Incidence and risk factors of acute encephalopathy with biphasic seizures in febrile status epilepticus

Fumio Ichinose, Takuji Nakamura, Ryutaro Kira, Kenji Furuno, Shigeki Ishii, Kazunari Takamura, Marina Hashiguchi, Takushi Inoue, Ayako Senju, Yuko Ichimiya, Takafumi Sakakibara, Nobuyoshi Sugiyama, Tomomi Naitou, Naoya Higuchi, Masami Togawa, Ken ichi Torii, Soichiro Toda, Hiroko Iwamatsu, Tatsuharu Sato, Satoshi TsuruiHidenori Tanaka, Mitsuo Motobayashi, Akiko Abe, Atsushi Kawaguchi, Muneaki Matsuo

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To clarify the incidence and risk factors of acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) in pediatric patients with febrile status epilepticus (FSE). Methods: We retrospectively surveyed patients with FSE (≥20 min and ≥40 min) who were younger than 6 years by mailing a questionnaire to 1123 hospitals in Japan. The survey period was 2 years. We then collected clinical data on patients with prolonged febrile seizures (PFS) ≥40 min and those with AESD, and compared clinical data between the PFS and AESD groups. Results: The response rate for the primary survey was 42.3%, and 28.0% of hospitals which had applicable cases responded in the secondary survey. The incidence of AESD was 4.3% in patients with FSE ≥20 min and 7.1% in those with FSE ≥40 min. In the second survey, a total of 548 patients had FSE ≥40 min (AESD group, n = 93; PFS group, n = 455). Univariate analysis revealed significant between-group differences in pH, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, creatine kinase, NH3, procalcitonin (PCT), uric acid, blood urea nitrogen, creatinine (Cr), and lactate. Multivariate analysis using stratified values showed that high PCT was an only risk factor for AESD. A prediction score of more than 3 was indicative of AESD, as determined using the following indexes: HCO3 < 20 mmol/L (1 point), Cl <100 mEq/L (1 point), Cr ≥0.35 mg/dL (1 point), glucose ≥200 mg/dL (1 point), and PCT ≥1.7 pg/mL (2 points). The scoring system had sensitivity of 84.2% and specificity of 81.0%. Conclusion: Incidence data and prediction scores for AESD will be useful for future intervention trials for AESD.

Original languageEnglish
JournalBrain and Development
DOIs
Publication statusAccepted/In press - 2021

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Developmental Neuroscience
  • Clinical Neurology

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