Age-stratified clinical characteristics and long-term neurological outcomes of pediatric herpes simplex virus encephalitis: a longitudinal cohort study of 56 children.
Most children with herpes simplex encephalitis had poor long-term neurological outcomes.
Age-stratified clinical characteristics and long-term neurological outcomes of pediatric herpes simplex virus encephalitis: a longitudinal cohort study of 56 children.
Age-specific clinical characteristics and prognostic predictors of pediatric herpes simplex virus encephalitis (HSE) remain incompletely characterized.
This study aimed to characterize age-dependent manifestations and identify factors independently associated with poor long-term outcomes.
Were stratified into three age groups: infant/toddler group (0-3 years), preschool group (3-6 years), and school-age and older group (6-18 years).
73.2% of children had poor neurological outcomes on modified Rankin Scale at follow-up.
The median age of onset was 2.09 years, and 60.7% of patients were aged under 3 years.
Unilateral facial and/or perioral twitching occurred in 33.9% of patients, all of whom under 5 years of age, with the highest incidence in the preschool group (70.0%, p = 0.001).
The incidence of post-encephalitic epilepsy (PE) was 53.6%, of which 63.3% were drug-refractory.
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis developed in 17.9% of patients, and its incidence increased significantly with age ( p = 0.002).
Pediatric HSE exhibits notable age-associated heterogeneity.
A low acute Glasgow Coma Scale score and prolonged seizure duration were identified as independent associated factors for poor prognosis in this exploratory analysis, whereas early facial/perioral twitching was associated with subsequent language sequelae.
The risk of anti-NMDAR encephalitis increases with age, necessitating long-term surveillance. These age-stratified findings are descriptive and hypothesis-generating and require confirmation in larger prospective cohorts.