title: Should Posterior Reversible Encephalopathy Syndrome Be Mainly Considered an Epileptic Disorder? Results of a Sequential Neurophysiological Study in a Pediatric Cohort.
abstract: Despite a wide number of studies trying to define clinical, physiopathological, and neuroradiological features of posterior reversible encephalopathy syndrome (PRES), the true nature of symptoms is still not fully understood. We studied a standard cohort of 24 pediatric patients, affected by hemato-oncological diseases, with a neuroradiological diagnosis consistent with PRES identified from 2006 to 2013. Ten of them developed PRES after hematopoietic stem cell transplantation. We analyzed the sequence of clinical, radiological, and electrophysiological data. In all the patients who were recorded at the onset of the first symptoms, electroencephalograms showed focal nonconvulsive seizures or status epilepticus (SE). We found a sensitivity of 100% for electroencephalogram (EEG) with a good correlation between clinical signs and the localization of seizures, whereas computed tomography scans showed a sensitivity of 50% only. Following prompt treatment, intensive care unit admission rate was only 8%. PRES is a multifactorial neurologic event with focal nonconvulsive seizures or SE as the main feature in pediatric patients. Clinical manifestations are epileptic in nature, and prompt EEG recording is useful for diagnosis and supports an earlier treatment, potentially preventing the appearance of complications such as generalized seizures or refractory SE.
authors.affiliation: Child Neuropsychiatric Unit, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Grioni
authors.affiliation: BMT Unit, Department of Pediatrics, MBBM Foundation, Monza, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Pavan
authors.affiliation: BMT Unit, Department of Pediatrics, MBBM Foundation, Monza, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Prunotto
authors.affiliation: Department of Radiology, San Gerardo Hospital, Milano-Bicocca University, Monza, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Canonico
authors.affiliation: Department of Radiology, San Gerardo Hospital, Milano-Bicocca University, Monza, Italy.
authors.forename: Carlo de
authors.initials: C
authors.lastname: Grandi
authors.affiliation: BMT Unit, Department of Pediatrics, MBBM Foundation, Monza, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Rovelli
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D006402:Hematologic Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D054038:Posterior Leukoencephalopathy Syndrome / Q000145:classification* / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D012189:Retrospective Studies; D012640:Seizures / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D012680:Sensitivity and Specificity; D013226:Status Epilepticus / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants