title: Prediction of acute encephalopathy with biphasic seizures and late reduced diffusion in patients with febrile status epilepticus.
abstract: BACKGROUND
  Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is the most common subtype of acute encephalopathy among children in Japan. The pathogenesis of AESD is mostly delayed cerebral edema caused by excitotoxic injury. It is difficult to discriminate AESD and complex febrile seizure in the early phase. Many cases have neurologic sequelae because early intervention is difficult.
  
  
  METHODS
  To establish an early diagnostic method, we assessed 213 hospitalized cases of febrile status epilepticus (FSE) between January 2004 and August 2014. We categorized FSE cases into an AESD group and a non-AESD group and compared their clinical courses, laboratory data and cranial computed tomography (CT) findings.
  
  
  RESULTS
  Of 213 hospitalized FSE cases, 19 (9%) were AESD. Univariate analysis showed that the AESD group took a significantly longer time to wake after FSE, had a higher degree of respiratory acidemia, and higher levels of serum AST, ALT, LD, hyperglycemia and hyperammonemia than the non-AESD group. We developed a scoring model that predicts AESD based on multivariate analysis. Using cut-off points of 4 and more with this scoring model, we could identify the AESD cases with 93% sensitivity and 91% specificity. These scores also had a positive correlation with prognosis.
  
  
  CONCLUSIONS
  Our scoring model enables early diagnosis of AESD. Patients with high scores should be observed carefully and early intervention should be considered.
authors.affiliation: Department of Pediatrics, St. Mary's Hospital, Fukuoka, Japan.
authors.forename: Takaoki
authors.initials: T
authors.lastname: Yokochi
authors.affiliation: Department of Pediatrics, St. Mary's Hospital, Fukuoka, Japan.
authors.forename: Takahito
authors.initials: T
authors.lastname: Takeuchi
authors.affiliation: Department of Pediatrics, St. Mary's Hospital, Fukuoka, Japan.
authors.forename: Jumpei
authors.initials: J
authors.lastname: Mukai
authors.affiliation: Department of Pediatrics, St. Mary's Hospital, Fukuoka, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Akita
authors.affiliation: Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Nagai
authors.affiliation: Department of Pediatrics, St. Mary's Hospital, Fukuoka, Japan.
authors.forename: Keizo
authors.initials: K
authors.lastname: Obu
authors.affiliation: Center for Bio-Statistics, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Tatsuyuki
authors.initials: T
authors.lastname: Kakuma
authors.affiliation: Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan. Electronic address: tmatsu@med.kurume-u.ac.jp.
authors.forename: Toyojiro
authors.initials: T
authors.lastname: Matsuishi
mesh_terms: D000293:Adolescent; D001927:Brain Diseases / Q000175:diagnosis* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007223:Infant; D007564:Japan; D008297:Male; D011237:Predictive Value of Tests; D012640:Seizures / Q000175:diagnosis* / Q000503:physiopathology; D003294:Seizures, Febrile / Q000175:diagnosis / Q000503:physiopathology; D013226:Status Epilepticus / Q000175:diagnosis* / Q000503:physiopathology
keywords: Acute encephalopathy; Biphasic; Brain hypothermia; Complex febrile seizures; Diffusion MRI; Status epilepticus