Epidemiology and treatment trends for acute encephalopathy under the impact of SARS-CoV-2 pandemic based on a prospective multicenter consecutive case registry.

Abstract

Background: Acute encephalopathy is a severe condition predominantly affecting children with viral infections. The purpose of this study was to elucidate the epidemiology, treatment, and management of acute encephalopathy. The study also aimed to understand how the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has affected epidemiological trends.

Methods: This retrospective study used the database of the Febrile Acute Convulsion and Encephalopathy registry, a prospective multicenter consecutive case registry for acute encephalopathy and febrile convulsive status epilepticus. Pediatric patients aged 0-18 years hospitalized and diagnosed with acute encephalopathy between January 2020 and August 2023 were included in this study.

Results: Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) was the most common syndrome (36 cases, 27.5 %). SARS-CoV-2 was the most common pathogen (19 cases, 14.5 %), followed by influenza virus type A (15 cases, 11.5 %). Targeted temperature management was performed for 25 (69.4 %) of 36 patients with AESD; 5 (50.0 %) of 10 patients with hemorrhagic shock and encephalopathy; and only 1 (5.9 %) of 17 patients with mild encephalitis or encephalopathy with a reversible splenial lesion (MERS). High-dose corticosteroids were administered to 9 (90.0 %) of 10 patients with hemorrhagic shock and encephalopathy and 11 (30.6 %) of 36 patients with AESD.

Conclusions: The primary causative pathogen of acute encephalopathy has changed to SARS-CoV-2. AESD remains the most common syndrome. Targeted temperature management is more, whereas high-dose corticosteroid therapy is less, frequently used. No specific treatment for mild encephalitis or encephalopathy with a reversible splenial lesion has been established.