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Periodic lateralized epileptiform discharges of pediatric patients in Taiwan
Kuo-Shin Chen1, Meng-Fai Kuo, Huei-Shyong Wang
1Department of Pediatrics, St. Paul's Hospital, Taoyuan, Taiwan.
Insights
Periodic lateralized epileptiform discharges (PLEDs) in children are often caused by central nervous system infections, unlike in adults. Herpes simplex virus is a common cause, but other pathogens should also be considered.
Area of Science:
- Neurology
- Pediatrics
- Clinical Electrophysiology
Background:
- Periodic lateralized epileptiform discharges (PLEDs) are EEG abnormalities typically seen in adults with acute brain injury.
- Etiologies and clinical significance of PLEDs in pediatric populations are less understood compared to adults.
Purpose of the Study:
- To investigate the specific etiologies of PLEDs in pediatric patients.
- To compare the findings in children with existing literature on adult PLEDs.
Main Methods:
- Retrospective review of 8002 pediatric electroencephalographic (EEG) records over 12 years.
- Identification and analysis of 44 pediatric cases with PLEDs, including associated illnesses and outcomes.
Main Results:
- Central nervous system (CNS) infections were the predominant etiology (nearly two-thirds) in pediatric PLEDs.
- Herpes simplex virus (HSV) was identified in 12 of 18 children with confirmed CNS infections.
- Other causes included head injury, encephalopathy, and epilepsy; 10 cases had no defined pathogen.
Conclusions:
- PLEDs in pediatric patients have distinct etiologies compared to adults, with CNS infections being most common in Taiwan.
- While HSV is a frequent cause of CNS infection-related PLEDs in children, it is not the sole pathogen responsible for encephalitis.
Abstract:
Periodic lateralized epileptiform discharges are special electroencephalographic abnormalities present in adults with stroke, brain tumor, intracranial hemorrhage, or other rare etiologies. Few reports focused on the etiologies in pediatric patients. We retrospectively reviewed 8002 of our pediatric electroencephalographic records for the past 12 years and listed all associated illness and their outcomes. Forty-four children with periodic lateralized epileptiform discharges were collected. We found that there was an obvious difference in etiologies of our pediatric patients from those reported in the literature. Nearly two thirds of our patients (28 children) were associated with central nervous system infections. The other etiologies included head injury, encephalopathy, epilepsy, and others. Herpes simplex virus was responsible for two thirds (12) of the 18 children with identified pathogens causing a central nervous system infection. Ten patients failed to have a defined pathogen. Periodic lateralized epileptiform discharges have a different clinical significance in pediatric patients than in adults. In Taiwan, central nervous system infection is the most common etiology of periodic lateralized epileptiform discharges in pediatric patients. Herpes simplex virus, although the most common pathogen, should not be considered to be the only cause of encephalitis in children with periodic lateralized epileptiform discharges.