title: Postencephalitic epilepsy and drug-resistant epilepsy after infectious and antibody-associated encephalitis in childhood: Clinical and etiologic risk factors.
abstract: To define the risk factors for postencephalitic epilepsy (PE) and drug-resistant epilepsy (DRE) in childhood following infectious and autoimmune encephalitis, we included 147 acute encephalitis patients with a median follow-up of 7.3 years (range 2-15.8 years). PE was defined as the use of antiepileptic drugs (AEDs) for ≥24 months, and DRE was defined as the persistence of seizures despite ≥2 appropriate AEDs at final follow-up. PE and DRE were diagnosed in 31 (21%) and 15 (10%) of patients, respectively. The features during acute encephalitis predictive of DRE (presented as odds ratio [OR] with confidence intervals [CIs]) were status epilepticus (OR 10.8, CI 3.4-34.3), visual disturbance (6.4, 1.4-29.9), focal seizures (6.2, 1.9-20.6), magnetic resonance imaging (MRI) hippocampal/amygdala involvement (5.0, 1.7-15.4), intensive care admission (4.7, 1.4-15.4), use of >3 AEDs (4.5, 1.2-16.1), MRI gadolinium enhancement (4.1, 1.2-14.2), any seizure (3.9, 1.1-14.4), and electroencephalography (EEG) epileptiform discharges (3.9, 1.3-12.0). On multivariable regression analysis, only status epilepticus remained predictive of DRE in all models. DRE was common in herpes simplex virus (3/9, 33%) and unknown (8/40, 20%) encephalitis, but absent in acute disseminated encephalomyelitis (ADEM) (0/32, 0%), enterovirus (0/18), and anti-N-methyl-d-aspartate receptor-NMDAR encephalitis (0/9). We have identified risk factors for DRE and demonstrated "high-risk," and "low-risk" etiologies.
authors.affiliation: Neuroimmunology Group, Institute for Neuroscience and Muscle Research at The Kids Research Institute, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.|TY Nelson Department of Neurology and Neurosurgery, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors.forename: Sekhar C
authors.initials: SC
authors.lastname: Pillai
authors.affiliation: Neuroimmunology Group, Institute for Neuroscience and Muscle Research at The Kids Research Institute, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Shekeeb S
authors.initials: SS
authors.lastname: Mohammad
authors.affiliation: Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.
authors.forename: Yael
authors.initials: Y
authors.lastname: Hacohen
authors.affiliation: Neuroimmunology Group, Institute for Neuroscience and Muscle Research at The Kids Research Institute, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.|TY Nelson Department of Neurology and Neurosurgery, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors.forename: Esther
authors.initials: E
authors.lastname: Tantsis
authors.affiliation: Department of Medical Imaging, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors.forename: Kristina
authors.initials: K
authors.lastname: Prelog
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.|Department of Statistics, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Barnes
authors.affiliation: TY Nelson Department of Neurology and Neurosurgery, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors.forename: Deepak
authors.initials: D
authors.lastname: Gill
authors.affiliation: Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.|Evelina London Children's Hospital, London, United Kingdom.
authors.forename: Ming J
authors.initials: MJ
authors.lastname: Lim
authors.affiliation: Neuroimmunology Group, Institute for Neuroscience and Muscle Research at The Kids Research Institute, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Brilot
authors.affiliation: Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.
authors.forename: Angela
authors.initials: A
authors.lastname: Vincent
authors.affiliation: Neuroimmunology Group, Institute for Neuroscience and Muscle Research at The Kids Research Institute, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.|TY Nelson Department of Neurology and Neurosurgery, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors.forename: Russell C
authors.initials: RC
authors.lastname: Dale
mesh_terms: D000293:Adolescent; D001323:Autoantibodies / Q000097:blood; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D000069279:Drug Resistant Epilepsy / Q000209:etiology*; D004569:Electroencephalography; D004660:Encephalitis / Q000150:complications* / Q000276:immunology*; D004827:Epilepsy / Q000097:blood / Q000209:etiology*; D005260:Female; D005968:Glutamate Decarboxylase / Q000276:immunology; D006801:Humans; D008297:Male; D008565:Membrane Proteins / Q000276:immunology; D009419:Nerve Tissue Proteins / Q000276:immunology; D024642:Potassium Channels, Voltage-Gated / Q000276:immunology; D012372:ROC Curve; D016194:Receptors, N-Methyl-D-Aspartate / Q000276:immunology*; D012307:Risk Factors
chemical_list: D001323:Autoantibodies; C403049:CNTNAP2 protein, human; D008565:Membrane Proteins; D009419:Nerve Tissue Proteins; D024642:Potassium Channels, Voltage-Gated; D016194:Receptors, N-Methyl-D-Aspartate; D005968:Glutamate Decarboxylase
keywords: Autoimmune; Encephalitis; Epilepsy; Infection; Outcome