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Seizure evolution and outcome in pediatric autoimmune encephalitis

  • Hyewon Woo
    Affiliations
    Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea, Republic of

    Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Korea, Republic of
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  • Youngkyu Shim
    Affiliations
    Department of Pediatrics, Korea University Ansan Hospital, Ansan, Korea, Republic of
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  • Jong-Hee Chae
    Affiliations
    Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea, Republic of

    Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea, Republic of
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  • Ki Joong Kim
    Affiliations
    Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea, Republic of

    Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea, Republic of
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  • Byung Chan Lim
    Correspondence
    Corresponding author: Byung Chan Lim, Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea, Republic of
    Affiliations
    Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea, Republic of

    Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea, Republic of
    Search for articles by this author

      Abstract

      Background

      Our study aimed to characterize seizure incidence and seizure outcome of pediatric autoimmune encephalitis (AE) focusing on subgroup analysis based on antibody (Ab).

      Methods

      Among 110 pediatric AE patients, we compared seizure characteristics and outcomes in 68 patients with seizure, who satisfied the proposed criteria of pediatric AE. Accordingly, patients were classified into three groups, anti-MOG AE, anti-NMDAR AE, and Ab-negative AE. Univariate and multivariate analyses were performed to evaluate the risk factors for postencephalitic seizures, defined as persisting seizures six months after onset.

      Results

      Seizure incidence in the anti-NMDAR (88.9%) and Ab-negative (71.1%) groups differed from anti-MOG group (37.8%). Median seizure frequency within 6 months was higher in the Ab-negative group (6.0, interquartile range [IQR] 3.0–13.0) than in the anti-NMDAR group (3.0, IQR 2.0–4.5) and anti-MOG group (2.0, IQR 1.0–5.0). Patients in the Ab-negative group tended to develop postencephalitic seizures more frequently and have a lower seizure freedom rate than those in the anti-NMDAR and anti-MOG groups. Ab-negative status, high seizure frequency within 6 months, and the presence of status epilepticus were associated with the development of postencephalitic seizures on univariate analysis. On multivariate analysis, Ab-negative status remained the only significant variable linked with postencephalitic seizure (Odds Ratio, 4.17; 95% Confidence Interval, 1.02–18.05).

      Conclusions

      We delineated the seizure incidence, evolution, and outcome of Ab-positive and Ab-negative pediatric AE patients. Ab-negative status is predictive of higher seizure burden, more frequent development of postencephalitic seizures and less favorable seizure outcome than anti-NMDAR and anti-MOG Ab-positive status.

      Keywords

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