Postencephalitic Epilepsy Research Articles

Early Prediction of Epilepsy after Encephalitis in Childhood Based on EEG and Clinical Features.

The present study was designed to establish and evaluate an early prediction model of epilepsy after encephalitis in childhood based on electroencephalogram (ECG) and clinical features. 255 patients with encephalitis were randomly divided into training and verification sets and were divided into postencephalitic epilepsy (PE) and no postencephalitic epilepsy (no-PE) according to whether epilepsy occurred one year after discharge. Univariate and multivariate logistic regression analyses were used to screen the risk factors for PE. The identified risk factors were used to establish and verify a model. This study included 255 patients with encephalitis, including 209 in the non-PE group and 46 in the PE group. Univariate and multiple logistic regression analysis showed that hemoglobin (OR = 0.968, 95% CI = 0.951-0.958), epilepsy frequency (OR = 0.968, 95% CI = 0.951-0.958), and ECG slow wave/fast wave frequency (S/F) in the occipital region were independent influencing factors for PE (P < 0.05).The prediction model is based on the above factors: -0.031 × hemoglobin -2.113 × epilepsy frequency + 7.836 × occipital region S/F + 1.595. In the training set and the validation set, the area under the ROC curve (AUC) of the model for the diagnosis of PE was 0.835 and 0.712, respectively. The peripheral blood hemoglobin, the number of epileptic seizures in the acute stage of encephalitis, and EEG slow wave/fast wave frequencies can be used as predictors of epilepsy after encephalitis.

Predictors of seizure outcomes of autoimmune encephalitis: A clinical and morphometric quantitative analysis study

ObjectiveAutoimmune encephalitis can be followed by treatment-resistant epilepsy. Understanding its predictors and mechanisms are crucial to future studies to improve autoimmune encephalitis outcomes. Our objective was to determine the clinical and imaging predictors of postencephalitic treatment-resistant epilepsy. MethodsWe performed a retrospective cohort study (2012–2017) of adults with autoimmune encephalitis, both antibody positive and seronegative but clinically definite or probable. We examined clinical and imaging (as defined by morphometric analysis) predictors of seizure freedom at long term follow-up. ResultsOf 37 subjects with adequate follow-up data (mean 4.3 yrs, SD 2.5), 21 (57 %) achieved seizure freedom after a mean time of 1 year (SD 2.3), and one third (13/37, 35 %) discontinued ASMs. Presence of mesial temporal hyperintensities on the initial MRI was the only independent predictor of ongoing seizures at last follow-up (OR 27.3, 95 %CI 2.48–299.5). Morphometric analysis of follow-up MRI scans (n = 20) did not reveal any statistically significant differences in hippocampal, opercular, and total brain volumes between patients with postencephalitic treatment-resistant epilepsy and those without. SignificancePostencephalitic treatment-resistant epilepsy is a common complication of autoimmune encephalitis and is more likely to occur in those with mesial temporal hyperintensities on acute MRI. Volume loss in the hippocampal, opercular, and overall brain on follow-up MRI does not predict postencephalitic treatment-resistant epilepsy, so additional factors beyond structural changes may account for its development.

Clinical Features of Herpes Simplex Encephalitis and Risk Factors for Post-Encephalitic Epilepsy in Children

ObjectiveHerpes simplex encephalitis (HSE) is a common form of sporadic encephalitis and is prone to neurological sequelae such as epilepsy in young children, which can have a significant impact on young children at the time of neurological development. This study aimed to analyze the clinical features of HSE in children and to explore its risk factors for post-encephalitic epilepsy (PE).MethodsThe case data of children who met the HSE diagnostic criteria between January 2013 and June 2021 at the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.Results The incidence of PE in children with HSE was 42.2% (19/45cases). The initial symptoms were fever with headache or convulsions. In the acute phase, there were 13 cases (28.9%) with psychiatric behavior disorders, 16 cases (35.6%) with neurological deficit symptoms, and 24 cases (53.3%) with altered consciousness. Univariate analysis of fever duration, fever peak, psychiatric behavior disorders, neurological deficit symptoms, acute phase seizures and seizure frequency, ICU length of stay, admission GCS, and cranial imaging in children with HSE indicated statistically significant mixed involvement (all P < 0.05), and multivariate logistic regression analysis suggested that repetitive seizures (more than 5 seizures) (OR = 1.551;95% CI 1.229–1.958, P < 0.001) in the acute phase was an independent risk factor for the occurrence of PE.Conclusion The main symptoms in children with HSE in the acute phase include seizures, altered consciousness, neurological deficit symptoms, and psychiatric behavioral abnormalities. Children with HSE has a high incidence of PE, especially if they have repetitive seizures (more than 5 seizures) in the acute phase.

Risk factors and a predictive model for the development of epilepsy after Japanese encephalitis

BackgroundWe aimed to study seizure characteristics during the acute phase of Japanese encephalitis (JE) in children, determine the risk factors of postencephalitic epilepsy (PEE), establish a risk prediction model for the disease, and construct a nomogram to visualize the model. MethodsWe retrospectively analyzed the clinical data and follow-up results of 328 children with JE who were hospitalized between January 2011 and December 2020. Risk factors were screened using univariable analysis, a predictive model was built using binary logistic analysis, lasso regression was used for variable screening, and a nomogram was developed. ResultsOf the 328 children with JE enrolled in the study, 216 (65.9%, 216/328) had seizures in the acute phase. The incidence of PEE was 14.7% (39/264), The cumulative percentages of PEE after discharge was 10.6% (28/264)at 6 months, which increased to 13.6%(36/264)at 3 years. 38.5% of patients with PEE had generalized onset seizures, and 17.9% had focal motor seizures. Univariable analysis revealed that 22 clinical indicators were related to the PPE; Multivariable analysis identified seizure number >5 (OR (95%CI) = 3.013 (1.046–8.676), P = 0.041), status epilepticus (OR (95%CI) = 3.918 (1.212–12.669), P = 0.023), and Coma (OR (95%CI) = 22.495 (8.686–58.285), P<0.001) as independent risk factors for PEE. The risk prediction model: ln(p/1p)= -3.533 + 1.103 × (seizures number > 5) +1.366 × (status epilepticus) + 3.113 × (Coma) was developed, and a nomogram was constructed. The area under the ROC curve (AUC), calibration plot, and Hosmer-Lemeshow test showed that the model had good discrimination and calibration. Ordinary bootstrapping was used for internal validation, and the predictive results of the original and test sets were consistent. ConclusionsSeizure is a common manifestation during acute encephalitis and sequelae in children with JE. The nomogram constructed in this study could be used for early prediction, and could facilitate early intervention.

Efficacy and potential predictors of vagus nerve stimulation therapy in refractory postencephalitic epilepsy.

Background:Vagus nerve stimulation (VNS) is a therapeutic approach for patients with refractory postencephalitic epilepsy (PEE), which is characterized by drug resistance and disappointing surgical outcomes. However, the efficacy of VNS has not yet been studied in patients with refractory PEE. The present study aimed to demonstrate the efficacy of VNS and evaluate potential clinical predictors in patients with refractory PEE.Methods:We retrospectively collected the outcomes of VNS with at least a 1-year follow-up in all patients with refractory PEE. Subgroups were classified as responders and non-responders according to the efficacy of VNS (⩾50% or < 50% reduction in seizure frequency). Preoperative data were analyzed to screen for potential predictors of VNS responsiveness.Results:A total of 42 refractory PEE patients who underwent VNS therapy were enrolled, with an average age of 21.13 ± 9.70 years. Seizure frequency was reduced by more than 50% in 64.25% of patients, and 7.14% of patients achieved seizure-free events after VNS therapy. In addition, the response rates increased over time, with 40.5%, 50.0% and 57.1%, respectively at 6 months, 12 months, and 24 months after VNS therapy. Preoperative duration of epilepsy, monthly seizure frequency, and spatial distribution of interictal epileptic discharges (IEDs) were correlated with responders (p < 0.05) in the univariate analysis. Further multivariate regression analysis demonstrated that refractory PEE patients with high monthly seizure frequency or Focal IEDs (focal or multifocal epileptiform discharges) achieved better efficacy on VNS (p = 0.010, p = 0.003, respectively).Conclusion:VNS is an effective palliative therapy for patients with refractory PEE. Focal IEDs (focal or multifocal epileptiform discharges) and high seizure frequency were potential preoperative predictors of effectiveness after VNS therapy.

