Summary
Although the prognosis of PRES is relatively favorable, neurological sequelae may develop in few cases. Some patients may develop epilepsy in the remote stage even if they show no neurological sequelae. It is necessary for children who develop PRES to receive long-term observation, regardless of their neurological symptoms.
Original Article
Development of epilepsy after recovery from posterior reversible encephalopathy syndrome in children with renal disease
Medicine: Case Reports and Study Protocols
Takahashi, Masaki MD; Kamei, Koichi MD, PhD; Hayakawa, Itaru MD; Abe, Yuichi MD, Phc; Sato, Mai MD, PhD; Ogura, Masao MD; Ishikura, Kenji MD, PhD; Ito, Shuichi MD, PhD
Abstract
Rationale:
Posterior reversible encephalopathy syndrome (PRES) generally shows complete recovery of clinical and imaging findings within several weeks, although a few cases show neurological sequelae, such as developmental delay and epilepsy after recovery from PRES.
Patient concerns:
We report 4 pediatric patients with renal diseases (nephrotic syndrome in 3 and renovascular hypertension in 1) who developed epilepsy after recovery from PRES. None of the patients had epilepsy before PRES. Case 1 developed focal-onset bilateral tonic-clonic seizures at 32 months after PRES. Case 2 developed focal impaired-awareness seizures with nausea and deviation of the eyes to the left at 62 months after PRES. Case 3 developed focal impaired-awareness seizures with vomiting at 85 months after PRES. Case 4 developed focal impaired-awareness seizures at 2 months after PRES. Three patients developed epilepsy more than 2 years later in the remote stage.
Diagnosis:
All cases developed recurrent seizures and electroencephalograms of 3 cases except case 3 were abnormal.
Intervention:
Three patients required anticonvulsants and 1 did not require any medication.
Outcomes:
Case 1 was treated with multiple anticonvulsants and became seizure free 2 years later. He was free from anticonvulsants finally at the age of 11 years and developed intellectual disability with severe behavioral problems. Case 2 was seizure free with levetiracetam treatment for more than 2 years. Case 3 maintained seizure freedom with carbamazepine treatment for more than a year. Case 4 had no seizures for more than 2 years without taking any medication. There was no complication in the follow-up period in these 3 cases.
Lessons:
Although the prognosis of PRES is relatively favorable, neurological sequelae may develop in few cases. Some patients may develop epilepsy in the remote stage even if they show no neurological sequelae. It is necessary for children who develop PRES to receive long-term observation, regardless of their neurological symptoms.
Acknowledgments
We thank the patients and their families for their willingness to provide us with the clinical data for publication.
