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      Epilepsy surgery for epileptic encephalopathy as a sequela of herpes simplex encephalitis: case report

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          Abstract

          Herpes simplex virus (HSV) encephalitis can manifest with different clinical presentations, including acute monophasic illness and biphasic chronic granulomatous HSV encephalitis. Chronic encephalitis is much less common, and very rare late relapses are associated with intractable epilepsy and progressive neurological deficits with or without evidence of HSV in the cerebrospinal fluid. The authors report on an 8-year-old girl with a history of treated HSV-1 encephalitis when she was 13 months of age and focal epilepsy when she was 2 years old. Although free of clinical seizures, when she was 5, she experienced behavioral and academic dysfunction, which was later attributed to electrographic focal seizures and worsening electroencephalography (EEG) findings with electrical status epilepticus during slow-wave sleep (ESES). Following a right temporal lobectomy, chronic granulomatous encephalitis was diagnosed. The patient's clinical course improved with the resolution of seizures and EEG abnormalities.

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          Epilepsy and brain inflammation.

          Annamaria Vezzani, Eleonora Aronica, Andrey Mazarati … (2013)
          During the last decade, experimental research has demonstrated a prominent role of glial cells, activated in brain by various injuries, in the mechanisms of seizure precipitation and recurrence. In particular, alterations in the phenotype and function of activated astrocytes and microglial cells have been described in experimental and human epileptic tissue, including modifications in potassium and water channels, alterations of glutamine/glutamate cycle, changes in glutamate receptor expression and transporters, release of neuromodulatory molecules (e.g. gliotransmitters, neurotrophic factors), and induction of molecules involved in inflammatory processes (e.g. cytokines, chemokines, prostaglandins, complement factors, cell adhesion molecules) (Seifert et al., 2006; Vezzani et al., 2011; Wetherington et al., 2008). In particular, brain injury or proconvulsant events can activate microglia and astrocytes to release a number of proinflammatory mediators, thus initiating a cascade of inflammatory processes in brain tissue. Proinflammatory molecules can alter neuronal excitability and affect the physiological functions of glia by paracrine or autocrine actions, thus perturbing the glioneuronal communications. In experimental models, these changes contribute to decreasing the threshold to seizures and may compromise neuronal survival (Riazi et al., 2010; Vezzani et al., 2008). In this context, understanding which are the soluble mediators and the molecular mechanisms crucially involved in glio-neuronal interactions is instrumental to shed light on how brain inflammation may contribute to neuronal hyperexcitability in epilepsy. This review will report the clinical observations in drug-resistant human epilepsies and the experimental findings in adult and immature rodents linking brain inflammation to the epileptic process in a causal and reciprocal manner. By confronting the clinical evidence with the experimental findings, we will discuss the role of specific soluble inflammatory mediators in the etiopathogenesis of seizures, reporting evidence for both their acute and long term effects on seizure threshold. The possible contribution of these mediators to co-morbidities often described in epilepsy patients will be also discussed. Finally, we will report on the anti-inflammatory treatments with anticonvulsant actions in experimental models highlighting possible therapeutic options for treating drug-resistant seizures and for prevention of epileptogenesis. Copyright © 2011 Elsevier Inc. All rights reserved.
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            Human Toll‐like receptor‐dependent induction of interferons in protective immunity to viruses

            Shen-Ying Zhang, Emmanuelle Jouanguy, Vanessa Sancho-Shimizu … (2007)
            Summary: Five of the 10 human Toll‐like receptors (TLRs) (TLR3, TLR4, TLR7, TLR8, and TLR9), and four of the 12 mouse TLRs (TLR3, TLR4, TLR7, TLR9) can trigger interferon (IFN)‐α, IFN‐β, and IFN‐λ, which are critical for antiviral immunity. Moreover, TLR3, TLR7, TLR8, and TLR9 differ from TLR4 in two particularly important ways for antiviral immunity: they can be activated by nucleic acid agonists mimicking compounds produced during the viral cycle, and they are typically present within the cell, along the endocytic pathway, where they sense viral products in the intraluminal space. Investigations in mice have demonstrated that the TLR7/9–IFN and TLR3–IFN pathways are different and critical for protective immunity to various experimental viral infections. Investigations in humans with interleukin‐1 receptor‐associated kinase‐4 (IRAK‐4) deficiency (unresponsive to TLR7, TLR8, and TLR9), UNC‐93B deficiency (unresponsive to TLR3, TLR7, TLR8, and TLR9), and TLR3 deficiency have recently shed light on the role of these two pathways in antiviral immunity in natural conditions. UNC‐93B‐ and TLR3‐deficient patients appear to be specifically prone to herpes simplex virus 1 (HSV‐1) encephalitis, although clinical penetrance is incomplete, whereas IRAK‐4‐deficient patients appear to be normally resistant to most viruses, including HSV‐1. These experiments of nature suggest that the TLR7‐, TLR8‐, and TLR9‐dependent induction of IFN‐α, IFN‐β, and IFN‐λ is largely redundant in human antiviral immunity, whereas the TLR3‐dependent induction of IFN‐α, IFN‐β, and IFN‐λ is critical for primary immunity to HSV‐1 in the central nervous system in children but redundant for immunity to most other viral infections.
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              Treatment of electrical status epilepticus in sleep: A pooled analysis of 575 cases.

              Bart van den Munckhof, Violet van Dee, Liora Sagi … (2015)
              Epileptic encephalopathy with electrical status epilepticus in sleep (ESES) is a pediatric epilepsy syndrome with sleep-induced epileptic discharges and acquired impairment of cognition or behavior. Treatment of ESES is assumed to improve cognitive outcome. The aim of this study is to create an overview of the current evidence for different treatment regimens in children with ESES syndrome.
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                Author and article information

                Journal
                Title: Journal of Neurosurgery: Pediatrics
                Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
                ISSN (Print): 1933-0707
                ISSN (Electronic): 1933-0715
                Publication date Created: July 2017
                Publication date (Print): July 2017
                Volume: 20
                Issue: 1
                Pages: 56-63
                Affiliations
                [1 ]1Department of Pediatric Neurology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey; and
                [2 ]2Department of Pathology and Cell Biology, Division of Neuropathology;
                [3 ]3Department of Neurosurgery;
                [4 ]4Department of Psychiatry, Division of Child Psychiatry; and
                [5 ]5Department of Neurology, Division of Child Neurology, Columbia University Medical Center, New York
                Article
                DOI: 10.3171/2017.3.PEDS16632
                SO-VID: 0703ccbc-948a-416b-89b6-33e1161b1a92
                Copyright © © 2017
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