Neurological and cognitive outcomes after antibody‐negative autoimmune encephalitis in children

AIMTo characterize the neurological and cognitive outcomes in children with antibody‐negative autoimmune encephalitis (Ab‐negative AE).METHODA cohort of children presenting to our institution over a 10‐year period with autoimmune encephalitis was identified by structured retrospective review of medical records. Clinical features at presentation and final follow‐up were recorded. Neuropsychological testing was performed in a subset of patients. Outcomes after Ab‐negative AE were compared with outcomes after N‐methyl‐D‐aspartate receptor antibody encephalitis (NMDARE).RESULTSForty‐four patients (26 females, 18 males, median age 9y 2mo [interquartile range 4y 5mo–11y 8mo], 23 with NMDARE) with a diagnosis of autoimmune encephalitis were included. Postencephalitic epilepsy was more frequent after Ab‐negative AE compared to NMDARE (61% vs 14%, p=0.002). Cognitive testing was performed in a subset of patients (n=21; Ab‐negative AE=11, NMDARE=10). Full‐scale IQ was lower after Ab‐negative AE than NMDARE (mean IQ 75 vs 92, p=0.02), primarily because of reduced verbal comprehension index (80 vs 98, p=0.01) and working memory index (77 vs 95, p=0.09). The cognitive function most commonly impaired was executive function (80% [8/10] vs 22% [2/9]).INTERPRETATIONAb‐negative AE was associated with poorer cognitive outcomes than NMDARE at 1‐year follow‐up. Further studies are required to evaluate if immunotherapy can be optimized to improve outcome.

Vagus Nerve Stimulation Therapy for the Treatment of Seizures in Refractory Postencephalitic Epilepsy: A Retrospective Study.

BackgroundVagus nerve stimulation (VNS) has been demonstrated to be safe and effective for patients with refractory epilepsy, but there are few reports on the use of VNS for postencephalitic epilepsy (PEE). This retrospective study aimed to evaluate the efficacy of VNS for refractory PEE.MethodsWe retrospectively studied 20 patients with refractory PEE who underwent VNS between August 2017 and October 2019 in Chinese PLA General Hospital and Beijing Children’s Hospital. VNS efficacy was evaluated based on seizure reduction, effective rate (percentage of cases with seizure reduction ≥ 50%), McHugh classification, modified Early Childhood Epilepsy Severity Scale (E-Chess) score, and Grand Total EEG (GTE) score. The follow-up time points were 3, 6, and 12 months after VNS. Pre- and postoperative data were compared and analyzed.ResultsThe median [interquartile range (IQR)] seizure reduction rates at 3, 6, and 12 months after VNS were 23.72% (0, 55%), 46.61% (0, 79.04%), and 67.99% (0, 93.78%), respectively. The effective rates were 30% at 3 months, 45% at 6 months, and 70% at 12 months. E-chess scores before the operation and at 3, 6, and 12 months after the operation were 10 (10, 10.75), 9 (9, 10), 9 (9, 9.75), and 9 (8.25, 9) (P < 0.05), respectively. GTE scores before surgery and at 12 months after the operation were 11 (9, 13) and 9 (7, 11) (P < 0.05), respectively. The mean intensity of VNS current was 1.76 ± 0.39 (range: 1.0–2.5) mA. No intraoperative complications or severe post-operative adverse effects were reported.ConclusionsOur study shows that VNS can reduce the frequency and severity of seizure in patients with refractory PEE. VNS has a good application prospect in patients with refractory PEE.

