Predictive score for early diagnosis of acute encephalopathy with biphasic seizures and late reduced diffusion (AESD).
Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) at onset manifests an early seizure (ES) usually lasting more than 30 min. Following ES, some patients exhibit almost clear consciousness with no neurological symptoms, and no MRI abnormality for a few days, which may lead to an initial misdiagnosis of prolonged febrile seizures (PFS). To allow an early diagnosis of AESD, we retrospectively analyzed clinical manifestations, laboratory data, and radiologic and EEG findings in patients with AESD (n=62) having ES of over 30 min, and ones with PFS (n=54), using logistic regression analyses. Multivariate logistic regression analysis revealed that an age below 1.5 years and a Glasgow Coma Scale score of 14 or less than 14 (Japan Coma Scale score of 1 or higher) were high risk factors of developing AESD. We proposed an AESD prediction score system consisting of consciousness level, age, duration of convulsions, enforcement of mechanical intubation, and aspartate aminotransferase, blood glucose and creatinine levels (full score: 9), the mean scores in AESD and PFS being 5.9 and 1.8, which were significantly different (p<0.001). We herein propose a scoring system for differentiating patients with AESD and PFS around the time of ES (score of 4 or more than 4 suggesting AESD), which may contribute to early therapeutic intervention and an improved neurologic outcome.
Department of Pediatrics, Chibaken Saiseikai Narashino Hospital, Narashino, Japan. Electronic address: h.tada@hotmail.co.jp.
Hiroko
H
Tada
Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, Japan.
Jun-ichi
J
Takanashi
Department of Emergency, Osaka City General Hospital, Osaka, Japan.
Hideo
H
Okuno
Department of Pediatrics, National Center for Child Health and Development, Tokyo, Japan.
Masaya
M
Kubota
Department of Pediatrics, Graduate School of Medicine, Jichi Medical University, Shimono, Japan.
Takanori
T
Yamagata
Department of Pediatrics, Graduate School of Medicine, Kurume University, Fukuoka, Japan.
Gou
G
Kawano
Department of Neurology, Gunma Children's Medical Center, Shibukawa, Japan.
Takashi
T
Shiihara
Division of Neurology, Saitama Children's Medical Center, Saitama, Japan.
Shin-ichiro
S
Hamano
Department of Pediatrics, School of Medicine, Fukuoka University, Fukuoka, Japan.
Shinichi
S
Hirose
Department of Emergency, Kanagawa Children's Medical Center, Yokohama, Japan.
Takuya
T
Hayashi
Department of Neurology, Kanagawa Children's Medical Center, Yokohama, Japan.
Hitoshi
H
Osaka
Department of Developmental Medical Sciences, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Masashi
M
Mizuguchi
D000208:Acute Disease; D000367:Age Factors; D002675:Child, Preschool; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D004569:Electroencephalography; D018792:Encephalitis, Viral / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D008297:Male; D012307:Risk Factors; D012640:Seizures / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D003294:Seizures, Febrile / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D012720:Severity of Illness Index; D013577:Syndrome; D014474:Unconsciousness / Q000503:physiopathology
Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD); Infection; Logistic regression analysis; Pediatric; Predictive score; Prolonged febrile seizures (PFS)