Acute encephalitis with refractory, repetitive partial seizures: Pathological findings and a new therapeutic approach using tacrolimus

Yuko Sato, Yurika Numata-Uematsu, Mitsugu Uematsu, Atsuo Kikuchi, Tojo Nakayama, Yosuke Kakisaka, Tomoko Kobayashi, Naomi Hino-Fukuyo, Hiroyoshi Suzuki, Yukitoshi Takahashi, Yoshiaki Saito, Naoyuki Tanuma, Masaharu Hayashi, Masaki Iwasaki, Kazuhiro Haginoya, Shigeo Kure

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)

Abstract

Acute encephalitis with refractory, repetitive partial seizures (AERRPS) is characterized by prolonged severe seizures and a high-grade fever. We experienced a boy with severe AERRPS with frequent partial seizures that exhibited right-side predominance. The patient required the continuous intravenous administration of many antiepileptic drugs and respirator management for several months. Methylprednisolone pulse therapy and intravenous immunoglobulin administration were only temporarily effective. The MRI and EEG showed the abnormality in the left occipital lobe. Although occipital lobectomy was performed, his seizures continued. His cerebrospinal fluid exhibited elevated protein and proinflammatory cytokine levels, and was positive for anti-glutamate receptor ε2 antibodies. Pathological examination showed infiltration of many neutrophilic leukocytes, T cells, and microglia in the area exhibiting severe spongiosis. We thought that the exaggerated microglia and T-cell responses were related to the pathogenesis of the patient's seizures, and we therefore initiated treatment with tacrolimus. As a result, many of the daily seizure clusters were ameliorated, and the patient was discharged. We attempted to discontinue the tacrolimus twice, but the patient's seizure clusters recurred each time. This is the first case report of the pathological findings of AERRPS and showing an effective therapeutic approach using tacrolimus. Tacrolimus may be an effective immunosuppressant, especially for patients with severe AERRPS.

Original languageEnglish
Pages (from-to)772-776
Number of pages5
JournalBrain and Development
Volume38
Issue number8
DOIs
Publication statusPublished - 2016 Sep 1

Keywords

  • Acute encephalitis with refractory
  • Pathological findings
  • Repetitive partial seizures (AERRPS)
  • Surgery
  • Tacrolimus

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental Neuroscience
  • Clinical Neurology

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