Korean J Pediatr.  2019 Apr;62(4):131-137. 10.3345/kjp.2018.07066.

Respiratory syncytial virus-associated seizures in Korean children, 2011–2016

• Cha T
• Choi YJ
• Oh JW
• Kim CR
• Park DW
• Seol IJ
• Moon JH

• KMID: 2451950
• DOI: http://doi.org/10.3345/kjp.2018.07066

Abstract

PURPOSE
Respiratory syncytial virus (RSV) infection can cause various neurological complications. This study aimed to investigate the RSV-associated neurologic manifestations that present with seizures.
METHODS
We retrospectively reviewed the medical records of patients aged less than 15 years with laboratory-confirmed RSV infections and seizures between January 2011 and December 2016 in a regional hospital in South Korea.
RESULTS
During this period, 1,193 patients with laboratory-confirmed RSV infection were identified. Of these, 35 (35 of 1,193, 2.93%; boys, 19; girls, 16; mean age: 20.8±16.6 months) presented with seizure. Febrile seizure was the most common diagnosis (27 of 35, 77.1%); simple febrile seizures in 13 patients (13 of 27, 48.1%) and complex febrile seizures in 14 (14 of 27, 51.9%). Afebrile seizures without meningitis or encephalopathy were observed in 5 patients (5 of 35, 14.3%), seizures with meningitis in 2 (2 of 35, 5.7%), and seizure with encephalopathy in 1 (1 of 35, 2.9%) patient. Lower respiratory symptoms were not observed in 8 patients. In a patient with encephalopathy, brain diffusion-weighted magnetic resonance imaging revealed transient changes in white matter, suggesting cytotoxic edema as the mechanism underlying encephalopathy. Most patients recovered with general management, and progression to epilepsy was noted in only 1 patient.
CONCLUSION
Although febrile seizures are the most common type of seizure associated with RSV infection, the proportion of patients with complex febrile seizures was higher than that of those with general febrile seizures. Transient cytotoxic edema may be a pathogenic mechanism in RSV-related encephalopathy with seizures.

Keyword

Respiratory syncytial virus; Child; Seizure; Magnetic resonance imaging

MeSH Terms

Brain
Brain Diseases
Child*
Diagnosis
Edema
Epilepsy
Female
Humans
Korea
Magnetic Resonance Imaging
Medical Records
Meningitis
Neurologic Manifestations
Respiratory Syncytial Viruses
Retrospective Studies
Seizures*
Seizures, Febrile
White Matter