Increased volume of cerebral oedema is associated with risk of acute seizure activity and adverse neurological outcomes in encephalitis – regional and volumetric analysis in a multi-centre cohort
Abstract Background Seizures can occur unpredictably in patients with acute encephalitis syndrome (AES), and many suffer from poor long-term neurological sequelae. Establishing factors associated with acute seizures risk and poor outcomes could support clinical care. We aimed to conduct regional and...
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| Format: | Article |
| Language: | English |
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BMC
2022-11-01
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| Series: | BMC Neurology |
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| Online Access: | https://doi.org/10.1186/s12883-022-02926-5 |
| _version_ | 1798018385117708288 |
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| author | A. M. Alam J. P. K. Chen G. K. Wood B. Facer M. Bhojak K. Das S. Defres A. Marson J. Granerod D. Brown R. H. Thomas S. S. Keller T. Solomon B. D. Michael |
| author_facet | A. M. Alam J. P. K. Chen G. K. Wood B. Facer M. Bhojak K. Das S. Defres A. Marson J. Granerod D. Brown R. H. Thomas S. S. Keller T. Solomon B. D. Michael |
| author_sort | A. M. Alam |
| collection | DOAJ |
| description | Abstract Background Seizures can occur unpredictably in patients with acute encephalitis syndrome (AES), and many suffer from poor long-term neurological sequelae. Establishing factors associated with acute seizures risk and poor outcomes could support clinical care. We aimed to conduct regional and volumetric analysis of cerebral oedema on magnetic resonance imaging (MRI) in patients with AES. We assessed the relationship of brain oedema with acute seizure activity and long-term neurological outcome. Methods In a multi-centre cohort study, adults and children presenting with an AES were recruited in the UK. The clinical and brain MRI data were retrospectively reviewed. The outcomes variables were inpatient acute seizure activity and neurological disability at six-months post-discharge. A poor outcome was defined as a Glasgow outcome score (GOS) of 1–3. We quantified regional brain oedema on MRI through stereological examination of T2-weighted images using established methodology by independent and blinded assessors. Clinical and neuroimaging variables were analysed by multivariate logistic regression to assess for correlation with acute seizure activity and outcome. Results The study cohort comprised 69 patients (mean age 31.8 years; 53.6% female), of whom 41 (59.4%) had acute seizures as inpatients. A higher Glasgow coma scale (GCS) score on admission was a negative predictor of seizures (OR 0.61 [0.46–0.83], p = 0.001). Even correcting for GCS on admission, the presence of cortical oedema was a significant risk factor for acute seizure activity (OR 5.48 [1.62–18.51], p = 0.006) and greater volume of cerebral oedema in these cortical structures increased the risk of acute seizures (OR 1.90 [1.12–3.21], p = 0.017). At six-month post-discharge, 21 (30.4%) had a poor neurological outcome. Herpes simplex virus encephalitis was associated with higher risk of poor outcomes in univariate analysis (OR 3.92 [1.08–14.20], p = 0.038). When controlling for aetiology, increased volume of cerebral oedema was an independent risk factor for adverse neurological outcome at 6 months (OR 1.73 [1.06–2.83], p = 0.027). Conclusions Both the presence and degree of cerebral oedema on MRIs of patients with AES may help identify patients at risk of acute seizure activity and subsequent long-term morbidity. |
| first_indexed | 2024-04-11T16:23:04Z |
| format | Article |
| id | doaj.art-3fbbe326d7e24ebe99f2c9820a6af90c |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-04-11T16:23:04Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj.art-3fbbe326d7e24ebe99f2c9820a6af90c2022-12-22T04:14:16ZengBMCBMC Neurology1471-23772022-11-0122111310.1186/s12883-022-02926-5Increased volume of cerebral oedema is associated with risk of acute seizure activity and adverse neurological outcomes in encephalitis – regional and volumetric analysis in a multi-centre cohortA. M. Alam0J. P. K. Chen1G. K. Wood2B. Facer3M. Bhojak4K. Das5S. Defres6A. Marson7J. Granerod8D. Brown9R. H. Thomas10S. S. Keller11T. Solomon12B. D. Michael13Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of LiverpoolBarts Health NHS TrustDepartment of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of LiverpoolDepartment of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of LiverpoolDepartment of Neuroradiology, The Walton Centre NHS Foundation TrustDepartment of Neuroradiology, The Walton Centre NHS Foundation TrustDepartment of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of LiverpoolDepartment