New-Onset Status Epilepticus in an 11-year-old Patient with Thyroid Autoimmune Dysfunction: A Case Report of Pediatric Hashimoto Encephalopathy

Abstract

Hashimoto encephalopathy (HE) is a neuropsychiatric syndrome associated with positive thyroid antibodies (Ab). Its pathophysiology is still in debate and pediatric cases are considered rare. We present a case of an 11-year-old girl with new-onset refractory status epilepticus (NORSE) who presented a good initial response to corticosteroids but then required a second line of treatment with mycophenolate. In children presenting with NORSE of suspected autoimmune origin and no identification of autoimmune encephalitis traditional Ab, HE must be considered.

Keywords

Hashimoto encephalopathy - thyroid dysfunction - status epilepticus

Publikationsverlauf

Eingereicht: 24. April 2024

Angenommen: 14. Juni 2024

Artikel online veröffentlicht:
08. Juli 2024

• References

• 1 Boelen R, de Vries T. Clinical characteristics of paediatric Hashimoto's encephalopathy. Eur J Paediatr Neurol 2021; 32: 122-127
• 2 Farrell RM, Foster MB, Omoruyi AO, Kingery SE, Wintergerst KA. Hashimoto's encephalopathy: a rare pediatric brain disease. J Pediatr Endocrinol Metab 2015; 28 (5-6): 721-724
• 3 Brain L, Jellinek EH, Ball K. Hashimoto's disease and encephalopathy. Lancet 1966; 2 (7462) 512-514
• 4 Caselli RJ, Boeve BF, Scheithauer BW, O'Duffy JD, Hunder GG. Nonvasculitic autoimmune inflammatory meningoencephalitis (NAIM): a reversible form of encephalopathy. Neurology 1999; 53 (07) 1579-1581
• 5 Castillo P, Woodruff B, Caselli R. et al. Steroid-responsive encephalopathy associated with autoimmune thyroiditis. Arch Neurol 2006; 63 (02) 197-202
• 6 Graham BR, Shiff N, Nour M, Hasal S, Huntsman R, Almubarak S. Hashimoto encephalopathy presenting with stroke-like episodes in an adolescent female: a case report and literature review. Pediatr Neurol 2016; 59: 62-70
• 7 Gul Mert G, Horoz OO, Herguner MO. et al. Hashimoto's encephalopathy: four cases and review of literature. Int J Neurosci 2014; 124 (04) 302-306
• 8 Lee J, Yu HJ, Lee J. Hashimoto encephalopathy in pediatric patients: homogeneity in clinical presentation and heterogeneity in antibody titers. Brain Dev 2018; 40 (01) 42-48
• 9 Yu HJ, Lee J, Seo DW, Lee M. Clinical manifestations and treatment response of steroid in pediatric Hashimoto encephalopathy. J Child Neurol 2014; 29 (07) 938-942
• 10 Hilberath JM, Schmidt H, Wolf GK. Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT): case report of reversible coma and status epilepticus in an adolescent patient and review of the literature. Eur J Pediatr 2014; 173 (10) 1263-1273
• 11 Mamoudjy N, Korff C, Maurey H. et al. Hashimoto's encephalopathy: identification and long-term outcome in children. Eur J Paediatr Neurol 2013; 17 (03) 280-287
• 12 Olmez I, Moses H, Sriram S, Kirshner H, Lagrange AH, Pawate S. Diagnostic and therapeutic aspects of Hashimoto's encephalopathy. J Neurol Sci 2013; 331 (1-2): 67-71
• 13 Graus F, Titulaer MJ, Balu R. et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol 2016; 15 (04) 391-404
• 14 Adams AV, Mooneyham GC, Van Mater H, Gallentine W. Evaluation of diagnostic criteria for Hashimoto encephalopathy among children and adolescents. Pediatr Neurol 2020; 107: 41-47
• 15 Hirsch LJ, Gaspard N, van Baalen A. et al. Proposed consensus definitions for new-onset refractory status epilepticus (NORSE), febrile infection-related epilepsy syndrome (FIRES), and related conditions. Epilepsia 2018; 59 (04) 739-744
• 16 Harapan BN, Yoo HJ. Neurological symptoms, manifestations, and complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19). J Neurol 2021; 268 (09) 3059-3071
• 17 Fink EL, Robertson CL, Wainwright MS. et al; Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID) Investigators. Prevalence and risk factors of neurologic manifestations in hospitalized children diagnosed with acute SARS-CoV-2 or MIS-C. Pediatr Neurol 2022; 128: 33-44
• 18 Yang Y, Yu T, Yang J. et al. Clinical manifestations and EEG findings in children infected with COVID-19 and exhibiting neurological symptoms. BMC Pediatr 2024; 24 (01) 49
• 19 Brancatella A, Viola N, Santini F, Latrofa F. COVID-induced thyroid autoimmunity. Best Pract Res Clin Endocrinol Metab 2023; 37 (02) 101742