Ketogenic Diet Therapy for the Treatment of Post-encephalitic and Autoimmune-Associated Epilepsies.

Introduction: Acute Encephalitis is associated with a high risk of acute symptomatic seizures, status epilepticus, and remote symptomatic epilepsy. Ketogenic diet therapies (KDT) have been established as a feasible and safe adjunctive management of refractory- and super-refractory status epilepticus. However, the role of KDT in the chronic management of Post-encephalitic epilepsy (PE) and autoimmune-associated epilepsy (AE) is unknown. This study aims to investigate the use of KDT in patients with PE and AE.Methods: A retrospective single-center case series examining adult patients with PE and AE treated with the modified Atkins diet (MAD), a KDT commonly used by adults with drug-resistant epilepsy.Results: Ten patients with PE and AE who were treated with adjunctive MAD were included. Four patients had either confirmed or presumed viral encephalitis, five patients had seronegative AE, and one patient had GAD65 AE. The median latency between starting MAD and onset of encephalitis was 6 years (IQR: 1–10). The median duration of MAD was 10 months (IQR: 3.75–36). Three patients (30%) became seizure-free, one patient (10%) achieved 90% seizure freedom, and three patients (30%) achieved a 50–75% reduction in their baseline seizure frequency, while three patients (30%) had no significant benefit. Overall, seven patients (70%) achieved ≥50% seizure reduction.Conclusion: In addition to its established role in the treatment of RSE, KDT may be a safe and feasible option for the treatment of chronic PE and AE, particularly in those with prior history of SE. Prospective studies are warranted to explore the efficacy of KDT in management of patients with PE and AE.

Clinical characteristics and treatment outcomes of pediatric patients with postencephalitic epilepsy characterized by epileptic spasms

PurposeViral encephalitis (VE) or bacterial meningoencephalitis (BME) in early childhood may cause brain injury and neurological sequelae, including epilepsy. Postencephalitic epilepsy (PEE) characterized by epileptic spasms (ES) is a rare but serious condition; there is an urgent need to develop new methods to evaluate the characteristics of these children and select appropriate treatments. MethodsWe conducted an observational study of 20 patients (11 males, 9 females) who experienced ES after VE or BME at the Chinese PLA General Hospital. Patients were followed up for over 12 months, and outcomes were analyzed. ResultsThe median ages at the onset of encephalitis and ES were 5.5 and 11.5 months, respectively. The median age at follow-up was 35.5 months. Sixteen (80 %) patients developed drug-resistant epilepsy (DRE), including all 12 patients with VE and 4 of 8 patients with BME. Epileptiform discharges were detected on electroencephalography, including 15 patients with hypsarrhythmia and 5 without. Fifteen of the patients were treated with a 14-day intravenous infusion of adrenocorticotropic hormone (ACTH) at a dose 2.5 U/kg (≤25 U); 12 showed a short-term response but 10 experienced recurrence. Three patients received vigabatrin, and none of these patients responded to treatment. Six patients started a ketogenic diet (KD); five failed to respond and the outcome was not known in one. Four patients were treated by vagus nerve stimulation (VNS), and all showed a partial response. ConclusionChildren with PEE characterized by ES are more likely to develop DRE. The prognosis was worse for patients with VE compared to those with BME. Clarifying the efficacies of treatments involving ACTH (low-dose), KD, vigabatrin, and VNS will require further investigation.

