Shekeeb S Mohammad1, Samantha M Soe2, Sekhar C Pillai3, Margherita Nosadini4, Elizabeth H Barnes5, Deepak Gill6, Russell C Dale7. 1. Neuroimmunology Group, Institute of Neuroscience and Muscle Research at The Kids Research Institute, The Children's Hospital at Westmead, University of Sydney, Australia. Electronic address: shekeeb.mohammad@health.nsw.gov.au. 2. TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, Australia. Electronic address: samantha.soe@health.nsw.gov.au. 3. Neuroimmunology Group, Institute of Neuroscience and Muscle Research at The Kids Research Institute, The Children's Hospital at Westmead, University of Sydney, Australia. Electronic address: norwestpaedneurology@gmail.com. 4. Neuroimmunology Group, Institute of Neuroscience and Muscle Research at The Kids Research Institute, The Children's Hospital at Westmead, University of Sydney, Australia. Electronic address: margherita.nosadini@gmail.com. 5. NHMRC Clinical Trails Centre, University of Sydney, Australia. Electronic address: liz.barnes@ctc.usyd.edu.au. 6. TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, Australia. Electronic address: deepak.gill@health.nsw.gov.au. 7. Neuroimmunology Group, Institute of Neuroscience and Muscle Research at The Kids Research Institute, The Children's Hospital at Westmead, University of Sydney, Australia; TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, Australia. Electronic address: russell.dale@health.nsw.gov.au.
Abstract
OBJECTIVES: To examine EEG features in a retrospective 13-year cohort of children with encephalitis. METHODS: 354 EEGs from 119 patients during their admission were rated blind using a proforma with demonstrated inter-rater reliability (mean k=0.78). Patients belonged to 12 etiological groups that could be grouped into infectious and infection-associated (n=47), immune-mediated (n=36) and unknown (n=33). EEG features were analyzed between groups and for risk of abnormal Liverpool Outcome Score and drug resistant epilepsy (DRE) at last follow up. RESULTS: 86% children had an abnormal first EEG and 89% had at least one abnormal EEG. 55% had an abnormal outcome, and 13% had DRE after median follow-up of 7.3years (2.0-15.8years). Reactive background on first EEGs (9/11, p=0.04) and extreme spindles (4/11, p<0.001) distinguished patients with anti-N-Methyl-d-Aspartate Receptor encephalitis. Non-reactive EEG background (48% first EEGs) predicted abnormal outcome (OR 3.8, p<0.001). A shifting focal seizure pattern, seen in FIRES (4/5), anti-voltage gated potassium channel (2/3), Mycoplasma (1/10), other viral (1/10) and other unknown (1/28) encephalitis, was most predictive of DRE after multivariable analysis (OR 11.9, p<0.001). CONCLUSIONS: Non-reactive EEG background and the presence of shifting focal seizures resembling migrating partial seizures of infancy are predictors of abnormal outcome and DRE respectively in childhood encephalitis. SIGNIFICANCE: EEG is a sensitive but non-discriminatory marker of childhood encephalitis. We highlight the EEG features that predict abnormal outcome and DRE.
OBJECTIVES: To examine EEG features in a retrospective 13-year cohort of children with encephalitis. METHODS: 354 EEGs from 119 patients during their admission were rated blind using a proforma with demonstrated inter-rater reliability (mean k=0.78). Patients belonged to 12 etiological groups that could be grouped into infectious and infection-associated (n=47), immune-mediated (n=36) and unknown (n=33). EEG features were analyzed between groups and for risk of abnormal Liverpool Outcome Score and drug resistant epilepsy (DRE) at last follow up. RESULTS: 86% children had an abnormal first EEG and 89% had at least one abnormal EEG. 55% had an abnormal outcome, and 13% had DRE after median follow-up of 7.3years (2.0-15.8years). Reactive background on first EEGs (9/11, p=0.04) and extreme spindles (4/11, p<0.001) distinguished patients with anti-N-Methyl-d-Aspartate Receptor encephalitis. Non-reactive EEG background (48% first EEGs) predicted abnormal outcome (OR 3.8, p<0.001). A shifting focal seizure pattern, seen in FIRES (4/5), anti-voltage gated potassium channel (2/3), Mycoplasma (1/10), other viral (1/10) and other unknown (1/28) encephalitis, was most predictive of DRE after multivariable analysis (OR 11.9, p<0.001). CONCLUSIONS: Non-reactive EEG background and the presence of shifting focal seizures resembling migrating partial seizures of infancy are predictors of abnormal outcome and DRE respectively in childhood encephalitis. SIGNIFICANCE: EEG is a sensitive but non-discriminatory marker of childhood encephalitis. We highlight the EEG features that predict abnormal outcome and DRE.
Authors: Dirkje de Blauw; Andrea H L Bruning; Katja C Wolthers; Anne-Marie van Wermeskerken; Maarten H Biezeveld; Joanne G Wildenbeest; Dasja Pajkrt Journal: Pediatr Infect Dis J Date: 2022-04-01 Impact factor: 3.806
Authors: Dirkje de Blauw; Andrea H L Bruning; C B E Busch; Lisa M Kolodziej; N J G Jansen; J B M van Woensel; Dasja Pajkrt Journal: Pediatr Infect Dis J Date: 2020-04 Impact factor: 3.806