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Acute symptomatic seizures and epilepsy in pediatric patients with central nervous system inflammatory demyelinating
Shangru Li1, Xuting Chang1, Jie Zhang1
1Children's Medical Center, Peking University First Hospital, Beijing 102627, China.
Insights
Acute symptomatic seizures (ASSs) affect over a third of children with central nervous system inflammatory demyelinating diseases (CIDDs), particularly those with MOGAD or seronegative CIDDs. Epilepsy develops in 9.9% of these children.
Area of Science:
- Pediatric Neurology
- Neuroimmunology
- Demyelinating Diseases
Background:
- Central nervous system inflammatory demyelinating diseases (CIDDs) encompass a group of acquired immune-mediated disorders affecting the brain and spinal cord.
- Acute symptomatic seizures (ASSs) and epilepsy are potential neurological complications in pediatric CIDDs, impacting patient outcomes.
- Understanding the epidemiology and risk factors for these seizures is crucial for timely diagnosis and management.
Purpose of the Study:
- To determine the prevalence of acute symptomatic seizures (ASSs) and epilepsy in children diagnosed with central nervous system inflammatory demyelinating diseases (CIDDs).
- To identify clinical and radiological risk factors associated with the occurrence of ASSs and the development of epilepsy in this pediatric cohort.
- To compare the incidence of ASSs across different subtypes of CIDDs.
Main Methods:
- A retrospective cohort study was conducted on children diagnosed with CIDDs at Peking University First Hospital from January 2013 to June 2024.
- The incidence of ASSs was evaluated and compared among patients with various CIDD classifications.
- Clinical data, including seizure characteristics, brain MRI findings, and disease course, were analyzed to identify risk factors for ASSs and epilepsy.
Main Results:
- Out of 204 children with CIDDs, 75 (36.8%) experienced ASSs. The incidence was higher in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and seronegative CIDDs.
- ASSs were more frequent during attacks presenting as acute disseminated encephalomyelitis (ADEM) and cerebral cortical encephalitis (CCE) phenotypes.
- The overall prevalence of epilepsy was 9.9%, with multiple demyelinating attacks being a predictor for its development. Fever and cortical involvement on MRI were independent protective factors against ASSs.
Conclusions:
- A significant proportion of children with CIDDs experience ASSs, with MOGAD and seronegative CIDDs showing higher incidences.
- Specific clinical presentations like ADEM and CCE phenotypes are associated with an increased risk of ASSs.
- Epilepsy is a notable long-term complication, affecting nearly 10% of children with CIDDs, particularly those with recurrent demyelinating events.
Background And Objective:
To understand the prevalence and risk factors of acute symptomatic seizures (ASSs) and epilepsy in children with central nervous system inflammatory demyelinating diseases (CIDDs).
Methods:
The cohort of children with CIDDs in pediatric department of Peking University First Hospital between January 2013 and June 2024 were followed up. We evaluated and compared the incidence of ASSs among patients with different CIDDs. The correlation between clinical information and the occurrence of ASS was further analyzed. The incidence of epilepsy was analyzed in patients with disease course longer than 1 year.
Results:
Of 204 patients with CIDDs, 97 were female (47.5 %), and the age at onset was 6.75 (IQR: 4.50, 9.73) years, with a total of 598 attacks. Of 204 patients, 75 (36.8 %) experienced ASSs, and the incidence of ASSs were significantly higher in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) (39/94, 41.5 %) and seronegative CIDDs (31/72, 43.1 %). Among 598 attacks, 143 (23.9 %) were accompanied by ASSs. ASSs were more likely to occur in attacks manifested as acute disseminated encephalomyelitis (ADEM) and cerebral cortical encephalitis (CCE) phenotypes. Fever (OR=0.453) and cortical involvement on brain MRI (OR=0.191) were independent risk factors for ASSs. Prevalence of epilepsy was 9.9 % (19/192). Patients with multiple demyelinating attacks were more likely to develop epilepsy.
Conclusion:
The incidence of ASS in children with CIDDs was 36.8 %, which was more common in children with MOGAD or seronegative CIDDs. ASSs were more likely to occur in attacks presented with ADEM and CCE. Prevalence of epilepsy was 9.9 %.
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