Cytokines and neuron-specific proteins in pediatric viral encephalitis and convulsive syndrome. I. Viral encephalitis

Convulsive syndrome in children is manifested in the three forms: febrile convulsions in acute infections, symptomatic convulsions during acute neuroinfection, as well as onset of epilepsy requiring careful differentiation to prescribe adequate therapy. A threat of convulsive syndrome spreads beyond complications related to ongoing infection, because its development is associated with the risk of emerging symptomatic epilepsy in the future. Postencephalitic epilepsy developing in children within the first years after viral encephalitis has been specifically highlighted. A necessity to identify groups at risk of developing epilepsy gave a momentum to seek out for biomarkers of epileptogenesis reflecting the features of systemic and local inflammatory process in the central nervous system during the immune response to infection. Cytokines mainly mediating inflammation are currently examined being studied as candidate biomarkers of the risk of epilepsy. On the other hand, neuron-specific proteins known as inflammation biomarkers identified in various diseases of the central nervous system are being investigated to reveal brain cell injury in neuroinfections and epilepsy. Here we review publications assessing a potential to use inflammation biomarkers (cytokines and neuron-specific proteins) to diagnose and monitor pediatric neurological diseases associated with convulsive syndrome. The first part of the review describes the results of determining the inflammation biomarkers in the blood and cerebrospinal fluid during acute viral encephalitis/encephalopathy associated with various neurotropic viruses (herpes viruses, flaviviruses, enteroviruses). A significance of diverse biomarkers in predicting an outcome and long-term disease consequences are discussed.

Cytokines and neuro-specific proteins in viral encephalitis and convulsive syndrome in children. II. Convulsive syndrome

In this Section we provide new data on the pathogenetic factors in pediatric convulsive syndrome, including a prominent role of viral infection in developing seizures and epilepsy (EPL) in children, as evidenced by clinical and experimental studies. Various forms of convulsive syndrome associated with viral infection include febrile convulsions and febrile epileptic status, encephalitis-related acute symptomatic seizures, and postencephalitic epilepsy. The human herpesvirus-6 isolated in temporal lobe epilepsy is a frequent causative agent of febrile seizures and febrile epileptic status. Febrile seizures and, especially, febrile epileptic status are associated with further developing epilepsy. Of special note is the febrile infection-related epileptic syndrome (FIRES) more often affecting school-aged children and characterized by extremely severe course and unfavorable outcome. Convulsive syndrome is associated with systemic inflammation and overproduced pro-inflammatory cytokines that increase permeability of the blood-brain barrier and functional activity of brain-resident cells, which are involved in eliciting seizures and maintaining epileptogenesis. Taking into consideration the key role of inflammation underlying convulsive syndrome, in recent decades cytokines and chemokines have been widely studied as possible prognostic criteria for epileptogenesis. Neuron-specific proteins are examined as markers of brain cell damage in various inflammatory diseases of the central nervous system. The first Section of the review presented current understanding on systemic and local cytokine/chemokine response in viral encephalitis. Here we present clinical trials published within the last 5—7 years assessing cytokines/chemokines and neuron-specific proteins in children with various forms of convulsive syndrome, including epilepsy. Association between biomarker level and disease clinical parameters as well as potential for their use to diagnose and predict its further course are discussed.

Prognostic Factors of Patients with Postinfantile Epilepsy and Multiple Independent Spike Foci on Electroencephalography

Purpose Multiple independent spike foci (MISF) have been reported to be associated with hypsarrhythmia and slow spikes and waves. However, some patients with MISF demonstrate a good prognosis, such as benign focal epilepsy. This study aimed to elucidate the prognosis of epileptic children with MISF and to analyze the prognostic factors. Methods The subjects were 115 epileptic children aged 1 to 18 years who visited Pusan National University Children’s Hospital between November 2008 and July 2016 and in whom MISF were noted on electroencephalography. We excluded patients with infantile spasms, congenital metabolic diseases, neurodegenerative diseases, or post-encephalitic epilepsy. We retrospectively reviewed participants’ clinical information. Seizure control was defined as no seizures over 6 months at the last visit. Prognostic factors were analyzed in the seizure control (group A; 84 [73%]) and no seizure control (group B; 31 [27%]) groups. Results Generalized seizure (P=0.033), intellectual disability (P<0.001), cerebral palsy (P=0.046), and abnormal background activity and electrodecrements on electroencephalography (P<0.001) were significantly more common in group B. No clinically significant abnormalities were noted on magnetic resonance imaging of the brain. The MISF improved on follow-up electroencephalography in 58 (71.6%) patients in group A versus 10 (35.7%) in group B (P=0.002). Conclusion Despite MISF on electroencephalography, two-thirds of patients had a benign clinical course, particularly those with post-infantile epilepsy and no infantile spasms. The prognostic factors of poor outcomes were generalized seizures, intellectual disability, and abnormal background activity on electroencephalography. Keywords: Child; Electroencephalography; Epilepsy; Prognosis

Perisylvian vulnerability to postencephalitic epilepsy

ObjectivePostencephalitic epilepsy is often resistant to antiseizure medications, leading to evaluation for epilepsy surgery. Characterizing its localization carries implications for optimal surgical approach. We aimed to determine whether a prior history of encephalitis is associated with specific epileptogenic networks among patients with drug resistant epilepsy undergoing stereotactic EEG (SEEG). MethodsWe conducted a retrospective cohort study of drug resistant epilepsy, with and without a prior history of encephalitis. We analyzed SEEG recordings to identify patterns of seizure onset and organization. Seventeen patients with a history of encephalitis (of infectious etiology in two subjects) were identified from a database of patients undergoing SEEG and were compared to seventeen drug-resistant epilepsy controls without a history of encephalitis matched for confounding variables including pre-implantation hypotheses, epilepsy duration, age, and sex. ResultsIndependent bilateral seizures were noted in 65% of the postencephalitic epilepsy cohort. We identified four SEEG-ictal patterns in patients with a prior history of encephalitis: (1) anteromesial temporal onset (24%), (2) anteromesial temporal onset with early spread to the perisylvian region (29%), (3) perisylvian (59%) and (4) synchronized anteromesial temporal and perisylvian (29%) onsets. Patterns 3 and 4, with perisylvian involvement at onset, were unique to the encephalitis group (p = 0.0003 and 0.04 respectively) and exhibited a “patchwork” organization. None of the encephalitis patients vs 5/7 matched controls had Engel I outcome (p = 0.0048). ConclusionsPostencephalitic epilepsies involve anteromesial temporal and perisylvian networks, often in a bilateral independent manner. Unique ictal patterns involving the perisylvian regions was identified in the encephalitis group, but not in the matched control group. Significance: These findings may reflect a selective vulnerability of the perisylvian regions to epilepsy resulting from encephalitis, significantly mitigating the chances of success with SEEG-guided temporal resections.

Influencing factors of postencephalitic epilepsy in children with viral encephalitis at acute symptomatic seizure

