The role of viral encephalitis in the development of epileptic attacks and epilepsy

Authors

  • T.A. Litovchenko Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine, Ukraine
  • A.V. Litovchenko Kharkiv State Academy of Physical Education, Kharkiv, Ukraine, Ukraine

DOI:

https://doi.org/10.22141/2224-0713.17.2.2021.229896

Keywords:

viral encephalitis, HIV-infection, epileptic seizures, risk factors, treatment, levetiracetam, review

Abstract

The role of non-epidemic viral encephalitis and HIV-infection in the development of acute epileptic seizures and epilepsy, analysis of recent epidemiological data and risk factors are discussed. Infections of the central nervous system produce up to 15 % of all types of new-onset symptomatic epileptic seizures. The risk depends on the ethology of infection, localization of lesion and severity. A high risk of development of epilepsy is seen in case of herpetic encephalitis and HIV-infection. The viral infections have been shown to be often accelerated by epileptic seizures in the acute phase of encephalitis and lead to an increased risk of developing epilepsy later. The mechanisms of development of early and late seizures are different. There are many forms of viral encephalitis, and all are associated to varying degrees with subsequent epilepsy. The risk of developing epilepsy following viral encephalitis is increased seven- to tenfold over premorbid levels. This risk increases the premorbid risk by 22 times if a patient experiences early seizures during the acute infection. Timely treatment of viral infections and early seizures reduces the risk of developing epilepsy later. The treatment of epileptic seizures due to viral infection is similar to those of symptomatic epilepsy. It is necessary to take into account possible drug-drug interactions between antiepileptic and antiviral drugs. Levetiracetam is used as an antiepileptic drug of the first choice in the treatment of epilepsy and epileptic seizures in the case of viral encephalitis.

References

Bhalla D., Godet B., Druet-Cabanac M. et al. Etiologies of epilepsy: a comprehensive review. Expert Rev. Neurother. 2011. 11. 861-876.

Fujiwara T., Shigematsu H. Etiologic factors and clinical features of symptomatic epilepsy: focus on pediatric cases. Psychiatry Clin. Neurosci. 2004. 58. S9-S12

Singh T.D., Fugate J.E., Hocker S.E., Rabinstein A.A. Postencephalitic epilepsy: Clinical characteristics and predictors. Epilepsia. 2015. 56(1). 133-138.

Sander J.W., Hart Y.M., Johnson A.I., Shorvon S.D. National general practice Study of Epilepsy: newly diagnosed epileptic seizures in general population. Lancet. 1990. Vol. 336. P. 1267-1271.

The Treatment of Epilepsy. Ed. by S.D. Shorvon, E Perukka, J. Engel. 3rd edition. Blackwell Publishing Ltd, UK, 2009. 1075 p.

Ziai W.C., Lewin J.J. Update in the diagnosis and management of central nervous system infections. Neurol. Clin. 2008. 26. 47-68.

Duncan J.S., Shorvon S.D., Fish D.R. Clinical Epilepsy. London: Churchill Livingstone, 1995. 540 p.

The Causes of Epilepsy. Ed. by Shorvon S.D., Andermann F., Guerrini R. Cambridge, UK: Cambridge Univers. press, 2011. 787 p.

Annegers J.F., Hauser W.A., Beghi E. et al. The risk of unprovoked seizures after encephalitis and meningitis. Neurology. 1988. 38. 1407-1410.

Satishandra P., Sinha S. Seizures in HIV seropositive individuals: NIMHANS experience and review. Epilepsia. 2008. Vol. 49. P. 33-41.

Mintz M. Clinical comparison of adult and pediatric neuro-AIDS. Adv. Neuroimmunol. 1994. 4. 207-21.

Kellingaus C., Engbring C., Kovac S. et al. Frequency of seizures and epilepsy in neurological HIV-infected patients. Seizure. 2008. Vol. 17. P. 23-33.

Sinha S., Satishandra P., Nalini at al. New-onset seizures among HIV infected drug naïve patients from south India. Neurology Asia. 2005. Vol. 10. P. 29-33.

Cury R.F., Wichert-Ana L., Sacamoto A.C., Fernandes R.M. Focal non-convulsive status epilepticus associated to PLEDs and intense focal hyperemia in an AIDS patient. Seizure. 2004. Vol. 13. P. 358-361.

Wong M.C., Suite N.D.A., Labar D.R. Seizures in human immunodeficiency virus infection. Arch. Neurol. 1990. Vol. 47. P. 640-642.

Udgicar V.S., Tullu M.S., Bavdecar S.B. et al. Neurological manifestations of HIV infection. Ind. Pediatr. 2003. Vol. 40. P. 230-234.

