Nonconvulsive Status Epilepticus Complicating Epstein-Barr Virus Encephalitis in a Child

Children with acute encephalopathy show prolonged electrographic seizure activity consistent with nonconvulsive status epilepticus (NCSE). Pediatric NCSE is a heterogeneous clinical entity with poor outcome and different etiologies, including central nervous system infection, stroke, toxic-metabolic syndrome, and epileptic syndrome. We report a 4-year-old girl with seizure and behavioral changes in whom the analysis of cerebrospinal fluid by polymerase chain reaction was positive for Epstein-Barr virus. We emphasize the importance of electroencephalography (EEG), and particularly, of continuous EEG monitoring for early recognition and appropriate treatment of this condition. 1. Introduction Epstein-Barr virus (EBV) is associated in childhood with many neurological manifestations, including encephalitis, meningitis, myelitis, cerebellitis, cranial nerves palsy, acute disseminated encephalomyelitis, and acute inflammatory polyneuropathy (Guillain-Barré syndrome; GBS) [1]. We report a 4-year-old girl with seizures and confusional state, followed by an electroencephalography (EEG) pattern consistent with nonconvulsive status epilepticus (NCSE), where EBV was detected by polymerase chain reaction performed on cerebrospinal fluid. 2. Case Presentation The patient was the third female child born to nonconsanguineous parents. The family history was unremarkable. She was born at 38 weeks gestation by normal delivery after uncomplicated pregnancy. Birth weight was 3.2？kg, length 49？cm, and head circumference 34？cm. The perinatal period was uneventful and psychomotor development was normal. At the age of 3 years and 11 months, the patient developed fever and sore throat lasting for 3 days. A diagnosis of bacterial tonsillitis was made and treatment with oral cephalosporin was started. After 1 month, in good health, she exhibited a motor partial complex seizure involving arm and left leg lasting for less than 5 minutes and followed by an acute confusional state that lasted for 3 hours. At admission to the Clinical Pediatric Division of the University of Catania, her weight was 14？kg (10th percentile), height 96？cm (10th percentile), and head circumference 50？cm (50th percentile). On clinical examination she was not febrile and a mild cervical lymphadenopathy was evident. Cardiovascular and respiratory physical exam including blood pressure were normal and the liver and spleen were within normal limits. Irritability and significant behavioral changes, in particular, in arousal and memory were observed. Mild hyposthenia of the upper limbs was evident; there were no