title: Rasmussen's encephalitis: experience from a developing country based on a group of medically and surgically treated patients.
abstract: OBJECTIVE
  To describe the attributes of patients with Rasmussen's encephalitis (RE) seen in a tertiary epilepsy referral center in southern India and to enquire factors helpful in predicting responsiveness to immunotherapy.
  
  
  METHODS
  We diagnosed RE based on the European consensus criteria. To assess the factors that could potentially predict the natural course and therapeutic outcome, we subcategorized our patients according to age at onset (<or> 6 years), duration from onset to presentation (<or> 2 years), immunotherapy versus surgery, and early (<or=2 years from the onset) versus late surgery.
  
  
  RESULTS
  The median age at disease onset of 19 patients was 6.0 years (range 2.3-13 years). Epilepsia partialis continua (EPC) and hemiparesis were noted in 14 (73.6%) and 16 (84.2%) patients, respectively. One patient, who presented with dysarthria due to tongue EPC, did not have hemiparesis despite having had the disease for over 15 years. The MRI findings in majority conformed to stage 3 of Bien classification. While 9/10 patients treated by surgery achieved seizure-freedom, only 1/11 patients who received immunotherapy did so. One patient expired due to subsequent development of contralateral hemispheric disease following successful hemispherectomy. None of the factors such as age at onset, age at presentation, presence/absence of antecedents, seizure burden, MRI stage predicted responsiveness to immunotherapy.
  
  
  CONCLUSIONS
  This study from a developing country, in addition to substantiating the well known characteristics of RE, noted the following unusual findings: isolated lingual EPC abolished by focal cortical resection, bilateral RE, putaminal atrophy and absence of hemiparesis despite long standing disease.
authors: R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
authors: K N
authors: KN
authors: Ramesha
authors: B
authors: B
authors: Rajesh
authors: R
authors: R
authors: Ashalatha
authors: C
authors: C
authors: Kesavadas
authors: M
authors: M
authors: Abraham
authors: V V
authors: VV
authors: Radhakrishnan
authors: P S
authors: PS
authors: Sarma
authors: K
authors: K
authors: Radhakrishnan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D004569:Electroencephalography / Q000379:methods; D004660:Encephalitis / Q000150:complications* / Q000628:therapy*; D004827:Epilepsy / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007194:India / Q000453:epidemiology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D016756:Immunoglobulins, Intravenous