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Posterior Reversible Encephalopathy Syndrome in infants and young children
Duccio Maria Cordelli1, Chiara Marra1, Lara Ciampoli1
1Unit of Child Neurology and Psychiatry, Department of Medical and Surgical Sciences (DIMEC), S. Orsola Hospital, University of Bologna, Italy.
Insights
Posterior Reversible Encephalopathy Syndrome (PRES) presents more severely in children under 6 years old, with a higher incidence of epileptic seizures and intensive care unit admissions compared to older children.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Posterior Reversible Encephalopathy Syndrome (PRES) is a neurological condition affecting brain imaging.
- Understanding PRES characteristics in pediatric populations is crucial for timely diagnosis and management.
Purpose of the Study:
- To delineate the clinical and radiological features of PRES in young children (<6 years).
- To compare PRES presentation and outcomes between younger (<6 years) and older (6-17 years) pediatric groups.
- To identify factors associated with intensive care unit (ICU) admission in pediatric PRES cases.
Main Methods:
- Retrospective review of 111 pediatric PRES cases (0-17 years) from 2000-2018 across six Italian pediatric hospitals.
- Comparison of clinical, radiological, and EEG findings, ICU admission rates, and outcomes between children <6 years and those 6-17 years.
- Statistical analysis to determine factors linked to ICU admission in the entire pediatric cohort.
Main Results:
- Twenty-nine patients (<6 years) showed epileptic seizures (93%) and status epilepticus (SE) (72%), including nonconvulsive SE (NCSE) (35%), more frequently than older children.
- Younger children had higher ICU admission rates (59% vs 37%).
- SE was significantly associated with ICU admission (p=0.001) in the overall pediatric PRES cohort.
Conclusions:
- PRES in children under 6 years old exhibits a distinct and more severe clinical presentation compared to older children.
- Younger age at PRES onset is associated with increased risk of seizures, status epilepticus, and ICU admission.
- These findings highlight age-specific differences in PRES pathophysiology and clinical impact in pediatric patients.
Aim:
The aim of this study was to describe the characteristics of Posterior Reversible Encephalopathy Syndrome (PRES) in infants and young children (<6 years) and to compare them with the older pediatric population affected by PRES.
Methods:
we retrospectively reviewed records of 111 children (0-17 years) diagnosed with PRES from 2000 to 2018 in 6 referral pediatric hospitals in Italy. The clinical, radiological and EEG features, as well as intensive care unit (ICU) admission rate and outcome of children aged <6 years were compared to those of older children (6-17 years). Factors associated with ICU admission in the whole pediatric cohort with PRES were also evaluated.
Results:
Twenty-nine patients younger than 6 years (26%) were enrolled with a median age at onset of PRES of 4 years (range: 6 months-5 years). Epileptic seizures were the most frequent presentation at the disease onset (27/29 patients). Status epilepticus (SE) was observed in 21/29 patients: in detail, 11 developed convulsive SE and 10 presented nonconvulsive SE (NCSE). SE was more frequent in children <6 years compared with older children (72% vs 45%) as well as NCSE (35% vs 10%). Seventeen children aged <6 years required ICU admission. Prevalence of ICU admissions was higher within younger population compared to older (59% vs 37%). In the whole study population SE was significantly associated with ICU admission (p = 0.001).
Conclusions:
PRES in children < 6 years differs from older children in clinical presentation suggesting a more severe presentation at younger age.
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