follow outcomes of these children. Disclosure: Dr. Avallone has nothing to disclose. Dr. Maski has nothing to disclose.