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Clinical findings, imaging characteristics and outcome in catastrophic post-encephalitic epilepsy
E Trinka1, F Dubeau, F Andermann
1Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
Objectives:
The aim of this study is to characterize the clinical features and prognostic factors for intractable, post-encephalitic epilepsy.
Methods:
We studied retrospectively 42 patients (26 men) evaluated between 1982 and 1999. MRI, neuropsychological findings, interictal and ictal scalp EEG were reviewed for all patients. Fifteen patients had additional stereo EEG (SEEG) studies.
Results:
The mean age at encephalitis was 17 years (SD = 15.5); etiology was identified in 18 patients. During the acute illness, 79% had status epilepticus (SE) or recurrent seizures and 76% were in coma; mean Glasgow outcome scale (GOS) was 3.6 (SD = 0.8). The mean latency to seizure onset was 0.8 years (SD = 1.9). The majority (72%) presented with complex partial seizures with or without secondary generalization. According to interictal epileptiform findings and the predominant seizure onset pattern as found on scalp EEG, patients were unilateral temporal (UTLE) = 8, bilateral temporal (BTLE) = 12, and extratemporal/multifocal or generalized (ETMFE) = 22 patients. MRI atrophy and/or signal changes were unilateral temporal in 7 (18%), bilateral temporal in 5 (13%), multilobar/diffuse in 20 (51%), and absent in 7 (18%). ANOVA revealed significant differences in mean GOS between UTLE versus BTLE and ETMFE (4.7 versus 3.2 versus 3.6; p < 0.0001), but not in age at encephalitis. Latency to the first unprovoked seizure was shorter in patients with ETMFE compared to UTLE and BTLE (p < 0.01). Surgery was performed in 24 patients. The best outcome was obtained in UTLE (7/8 class I and II). In the others, outcome was poor in the majority (13/16 class III and IV).
Conclusion:
There is a small subgroup of patients with postencephalitic UTLE for whom the outcome is favorable. The majority of our patients had multifocal seizure onset with BTLE and ETMFE, and poor outcome after surgical treatment.
Insights
This study found that a small group of patients with unilateral temporal lobe epilepsy after encephalitis have favorable outcomes. However, most patients with multifocal epilepsy experience poor results, even after surgery.
Area of Science:
- Neurology
- Epileptology
- Neuroscience
Background:
- Post-encephalitic epilepsy presents a significant clinical challenge.
- Identifying prognostic factors is crucial for managing intractable cases.
Purpose of the Study:
- To characterize clinical features of intractable post-encephalitic epilepsy.
- To determine prognostic factors influencing outcomes in these patients.
Main Methods:
- Retrospective analysis of 42 patients with post-encephalitic epilepsy.
- Review of MRI, neuropsychological data, and scalp/stereo EEG (SEEG).
Main Results:
- Unilateral temporal lobe epilepsy (UTLE) showed a favorable outcome (7/8 patients).
- Multifocal or extratemporal epilepsy (ETMFE) and bilateral temporal lobe epilepsy (BTLE) had poor outcomes (13/16 patients).
- Shorter seizure onset latency was observed in ETMFE patients.
Conclusions:
- A subset of patients with UTLE may have a good prognosis.
- The majority of patients, particularly those with ETMFE and BTLE, face poor outcomes despite surgical intervention.