Prediction and assessment of acute encephalopathy syndromes immediately after febrile status epilepticus

• Published in: Brain & development (Tokyo. 1979) Vol. 45; no. 2; pp. 93 - 101
• Main Authors: Uematsu, Kenji, Matsumoto, Hiroshi, Zaha, Kiyotaka, Mizuguchi, Masashi, Nonoyama, Shigeaki
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.02.2023
• Subjects: Acute encephalopathy syndromes; Brain Diseases - diagnostic imaging; Brain Diseases - epidemiology; Brain Diseases - physiopathology; Child; Creatinine; Creatinine - blood; Electroencephalogram; Electroencephalography; Febrile seizure; Humans; Magnetic Resonance Imaging; Predictive Value of Tests; Risk Assessment; Seizures, Febrile - complications; Seizures, Febrile - diagnosis; Status epilepticus; Status Epilepticus - complications; Status Epilepticus - diagnosis; Syndrome; Creatinine; Febrile seizure; Acute encephalopathy syndromes; Magnetic resonance imaging; Electroencephalogram; Status epilepticus
• ISSN: 0387-7604; 1872-7131
• DOI: 10.1016/j.braindev.2022.10.004

This study aimed to predict occurrence of acute encephalopathy syndromes (AES) immediately after febrile status epilepticus in children and to explore the usefulness of electroencephalogram (EEG) in the early diagnosis of AES. We reviewed data from 120 children who had febrile status epilepticus lasting >30 min and were admitted to our hospital between 2012 and 2019. AES with reduced diffusion on brain magnetic resonance imaging was diagnosed in 11 of these patients. EEG and serum cytokines were analyzed in AES patients. Clinical symptoms and laboratory data were compared between AES and non-AES patients. Logistic regression analysis was used to identify early predictors of AES. Multivariate logistic regression identified serum creatinine as a risk factor for developing AES. A scoring model to predict AES in the post-ictal phase that included serum creatinine, sodium, aspartate aminotransferase, and glucose was developed, and a score of 2 or more predicted AES with sensitivity of 90.9% and specificity of 71.6%. Post-ictus EEG revealed non-convulsive status epilepticus in four of the seven AES patients. Children with febrile status epilepticus may be at risk of developing severe AES with reduced diffusion. Post-ictus EEG and laboratory data can predict the occurrence of severe AES.