Objective To discuss the incidence rate and influencing factors of postencephalitic epilepsy (PE) in children with viral encephalitis at acute symptomatic seizure(ASS). Methods The data of 132 children with ASS in the First Affiliated Hospital of Zhengzhou University from September 2013 to July 2018 were retrospectively analyzed, and the patients were divided into PE group (62 cases) and non-PE group (70 cases) according to whether they had PE at final follow-up.The risk factors of PE in children with ASS were analyzed using the multivariate Logistic regre-ssion methods. Results The incidence of PE in children with ASS was 46.97% (62/132 cases). There were statistically significant differences in terms of psychological and behavioral abnormalities[19.4%(12/62 cases) vs.2.9%(2/70 cases)], repetitive seizures (more than 5 seizures) [67.7%(42/62 cases) vs.17.1%(12/70 cases)], status epilepticus (SE) [30.6%(19/62 cases) vs.11.4%(8/70 cases)], generalized seizures [72.6%(45/62 cases) vs.88.6%(62/70 cases)], endotracheal intubation [21.0%(13/62 cases) vs.2.9%(2/70 cases)], the duration of fever [5.5(3.0, 11.0) d vs.3.0(2.0, 6.0) d], the duration in the intensive care unit (ICU) [13(5, 21) d vs.6(3, 8) d], electroencephalography epileptiform discharges [49.1%(27/55 cases) vs.6.8%(4/59 cases)], presence of subcortical involvement on neuroimaging [37.3%(22/55 cases) vs.20.3%(14/59 cases)] in children with ASS between the PE group and the non-PE group(all P<0.05). The multivariate Logistic regression analysis showed that repetitive seizures (more than 5 seizures) (OR=5.256, 95%CI: 1.538-17.961, P=0.008), SE(OR=6.003, 95%CI: 1.411-25.539, P=0.015), electroencephalography epileptiform discharges (OR=36.693, 95%CI: 7.031-191.485, P<0.01) and the duration in ICU (OR=1.170, 95%CI: 1.058-1.298, P=0.002) were the risk factors for PE in children with ASS. Conclusions The incidence rate of PE in children with ASS is high.Children with ASS are more likely to develop into PE if they have repetitive seizures (more than 5 seizures), SE, electroencephalography epileptiform discharges, and the longer duration in ICU. Key words: Child; Viral encephalitis; Seizures; Postencephalitic epilepsy; Risk factor

Postencephalitic epilepsy in dogs with meningoencephalitis of unknown origin: Clinical features, risk factors, and long-term outcome.

BackgroundAlthough the presence of seizures in dogs with meningoencephalitis of unknown origin (MUO) has been associated with shorter survival times, data regarding the prevalence and risk factors for postencephalitic epilepsy (PEE) is lacking.ObjectivesTo describe the clinical features, prevalence, risk factors, and long‐term outcome of PEE in dogs with MUO.AnimalsSixty‐one dogs with presumptive diagnosis of MUO based on the clinicopathological and diagnostic imaging findings.MethodsRetrospective study. Cases were identified by search of hospital medical records for dogs with suspected or confirmed MUO. Medical records of dogs meeting inclusion criteria were reviewed. Signalment, seizure history, clinicopathologic, and magnetic resonance imaging (MRI) findings were recorded.ResultsAmong 61 dogs at risk of PEE, 14 (23%) dogs developed PEE. Three of 14 dogs with PEE (21%) developed drug‐resistant epilepsy. Dogs with PEE were younger (P = .03; ORadjusted = 0.75; 95% confidence interval [CI], 0.58‐0.98) and had significantly shorter survival times (log‐rank test P = .04) when compared to dogs that did not develop epilepsy. The risk factors associated with the development of PEE were the presence of acute symptomatic seizures (ASS; P = .04; ORadjusted = 4.76; 95% CI, 1.11‐20.4) and MRI lesions in the hippocampus (P = .04; ORadjusted = 4.75; 95% CI, 1.07‐21.0).Conclusions and Clinical ImportanceDogs with MUO and seizures at the early stage of the disease (ASS) seem to be at a higher risk of developing PEE.

Chronic post-encephalitic epilepsy following Japanese encephalitis: Clinical features, neuroimaging data, and outcomes

PurposeJapanese encephalitis (JE), the main cause of viral encephalitis in Asia, usually presents with acute symptomatic seizures; however, there have been very few systematic reports regarding late unprovoked seizures and epilepsy. We aimed to describe the clinical features and outcomes of post-encephalitic epilepsy following JE. MethodsPatients with epilepsy with a previous confirmed diagnosis of JE visiting West China Hospital from 2013 to 2019 were enrolled in the observational case-controlled study. Patients with epilepsy with a history of other non-specific viral encephalitis were enrolled as controls. For all enrolled subjects, disease related information was recorded. ResultsForty-eight patients with JE (20 males; median age, 21.0 years; average epilepsy duration, 8.55 years) were identified. The median duration from JE to the first unprovoked seizure was 7.73 years, which significantly differed from that of the controls (7.73 vs. 2.69 years, respectively; p = 4.59 × 10−6). Most patients had focal epilepsy, and 29 (78.38%) were drug resistant. Among 45 patients with available neuroimaging data, three in fourth had no obvious abnormality, and the temporal lobe and hippocampus (22.22%) were the most affected brain regions. Six patients had surgery, and three achieved class-one seizure-free status. ConclusionThe latency to the first unprovoked seizure was longer in patients with JE than controls. Regarding chronic epilepsy, three in four had structural abnormalities, and the long-term outcomes of post-encephalitic epilepsy following JE were poor. Surgery remains an option for drug-resistant epilepsy.

