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Refractory status epilepticus in suspect encephalitis.

Carol A Glaser1, Sabrina Gilliam, Somayeh Honarmand

  • 1Viral and Rickettsial Disease Branch, California Department of Public Health, 850 Marina Bay Parkway, Richmond, CA 94804, USA. carol.glaser@cdph.ca.gov

Neurocritical Care
|December 22, 2007
PubMed
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Refractory status epilepticus in encephalitis is more common in children and often lacks a clear infectious cause. Outcomes for these patients are frequently poor, with significant mortality and long-term impairment.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Pediatrics

Background:

  • The California Encephalitis Project (CEP) monitors encephalitis causes.
  • Investigated distinguishing features of encephalitis patients with refractory status epilepticus.

Purpose of the Study:

  • To identify unique characteristics of encephalitis patients who develop refractory status epilepticus (RSE).
  • To compare RSE patients with those whose seizures respond to therapy or have no seizures.

Main Methods:

  • Retrospective analysis of 1,151 California Encephalitis Project patients.
  • Categorization into: refractory status epilepticus (Group I), responsive seizures (Group II), and no seizures (Group III).
  • Detailed supplementary data collection for Group I patients.

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Main Results:

  • Group I (RSE) patients were younger (median 10 years) with higher rates of fever, respiratory, and gastrointestinal prodromes.
  • Group I patients had less CSF pleocytosis and abnormal neuroimaging compared to other groups.
  • An infectious agent was identified in only 3 Group I patients; outcomes were poor, with 28% mortality and 56% neurological impairment within 2 years.

Conclusions:

  • Refractory status epilepticus in encephalitis predominantly affects the pediatric population.
  • Established infectious etiology is uncommon in RSE encephalitis cases.
  • Outcomes for pediatric encephalitis with RSE are generally poor, indicating a need for improved management strategies.