الفهرس 
ACUTE VIRAL ENCEPHALITISOnly 14 pages are availabe for public view
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Abstract
Encephalitis in children is relatively uncommon but potentially devastating. It can be life threatening and results in permanent neuropsychiatric and cognitive impairment in a significant proportion of survivors. Currently, there are no prognostic markers other than some etiologies that can predict the risk of developing severe illness or incomplete recovery after acute encephalitis.
The aim of this study was to assess the short-term prognostic aid of the initial Electroencephalography (EEG) in patients with acute encephalitis regardless the cause.
This prospective observational study was conducted in the period from April 2019 to January 2020 in the Pediatric Intensive Care Unit, In-patient Wards and pediatrics Neurology Clinic at Ain Shams University Pediatric Hospital. The study was conducted on 30 acute encephalitis pediatric patients.
Cases were subjected to full history taking, examination and an EEG recording obtained during hospital admission. Functional outcome assessment was done using the Liverpool outcome score during admission and repeated again at 3 months post discharge.
The mean age of patients was 2.8 ±3.5 years old, with ages ranging from 6 months to 15 years. 73% of the cases were males. Altered mental status and fever were present in 100% of our patients. Clinical seizures were observed in 96.7% of the cases. Status Epilepticus occurred in 2 patients (6.7%) at presentation. 43.4% had generalized weakness on neurological examination. Total GCS of cases at admission ranged from 5 to 14, median 11 while that of discharge ranged from 11 to 15 with median of GCS 15.
Leukocytosis was present in 9 patients (30%). 17 (56.7%) patients had hyponatremia. CSF hypoglcorrhacia was not found in any of our cases and CSF proteins were elevated in 40% of cases. CSF cytology was positive in 53.3% of cases with 46.7% of them showed Lymphocytes in CSF cell type. CSF HSV PCR was negative in 100% of our cases. EEG was abnormal in 26.7% of cases. EEG epileptiform activities were present in 6.7% of cases. Abnormal MRI findings were present in 17% of our cases.
The median Liverpool outcome scores were significantly higher at 3 months compared to those at hospital discharge.
The Liverpool outcome scores were significantly lower at discharge and even more so after 3 months in cases with epileptiform activity on EEG. Abnormalities of EEG background either in sleep or in wakefulness did not significantly impact the Liverpool outcome score of the patients at discharge or after 3 months.
Cases with status epilepticus had significantly lower Liverpool outcome scores at discharge. The difference became even more highly significant at the 3 months mark. Using ROC curve, it was shown that presence of status epilepticus at presentation could be used for detection of low Liverpool outcome score at a cutoff level of ≤3, with 100% and 92.8% Sensitivity and Specificity respectively.
Median GCS score was significantly lower in patients who has epileptiform activity. No significant relation could be seen between GCS scores and abnormalities of EEG background.
Patients with higher total GCS scores on admission showed higher Liverpool outcome scores at discharge. This positive correlation disappeared at the 3 months mark. Patients with higher total GCS scores on discharge had a significantly higher Liverpool outcome score both at discharge and after 3 months. All in all, the GCS score at discharge was more significantly correlated with both epileptiform abnormalities in EEG and the Liverpool outcome scores both at discharge and at 3 months, than the GCS at admission.
Leukocytosis was associated with a significantly lower Liverpool outcome score on discharge but not at three months.
Patients with longer hospital stay showed significantly lower Liverpool scores at discharge and more so after 3 months.
The presence of MRI abnormalities was associated with a lower Liverpool outcome score at 3 months but not at hospital discharge.
The patients’ gender, presence of intracranial hypertension, GCS score upon admission, abnormal neurological examination, the presence of positive CSF cellular reaction or elevated CSF proteins, hyponatremia, leukocytosis, the length of hospital stay, the presence of abnormal MRI findings did not significantly impact EEG findings among cases.
There was no significant relation between the presence of intracranial hypertension, abnormal neurological examination, positive CSF cellular reaction or elevated CSF proteins, hyponatraemia and the Liverpool outcome score at discharge or after 3 months. Females had significantly lower Liverpool scores at discharge, though this difference didn’t persist to the 3 months’ mark.