Outcome of acute necrotizing encephalopathy in relation to treatment with corticosteroids and gammaglobulin.
OBJECTIVE
To examine the relation between outcome and treatment with steroids and gammaglobulin in children with acute necrotizing encephalopathy.


METHODS
We retrospectively evaluated the clinical course and outcome of 34 children with acute necrotizing encephalopathy. They were divided into two groups; 17 patients with brainstem lesion and 17 patients without brainstem lesion. Early steroid use was defined as when steroids were administered within 24h after the onset. The outcome was judged as good when a patient had no or mild cognitive impairment and poor when a patient had more severe sequelae, or died.


RESULTS
Among patients without brainstem lesions, the outcome was good in 7 of 12 with early steroid, whereas it was poor in all 5 patients without early steroid. There was no significant difference in sex, age, and laboratory data between patients with and without early steroid. The outcome was not correlated with gammaglobulin treatment. As to patients without brainstem lesions, the outcome was not correlated with early steroid or gammaglobulin treatment.


CONCLUSIONS
Steroid within 24 h after the onset was related to better outcome of children with acute necrotizing encephalopathy without brainstem lesions. Early steroid treatment will be an important option of the treatment for acute necrotizing encephalopathy.
Okumura
Akihisa
A
Department of Pediatrics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan. okumura@med.juntendo.ac.jp
Mizuguchi
Masashi
M
Kidokoro
Hiroyuki
H
Tanaka
Manabu
M
Abe
Sinpei
S
Hosoya
Mitsuaki
M
Aiba
Hideo
H
Maegaki
Yoshihiro
Y
Yamamoto
Hitoshi
H
Tanabe
Takuya
T
Noda
Eiko
E
Imataka
George
G
Kurahashi
Hirokazu
H
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001927:Brain Diseases / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D001933:Brain Stem / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009336:Necrosis; D012189:Retrospective Studies; D012727:Sex Characteristics; D016896:Treatment Outcome; D005719:gamma-Globulins / Q000627:therapeutic use*
D000305:Adrenal Cortex Hormones; D005719:gamma-Globulins