of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of LiverpoolIndependent Scientific Consultant, formerly of Public Health EnglandUK Heath Security AgencyTranslational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle UniversityDepartment of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of LiverpoolDepartment of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of LiverpoolDepartment of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of LiverpoolAbstract Background Seizures can occur unpredictably in patients with acute encephalitis syndrome (AES), and many suffer from poor long-term neurological sequelae. Establishing factors associated with acute seizures risk and poor outcomes could support clinical care. We aimed to conduct regional and volumetric analysis of cerebral oedema on magnetic resonance imaging (MRI) in patients with AES. We assessed the relationship of brain oedema with acute seizure activity and long-term neurological outcome. Methods In a multi-centre cohort study, adults and children presenting with an AES were recruited in the UK. The clinical and brain MRI data were retrospectively reviewed. The outcomes variables were inpatient acute seizure activity and neurological disability at six-months post-discharge. A poor outcome was defined as a Glasgow outcome score (GOS) of 1–3. We quantified regional brain oedema on MRI through stereological examination of T2-weighted images using established methodology by independent and blinded assessors. Clinical and neuroimaging variables were analysed by multivariate logistic regression to assess for correlation with acute seizure activity and outcome. Results The study cohort comprised 69 patients (mean age 31.8 years; 53.6% female), of whom 41 (59.4%) had acute seizures as inpatients. A higher Glasgow coma scale (GCS) score on admission was a negative predictor of seizures (OR 0.61 [0.46–0.83], p = 0.001). Even correcting for GCS on admission, the presence of cortical oedema was a significant risk factor for acute seizure activity (OR 5.48 [1.62–18.51], p = 0.006) and greater volume of cerebral oedema in these cortical structures increased the risk of acute seizures (OR 1.90 [1.12–3.21], p = 0.017). At six-month post-discharge, 21 (30.4%) had a poor neurological outcome. Herpes simplex virus encephalitis was associated with higher risk of poor outcomes in univariate analysis (OR 3.92 [1.08–14.20], p = 0.038). When controlling for aetiology, increased volume of cerebral oedema was an independent risk factor for adverse neurological outcome at 6 months (OR 1.73 [1.06–2.83], p = 0.027). Conclusions Both the presence and degree of cerebral oedema on MRIs of patients with AES may help identify patients at risk of acute seizure activity and subsequent long-term morbidity.https://doi.org/10.1186/s12883-022-02926-5EncephalitisAcute encephalitis syndromeSeizuresMagnetic resonance imagingNeuroimaging |
| spellingShingle | A. M. Alam J. P. K. Chen G. K. Wood B. Facer M. Bhojak K. Das S. Defres A. Marson J. Granerod D. Brown R. H. Thomas S. S. Keller T. Solomon B. D. Michael Increased volume of cerebral oedema is associated with risk of acute seizure activity and adverse neurological outcomes in encephalitis – regional and volumetric analysis in a multi-centre cohort BMC Neurology Encephalitis Acute encephalitis syndrome Seizures Magnetic resonance imaging Neuroimaging |
| title | Increased volume of cerebral oedema is associated with risk of acute seizure activity and adverse neurological outcomes in encephalitis – regional and volumetric analysis in a multi-centre cohort |
| title_full | Increased volume of cerebral oedema is associated with risk of acute seizure activity and adverse neurological outcomes in encephalitis – regional and volumetric analysis in a multi-centre cohort |
| title_fullStr | Increased volume of cerebral oedema is associated with risk of acute seizure activity and adverse neurological outcomes in encephalitis – regional and volumetric analysis in a multi-centre cohort |
| title_full_unstemmed | Increased volume of cerebral oedema is associated with risk of acute seizure activity and adverse neurological outcomes in encephalitis – regional and volumetric analysis in a multi-centre cohort |
| title_short | Increased volume of cerebral oedema is associated with risk of acute seizure activity and adverse neurological outcomes in encephalitis – regional and volumetric analysis in a multi-centre cohort |
| title_sort | increased volume of cerebral oedema is associated with risk of acute seizure activity and adverse neurological outcomes in encephalitis regional and volumetric analysis in a multi centre cohort |
| topic | Encephalitis Acute encephalitis syndrome Seizures Magnetic resonance imaging Neuroimaging |
| url | https://doi.org/10.1186/s12883-022-02926-5 |
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