title: [A case of acute encephalitis with refractory, repetitive partial seizures requiring a high concentration of isoflurane to suppress the seizures and showing abnormal findings in the bilateral thalamus on MRI during the convalescent period].
abstract: We report a patient with acute encephalitis with refractory, repetitive partial seizures requiring a high concentration of isoflurane to suppress the seizures and showing rare abnormal findings in the bilateral thalamus on MRI during the convalescent period. A five-year-old boy was admitted to our hospital because of fever and convulsions. Shortly after admission, convulsions became frequent and disturbance of consciousness became apparent. Abnormal findings on electroencephalogram indicated encephalitis. Convulsions could not be suppressed by any intravenous anticonvulsants including barbiturates. Inhalational anticonvulsant treatment with isoflurane was performed, but it was ineffective at a low concentration. A high concentration of isoflurane was needed to suppress convulsions. Since a high concentration of isoflurane induces hypotension, various drugs to increase blood pressure were also administered. Convulsions reappeared during withdrawal of isoflurane. Finally isoflurane was withdrawn without inducing status epilepticus by administration of intravenous and oral anticonvulsants during the withdrawal process. Neurological sequelae were very severe and there are no anticonvulsants that have effectively suppressed the convulsions to date. MRI during the convalescent period showed high-intensity signal changes on fluid-attenuated inversion recovery, diffusion-weighted image and T2-weighted image in the bilateral thalamus. But it is uncertain whether these changes were the cause of this disorder.
authors.affiliation: Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama. shiraga@okayama3.hosp.go.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shiraga
mesh_terms: D000208:Acute Disease; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D002675:Child, Preschool; D004660:Encephalitis / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007530:Isoflurane / Q000009:adverse effects / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D012640:Seizures / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D013788:Thalamus / Q000473:pathology / Q000503:physiopathology*
chemical_list: D000927:Anticonvulsants; D007530:Isoflurane