title: Periodic lateralized epileptiform discharges in La Crosse encephalitis, a worrisome subgroup: clinical presentation, electroencephalogram (EEG) patterns, and long-term neurologic outcome.
abstract: La Crosse virus encephalitis is the most common mosquito-borne virus in children in the United States. La Crosse virus encephalitis has emerged as a significant health concern due to its potential for acute morbidity, including seizures, alterations in mental status, and, in rare cases, death, as well as the potential for chronic morbidity, including, epilepsy and cognitive and behavioral disorders. The aim of this study is to provide a clinical description of the largest series of children reported with periodic lateralizing epileptiform discharges (PLEDS) associated with La Cross virus encephalitis with reference to their clinical course, seizure type, electroencephalogram (EEG) patterns, and 2- and 10-year long-term neurologic outcome. In addition, to evaluate whether this subset of children may indeed have more severe disease than children with La Crosse virus encephalitis without PLEDS, comparisons are made between the 2 groups on specific variables. All patients presented with fever and disorientation; 6 of the 9 (66%) presented with seizures. PLEDS localized to the temporal lobe in 7 patients (77%). The children with PLEDS had longer intensive care unit stays (6.5 +/- 2.4 vs 3.2 +/- 1.9; P < .0001), a higher rate of intubation (88% vs 20%; P < .001), and a higher rate of cerebral herniation (1%; P < .05) than children with La Crosse virus encephalitis without PLEDS. Follow-up data on the subset with PLEDS also suggest a relatively high rate of epilepsy and behavioral difficulties with hyperactivity symptoms, memory deficits, and school difficulties. The implications for recognition, management, and follow-up of this worrisome subset of patients with La Crosse virus encephalitis are discussed.
authors.affiliation: Department of Pediatrics, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA. reyese@pediatrics.ohio
authors.forename: Emily C
authors.initials: EC
authors.lastname: de los Reyes
authors.forename: James E
authors.initials: JE
authors.lastname: McJunkin
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Glauser
authors.forename: Mark
authors.initials: M
authors.lastname: Tomsho
authors.forename: James
authors.initials: J
authors.lastname: O'Neal
mesh_terms: D001921:Brain / Q000473:pathology / Q000503:physiopathology* / Q000821:virology; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data; D004569:Electroencephalography; D004670:Encephalitis, California / Q000150:complications* / Q000473:pathology / Q000821:virology; D004677:Encephalocele / Q000209:etiology / Q000821:virology; D004827:Epilepsy / Q000209:etiology* / Q000473:pathology / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D006801:Humans; D018062:La Crosse virus; D007902:Length of Stay; D008297:Male; D012720:Severity of Illness Index; D013702:Temporal Lobe / Q000473:pathology / Q000503:physiopathology; D014474:Unconsciousness / Q000209:etiology / Q000821:virology