International consensus definitions for infection‐triggered encephalopathy syndromes
Hiroshi Sakuma, Terrence Thomas, Carly Debinski, Michael Eyre, Velda X. Han, Hannah Jones, Go Kawano, Vanessa Wan Mun Lee, Stephen Malone, Toyojiro Matsuishi, Shekeeb S. Mohammad, Takayuki Mōri, Hiroya Nishida, Margherita Nosadini, Jun‐ichi Takanashi, Masashi Mizuguchi, Ming Lim, Russell C. Dale
Abstract
AIM: To develop standardized diagnostic criteria for 'infection-triggered encephalopathy syndrome (ITES)' and five specific clinical syndromes of ITES. METHOD: The draft definitions were based on existing criteria, standardized, and discussed by a panel of international experts using nominal group technique over 18 months to achieve consensus. All criteria use the same format: (1) presence of infection/fever; (2) clinical features including encephalopathy; (3) neuroradiological features on magnetic resonance imaging; (4) exclusion of other causes. RESULTS: We first highlighted differences between ITES and infectious and autoimmune encephalitis, which is the most important differential diagnosis. Consensus was achieved to define five specific ITESs: acute encephalopathy with biphasic seizures and late reduced diffusion; acute necrotizing encephalopathy; mild encephalopathy with a reversible splenial lesion; acute fulminant cerebral oedema; and acute shock with encephalopathy and multiorgan failure. Two further conditions that are currently classified as epilepsy syndromes but have similar features to ITES, namely febrile infection-related epilepsy syndrome and hemiconvulsion-hemiplegia-epilepsy syndrome, are also discussed. INTERPRETATION: The consensus definition is expected to improve awareness of this disease concept, provide diagnostic framework, and facilitate future international research and clinical trials.