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Published on: November 20, 2015
Underlying Disorders in Children With Infection-Related Acute Encephalopathy
Tomohiko Nakata1, Jun Natsume2, Hiroyuki Yamamoto1
1Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Insights
Children with acute encephalopathy with reduced subcortical diffusion (AED) often have underlying seizure disorders or premature birth. These factors increase the risk for developing AED, highlighting the need for caution in these pediatric patients.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neuroscience
Background:
- Infection-related acute encephalopathy (AE) in children arises from various factors, including infectious agents and chronic conditions.
- Identifying predisposing underlying disorders is crucial for understanding AE development.
Purpose of the Study:
- To investigate and compare underlying disorders in children diagnosed with two types of AE: AE with reduced subcortical diffusion (AED) and clinically mild encephalopathy with a reversible splenial lesion (MERS).
- To identify specific predisposing factors for AED and MERS by comparing them with acute disseminated encephalomyelitis (ADEM).
Main Methods:
- Retrospective analysis of patient data from the Tokai area, Japan (2009-2022).
- Inclusion of 204 patients with AED, 137 with MERS, and 89 with ADEM.
- Comparison of underlying disorders and past medical histories across the three groups.
Main Results:
- AED cases showed a significantly higher prevalence of underlying disorders (34%) compared to ADEM (12%).
- Underlying disorders in AED and MERS included seizure disorders, premature birth, genetic/congenital disorders, and endocrine/renal diseases.
- Specific seizure syndromes like Dravet and West syndromes were prevalent in AED but absent in MERS; premature birth was also more common in AED.
Conclusions:
- Seizure susceptibility, particularly in chronic seizure disorders, is a significant predisposing factor for AED.
- Premature birth is also identified as an impactful factor in the development of AED.
- Clinical vigilance is recommended for children with chronic seizure disorders or premature birth due to their increased risk of developing AE.
Background:
Various factors contribute to the development of infection-related acute encephalopathy (AE) in children, such as infectious agents and chronic underlying disorders. We studied underlying disorders in children with AE to identify predisposing factors of AE.
Methods:
We investigated underlying disorders or past histories in patients with two types of AE from the database in the Tokai area of Japan between 2009 and 2022: 204 patients with AE with reduced subcortical diffusion (AED) and 137 with clinically mild encephalopathy with a reversible splenial lesion (MERS). We compared them with 89 patients with acute disseminated encephalomyelitis (ADEM) to clarify the specific disorders in the two AE types.
Results:
The prevalence of underlying disorders in AED (34%, 70 patients) was significantly higher than that in ADEM (12%, 11 patients) (P < 0.01). The prevalence of underlying disorders in MERS was 23% (32 patients). The underlying disorders included seizure disorders, premature birth, genetic/congenital disorders, and endocrine/renal diseases. In patients with seizure disorders in AED, five patients (18%) had Dravet syndrome and four (15%) had West syndrome, whereas none with MERS had these syndromes. Twenty-five (12%) of 204 patients with AED, three (2%) with MERS, and one (1%) with ADEM were preterm or low birth weight.
Conclusions:
The high prevalence of seizure disorders suggests that seizure susceptibility is an important predisposing factor in AED. Premature birth also has an impact on the development of AED. Caution is required regarding the development of AE in patients with chronic seizure disorders or premature birth.
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