Abstracts

Rationale: Very little information exists regarding how important it is to obtain rapid seizure control in presumed childhood encephalitis. Methods: We prospectively identified 217 consecutive patients with suspected encephalitis who had been referred to the California Encephalitis Project (CEP). Inclusion criteria included encephalopathy lasting 24 hours and at least one of the following: fever, seizure, pleocytosis, EEG or neuroimaging evidence concerning for encephalitis, or focal neurologic signs. 84 patients had seizures at or soon after presentation and had no pre-existing neurologic conditions. 56 of the 84 patients had adequate acute care and follow up data for analysis of time to acute seizure control and outcomes. We also analyzed outcomes in 74 patients who had pharmacologically induced coma. Early successful seizure management was defined as seizure control within 24 hours of initial seizure onset. Results: Patients were divided into two groups: seizure control within 24 hours and seizure control after 24 hours. The long term outcome analysis included whether or not follow-up neurological evaluation, after resolution of the presumed encephalitis, was normal or abnormal. An abnormal neurological status was defined as the presence of focal deficits, ataxia, developmental delay, cerebral palsy, cognitive, behavioral, or learnings impairments. Using chi-squared analysis, we found that if seizures were controlled within 24 hours, patients were more likely to be normal at follow-up (p< 0.05). Outcomes for patients placed in a medically-induced coma were not significantly different from patients who were not placed in coma (chi-square p>0.1). Conclusions: Through analysis of this cohort of previously neurologically normal children who had seizures in the context of presumed encephalitis, we show that those who obtained seizure control within 24 hours were more than twice as likely to have a full recovery. Additionally, use of medical coma for seizure control did not appear to negatively impact long-term neurological outcome. These results suggest achieving early seizure control is associated with better neurological outcomes. Use of pharmacologically induced coma did not appear to be associated with worse outcomes.