The supervision of postencephalitic epilepsy after viral encephalitis

Viral encephalitis(VE), one of important causes of postencephalitic epilepsy, is the common infectious disease of central nervous system.Although there are many researches of the clinical features and the medical effects about VE with epilepsy, it is scarce to find relative reports about the epilepsy in the sequelae stage.VE and epilepsy can cause heavy economic and psychological burden to the patients themselves, their family and society, so the epidemiology, the clinical feature, the therapy, the prognosis and the current status of follow-up studies of postencephalitic epilepsy after VE are summarized in order to provide the basis for the follow-up supervision. Key words: Viral encephalitis; Postencephalitic epilepsy; Supervision

Status epilepticus associated with Mycoplasma pneumoniae encephalitis in children: good prognosis following early diagnosis and treatment.

Status epilepticus associated with Mycoplasma pneumoniae encephalitis in children: good prognosis following early diagnosis and treatment.

Postencephalitic Epilepsy and Acute Symptomatic Seizures, in Infectious, Undetermined Etiology and Autoimmune Encephalitis (P4.5-028)

Postencephalitic Epilepsy and Acute Symptomatic Seizures, in Infectious, Undetermined Etiology and Autoimmune Encephalitis (P4.5-028)

Vagus nerve stimulation therapy for post-encephalitic intractable epilepsy in children

Objective To evaluate the effect of vagus nerve stimulation (VNS) on post-encephalitic intractable epilepsy and the improvement of postoperative cognitive function and quality of life. Methods The patients with post-encephalitic epilepsy in Sanbo Brain Hospital, Capital Medical University from January 2008 to December 2016 were selected.A single center and retrospective study method was used to evaluate the cognitive function, social function of preoperative and postoperative and postoperative seizure classification.The follow-up time points included preoperative, posto-perative in 6 months, 1 year after operation and postoperative annual review. Results A total of 43 patients were followed up, including 19 females and 24 males, with an average age of (9.37± 4.18) years old.The time of follow-up was (43.90 ± 33.04) months.According to Engel classification: Grade Ⅰ 3 cases (7.0%), grade Ⅱ 3 cases (7.0%), grade Ⅲ 14 cases (32.6%), grade Ⅳ 21 cases (48.8%). According to McHugh classification: Grade Ⅰ 8 cases (18.6%), grade Ⅱ 12 cases (28%), grade Ⅲ 11 cases (25.5%), grade Ⅳ 6 cases (14.0%), grade Ⅴ 4 cases (9.3%). Speech improvement of postoperative: significant improvement in 3 cases (7.0%), slightly improved in 17 cases (39.6%); interpersonal communication improvement of postoperative: significantly increased 7 cases (16.4%), slightly improved 16 cases(37.2%); learning/working ability improvement of postoperative: significantly improved 6 cases(14.0%), slightly increased 14 cases(32.6%). The postoperative VIQ (6.21±5.02) scores, PIQ (7.28±6.10) scores, FIQ (2.93±3.74) scores and MQ were (4.81±2.98) scores higher than preoperative. Conclusions VNS can effectively improve the seizures of post-encephalitic epilepsy as well as the children′s quality of life, cognition and social function. Key words: Post-encephalitic epilepsy; Vagus nerve stimulation; Cognitive function; Follow-up study