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Short and long-term outcomes in children with suspected acute encephalopathy
Masahiro Nishiyama1, Hiroaki Nagase2, Tsukasa Tanaka2
1Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan.
Insights
Acute encephalopathy in children can cause lasting brain dysfunction, especially with moderate to severe disability. However, mild disability may lead to improved brain function over time.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Critical Care Medicine
Background:
- Acute encephalopathy in children presents unclear time-dependent changes in brain function.
- Understanding long-term neurological outcomes is crucial for pediatric care.
Purpose of the Study:
- To assess the time-dependent changes in brain function following suspected acute encephalopathy in children.
- To evaluate the recovery of neurological function at 1 and 12 months post-onset.
Main Methods:
- Retrospective review of children (6 months–15 years) admitted to a pediatric intensive care unit for suspected acute encephalopathy.
- Outcomes assessed using the Pediatric Cerebral Performance Category (PCPC) scale at discharge, 1 month, and 12 months.
- Inclusion criteria: fever with convulsions or impaired consciousness, no prior neurological abnormality, and follow-up data.
Main Results:
- 78 children were enrolled, with varying initial PCPC scores at discharge.
- Of 13 cases with mild disability (PCPC score 2) at discharge, 7 showed recovery of normal brain function by 12 months.
- None of the 9 cases with moderate to severe disability (PCPC scores 3-5) at discharge recovered normal brain function.
Conclusions:
- Moderate to severe acute encephalopathy can result in persistent neurological deficits.
- Mild disability following acute encephalopathy may be associated with potential for functional improvement over time.
- Long-term neurodevelopmental outcomes vary significantly based on initial disability severity.
Background:
The time-dependent changes that occur in children after acute encephalopathy are not clearly understood. Therefore, we assessed changes in brain function after suspected acute encephalopathy over time.
Methods:
We created a database of children admitted to the pediatric intensive care unit at Kobe Children's Hospital because of convulsions or impaired consciousness with fever between 2002 and 2013. Clinical courses and outcomes were reviewed and patients who met the following criteria were included in the study: (1) 6months to 15years of age, (2) no neurological abnormality before onset, (3) treated for suspected acute encephalopathy, and (4) followed after 1 (0-2) month and 12 (10-17) months of onset. Outcomes were assessed using the Pediatric Cerebral Performance Category (PCPC) scale, with a score of 1 representing normal performance; 2, mild disability; 3, moderate disability; 4, severe disability; 5, vegetative state; and 6, brain death.
Results:
A total of 78 children (32 male) with a median (range) age at onset of 20 (6-172) months were enrolled. Fifty-one cases scored 1 on the PCPC, 13 scored 2, three scored 3, five scored 4, one scored 5, and five cases scored 6 at discharge. Whereas seven of the 13 cases that scored a 2 on the PCPC recovered normal brain function after 12months, none of the nine cases that scored a 3-5 on the PCPC recovered normal function.
Conclusions:
Our findings suggest moderate to severe disability caused by acute encephalopathy had lasting consequences on brain function, whereas mild disability might result in improved function.
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