Nagai Kota, Kawano Go, Sakaguchi Hirotaka, Yokochi Takaoki, Eshima Nobuoki, Matsuishi Toyojiro
Department of Paediatrics, St Mary's Hospital, Fukuoka, Japan.
Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan.
Front Neurol. 2025 Jul 22;16:1568566. doi: 10.3389/fneur.2025.1568566. eCollection 2025.
Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is a prevalent form of acute infection-triggered encephalopathy in children, excluding the unclassified type. It is marked by febrile seizures, referred to as early seizures and subsequent late seizures, along with a reduction in the apparent diffusion coefficient in cortical or subcortical white matter. AESD frequently results in neurological sequelae, including post-encephalitic epilepsy (PEE).
This retrospective study examined the incidence of PEE and investigated whether therapeutic hypothermia reduced the risk of PEE in 45 patients with AESD treated at St Mary's Hospital between July 2008 and April 2024. Patients whose Glasgow Coma Scale score was >8 and who had mild clinical symptoms, as judged by the attending physician, between July 2008 and December 2020, did not undergo therapeutic hypothermia. However, all patients with AESD underwent therapeutic hypothermia during the period between January 2021 and April 2024. There were 11, 24, and 10 patients in the Early-Hypo, Late-Hypo, and Non-Hypo groups, respectively.
The prevalence of PEE among patients with AESD was 26.7% (12 out of 45 patients), with a median observation period of 75 months (IQR 37-98 months, range 20-182 months). Univariate analysis revealed statistically significant differences between patients with and without PEE in several factors, including Glasgow Coma Scale scores between 12 and 24 h after early seizures, and the number of patients with AESD with biphasic course, Tada scores, and the Pediatric Cerebral Performance Category at 6 months post-onset. Multivariate logistic regression analysis identified higher Tada scores as an independent risk factor for developing PEE, and the treatment options of Early-Hypo or Late-Hypo significantly reduced the risk of PEE.
While further prospective studies with larger cohorts are warranted, this study highlights the association between higher Tada scores and an increased risk of PEE in patients with AESD, and the treatment options of Early-Hypo or Late-Hypo significantly reduced the risk of PEE.
伴有双相性癫痫发作和晚期弥散受限的急性脑病（AESD）是儿童急性感染引发的脑病的一种常见形式，不包括未分类类型。其特征为热性惊厥，即早期惊厥和随后的晚期惊厥，以及皮质或皮质下白质表观扩散系数降低。AESD常导致神经后遗症，包括脑炎后癫痫（PEE）。
这项回顾性研究调查了45例2008年7月至2024年4月在圣玛丽医院接受治疗的AESD患者中PEE的发病率，并研究了治疗性低温是否降低了PEE的风险。2008年7月至2020年12月期间，格拉斯哥昏迷量表评分>8且经主治医生判断临床症状较轻的患者未接受治疗性低温。然而，2021年1月至2024年4月期间，所有AESD患者均接受了治疗性低温。早期低温组、晚期低温组和非低温组分别有11例、24例和10例患者。
AESD患者中PEE的患病率为26.7%（45例患者中有12例），中位观察期为75个月（四分位间距37 - 98个月，范围20 - 182个月）。单因素分析显示，在几个因素方面，有PEE和无PEE的患者之间存在统计学显著差异，包括早期惊厥后12至24小时的格拉斯哥昏迷量表评分、双相病程的AESD患者数量、田田评分以及发病后6个月时的小儿脑功能分类。多因素逻辑回归分析确定较高的田田评分是发生PEE的独立危险因素，早期低温或晚期低温的治疗方案显著降低了PEE的风险。
虽然需要进一步开展更大样本量的前瞻性研究，但本研究强调了较高的田田评分与AESD患者发生PEE风险增加之间的关联，且早期低温或晚期低温的治疗方案显著降低了PEE的风险。
