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Involuntary movements as a prognostic factor for acute encephalopathy with biphasic seizures and late reduced
Yosuke Miyamoto1, Tohru Okanishi2, Masanori Maeda3
1Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, Tottori 683-8504, Japan; Department of Pediatrics, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
Background:
Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is characterized by biphasic seizures and white matter lesions with reduced diffusion, which are often accompanied by involuntary movements. The neurological outcomes of AESD vary from normal to mild or severe sequelae, including intellectual disability, paralysis, and epilepsy. The present study aimed to clarify the prognostic factors of AESD, including involuntary movements.
Methods:
We enrolled 29 patients with AESD admitted to Tottori University Hospital from 1991 to 2020 and retrospectively analyzed their clinical data. Neurological outcomes were assessed by the Pediatric Cerebral Performance Category score and cerebral paralysis as neurological sequelae.
Results:
Of the 29 patients, 12 had favorable outcomes and 17 had unfavorable outcomes. Univariate analysis revealed that the presence of underlying diseases, a decline in Glasgow Coma Scale (GCS) score 12-24 h after early seizures, and involuntary movements were associated with unfavorable outcomes. In multivariate analysis, a decline in GCS score and involuntary movements were associated with unfavorable outcomes. The sensitivities and specificities of underlying diseases, a decline of ≥ 3 points in GCS score 12-24 h after early seizures, and involuntary movements for unfavorable outcomes were 53% and 92%, 92% and 65%, and 59% and 92%, respectively.
Conclusions:
The appearance of involuntary movements may be associated with unfavorable outcomes of AESD. The prognostic factors identified herein are comparable with previously known prognostic factors of consciousness disturbances after early seizures.
Insights
Involuntary movements and declining Glasgow Coma Scale scores are linked to poor outcomes in acute encephalopathy with biphasic seizures and late reduced diffusion (AESD). Identifying these prognostic factors aids in predicting patient recovery and potential sequelae.
Area of Science:
- Neurology
- Pediatrics
Background:
- Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) presents with biphasic seizures, white matter lesions, and often involuntary movements.
- Neurological outcomes in AESD range widely, from complete recovery to severe sequelae like intellectual disability, paralysis, and epilepsy.
Purpose of the Study:
- To identify prognostic factors for neurological outcomes in patients with AESD.
- Specifically investigate the role of involuntary movements in predicting outcomes.
Main Methods:
- Retrospective analysis of clinical data from 29 AESD patients admitted to Tottori University Hospital (1991-2020).
- Neurological outcomes assessed using the Pediatric Cerebral Performance Category score and cerebral paralysis.
- Univariate and multivariate analyses were employed to determine prognostic factors.
Main Results:
- 17 out of 29 patients experienced unfavorable outcomes.
- Univariate analysis identified underlying diseases, a decline in Glasgow Coma Scale (GCS) score 12-24 hours post-seizure, and involuntary movements as associated with unfavorable outcomes.
- Multivariate analysis confirmed that a decline in GCS score and involuntary movements were significant predictors of unfavorable outcomes.
Conclusions:
- The presence of involuntary movements is a potential indicator of unfavorable outcomes in AESD.
- The identified prognostic factors, including consciousness disturbances after early seizures, align with existing knowledge and aid in predicting patient prognosis.