Zelano J., Westman G. Epilepsy after brain infections in adults: A register-based population-wide study. Neurology. 2020 Sep 28. doi: 10.1212/WNL.0000000000010954. Online ahead of print.

Granerod J., Crowcroft N.S. The epidemiology of acute encephalitis. Neuropsychol. Rehabil. 2007. 17. 406-28.

Singhi P. Infectious causes of seizures and epilepsy in the developing world. Developmental Medicine & Child Neurology. Mac Keith Press, 2011. P. 600-609.

Jmor F., Emsley H.C., Fosher M., Solomon T., Lewthwaite P. The incidence of acute encephalitis syndrome in Western industrial and tropical countries. Virol. J. 2008. Vol. 5 . P. 134-136.

Whitley R.J. Herpes simplex encephalitis: adolescents and adults. Antiviral Res. 2006. Vol. 71. P. 141-148.

Solomon T., Hart I.J., Beeching N.J. Viral encephalitis: a clinical guide. Pract. Neurol. 2007. Vol. 7. P. 288-305.

Yamada S., Kameyama T., Nagava S., Hashizume Y., Yoshida M. Relapsing herpes simplex encephalitis: pathological confirmation of viral reactivation. Neurol. Neurosurg. Psychiatry. Vol. 74. P. 262-264.

Kim M.A., Park K.M., Kim S.E., Oh M.C.K. Acute sympto-matic seizures in CNS infection. 2008. Vol. 15. P. 38-41.

Doja A., Bitnum A., Jones E.L. et al. Pediatric Epstein-Barr virus-associated encephalitis: 10 year review. J. Child. Neurol. 2006. Vol. 21. P. 385-391.

Hung K.L., Liao H.T., Tsai M.L. Epstein-Barr virus encephalitis in children. Acta Paediatr. Taiwan. 2000. Vol. 41. P. 140-146.

Hausler M., Schaade L., Kemeny S. et al. Encephalitis related to primery varicella-zoster virus infection in immunocompetent children. J. Neurol. Sci. 2002. Vol. 195. P. 111-116.

Perry R.T., Halsey N.A. The clinical significance of measles: a review. J. Infect. Dis. 2004. Vol. 189. P. 4-16.

Cherry J.D. Measles virus. Feigin R.D., Cherry J.D. (eds.) Textbook of Pediatric Infectious Diseases, 5th edition. Philadelphia, PA: WB Saunders, 2004. P. 2283-2299.

Hviid A., Rubin S., Mihlemann K. Mumps. Lancet. 2008. Vol. 371. P. 932-944.

Vincent A., Irani S.R., Lang B. Potentially pathogenic autoantibodies associated with epilepsy and encephalitis in children and adults. Epilepsia. 2011. 52(Suppl. 8). 8-11. doi: 10.1111/j.1528-1167.2011.03224.

Granerod J., Cunningham R., Zuckerman M. et al. Causa-lity in acute encephalitis: defining aetiologies. Epidemiol. Infect. 2010. 138. 783-800.

Chen Y.J., Fang P.C., Chow J.C. Clinical characteristics and prognostic factors of postencephalitic epilepsy in children. J. Child Neurol. 2006. 21. 1047-51.

Pillai S.C., Mohammad S.S., Hacohen Y. et al. Postencephalitic epilepsy and drug-resistant epilepsy after infectious and antibody-associated encephalitis in childhood: clinical and etiologic risk factors. Epilepsia. 2015. Epub 2015 Nov 22.

Armangue T., Moris G., Cantarın-Extremera V. et al. Autoimmune post-herpes simplex encephalitis of adults and teenagers. Neuro-logy. 2015. 85. 1736-1743.

Bradshaw M.J., Pawate S., Lennon V.A. et al. Herpes simplex virus 1 encephalitis associated with voltage-gated calcium channel autoimmunity. Neurology. 2015 Dec 15. 85(24). 2176-7.

Titulaer M.J., McCracken L., Gabilondo I. et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol. 2013. 12. 157-165.

Spatola M., Dalmau J. Seizures and risk of epilepsy in autoimmune and other inflammatory encephalitis. Curr. Opin. Neurol. 2017 June. 30(3). 345-353. doi: 10.1097/WCO.0000000000000449.

Murthy J.M.K., Prabhakar S. Bacterial meningitis and epilepsy. Epilepsia. 2008. 49 (Suppl. 6). 8-12. doi: 10.1111/j.1528-1167.2008.01750.

Gaspard N., Foreman B.P., Alvarez V. et al. New-onset refractory status epilepticus: etiology, clinical features, and outcome. Neurology. 2015. 85. 1604-1613.

Published

2021-05-19

Issue

Section

To practicing Neurologist