Etiological associations and outcome predictors of acute electroencephalography in childhood encephalitis

Publication date: October 2016
Source:Clinical Neurophysiology, Volume 127, Issue 10
Author(s): Shekeeb S. Mohammad, Samantha M. Soe, Sekhar C. Pillai, Margherita Nosadini, Elizabeth H. Barnes, Deepak Gill, Russell C. Dale
ObjectivesTo examine EEG features in a retrospective 13-year cohort of children with encephalitis.Methods354 EEGs from 119 patients during their admission were rated blind using a proforma with demonstrated inter-rater reliability (mean k=0.78). Patients belonged to 12 etiological groups that could be grouped into infectious and infection-associated (n=47), immune-mediated (n=36) and unknown (n=33). EEG features were analyzed between groups and for risk of abnormal Liverpool Outcome Score and drug resistant epilepsy (DRE) at last follow up.Results86% children had an abnormal first EEG and 89% had at least one abnormal EEG. 55% had an abnormal outcome, and 13% had DRE after median follow-up of 7.3years (2.0–15.8years). Reactive background on first EEGs (9/11, p=0.04) and extreme spindles (4/11, p<0.001) distinguished patients with anti-N-Methyl-d-Aspartate Receptor encephalitis. Non-reactive EEG background (48% first EEGs) predicted abnormal outcome (OR 3.8, p<0.001). A shifting focal seizure pattern, seen in FIRES (4/5), anti-voltage gated potassium channel (2/3), Mycoplasma (1/10), other viral (1/10) and other unknown (1/28) encephalitis, was most predictive of DRE after multivariable analysis (OR 11.9, p<0.001).ConclusionsNon-reactive EEG background and the presence of shifting focal seizures resembling migrating partial seizures of infancy are predictors of abnormal outcome and DRE respectively in childhood encephalitis.SignificanceEEG is a sensitive but non-discriminatory marker of childhood encephalitis. We highlight the EEG features that predict abnormal outcome and DRE.



from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2aOZFf9
via IFTTT