Devastating epileptic encephalopathy in school-aged children (DESC): a pseudo encephalitis

Epilepsy Res. 2006 Apr;69(1):67-79. doi: 10.1016/j.eplepsyres.2006.01.002. Epub 2006 Feb 15.

Abstract

Purpose: To describe the characteristics of a previously overlooked devastating epileptic encephalopathy that presents as intractable bilateral perisylvian epilepsy starting with prolonged status epilepticus (SE) in normally developing school-aged children.

Methods: Retrospective study over 7 years of all normally developing children admitted in our institution for a prolonged SE following non-specific febrile illness with at least one seizure recorded on EEG.

Results: Fourteen children were included at a median age of 7.5 years (4-11) (median follow-up of 4 years (1-7)). Intractable SE lasted 4-60 days (median 30). CSF cell count was normal in five cases and moderately increased in the others. During SE, seizures were recorded in 11 patients and involved temporal lobes in 7; the other 4 patients exhibited perisylvian clinical features with secondary generalization. Intractable epilepsy followed SE in all cases without any latent period. Persisting seizures were recorded in 10 patients and involved temporo-perisylvian regions in 8, frontal regions in 2; 3 others had perisylvian ictal semiology. Spiking was bilateral in 10 cases. MRI showed bilateral hippocampal hypersignal and/or atrophy in 10 cases (extended to the neocortex in 3). All children had major cognitive sequelae. When feasible (six patients), detailed neuropsychology suggested fronto-temporal impairment.

Conclusions: Among so called grey matter encephalitis patients, we identified a recognizable pattern we propose to call Devastating Epileptic encephalopathy in School-age Children (DESC) that begins with prolonged SE triggered by fever of unknown cause, and persists as intractable perisylvian epilepsy with severe cognitive deterioration.

MeSH terms

  • Anticonvulsants / therapeutic use
  • Cerebrospinal Fluid Proteins / analysis
  • Child
  • Child, Preschool
  • Cognition / physiology*
  • Drug Resistance
  • Electroencephalography
  • Encephalitis / cerebrospinal fluid
  • Encephalitis / etiology*
  • Encephalitis / physiopathology
  • Epilepsy / drug therapy
  • Epilepsy / etiology*
  • Fever of Unknown Origin / complications
  • Humans
  • Magnetic Resonance Imaging
  • Neuropsychological Tests
  • Prognosis
  • Retrospective Studies
  • Status Epilepticus / complications*

Substances

  • Anticonvulsants
  • Cerebrospinal Fluid Proteins