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Determinants of outcomes for acute encephalopathy with reduced subcortical diffusion
Kensuke Sakata1, Go Kawano2, Masao Suda1
1Department of Paediatrics, St Mary's Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan.
Scientific Reports
|June 6, 2020
Summary
Acute encephalopathy with reduced subcortical diffusion (AED) in children is common in East Asia. Basal ganglia/thalamus lesions and Tada score predict poor outcomes, with therapeutic hypothermia timing needing further study.
Area of Science:
- Neurology
- Pediatric Neurology
- Neuroimaging
Background:
- Acute encephalopathy with reduced subcortical diffusion (AED) is a frequent neurological emergency in East Asian children.
- It is characterized by seizure onset and widespread diffusion abnormalities in the brain's cortex and subcortical white matter.
Purpose of the Study:
- To investigate the outcome determinants and the role of therapeutic hypothermia in pediatric patients with AED.
- To analyze the impact of timing of therapeutic hypothermia initiation on patient outcomes.
Main Methods:
- A 14-year retrospective study of 34 pediatric patients diagnosed with AED.
- Therapeutic hypothermia was administered based on consciousness disturbance severity, drawing parallels with neonatal hypoxic encephalopathy and adult post-cardiac arrest syndrome.
- Multivariate analysis was employed to identify outcome predictors.
Main Results:
- Basal ganglia/thalamus lesions and the Tada score were identified as significant predictors of poor outcomes in AED patients.
- A correlation between delayed therapeutic hypothermia initiation and worse outcomes was observed specifically in patients cooled before the second phase.
- No significant correlation was found between delayed cooling and outcomes in the overall AED population or regarding the duration to the second phase.
Conclusions:
- Basal ganglia/thalamus lesions and the Tada score are key determinants of outcome in pediatric AED.
- Further research is necessary to elucidate the efficacy of therapeutic hypothermia, considering the critical timing of its initiation and the potential influence of the second phase of the condition.
