Two children, ages 6 and 7 years, with progressive hemiparesis and radiological and histopathological confirmation of Rasmussen encephalitis (RE) had no seizures or epileptic EEG activity until 6 to 7 months after onset of symptoms, in a report from Bikur Cholim Hospital, Jerusalem, Israel. The onset of epilepsy with RE may be dissociated from the early inflammatory stage of the disease. [1]
COMMENT. Seizures as a presenting symptom are not a sine qua non for a diagnosis of Rasmussen encephalitis, but partial seizures, often epilepsia partialis continua, following a nonspecific febrile illness are the usual early manifestations of the syndrome. Seizures are usually accompanied by a progressive hemiparesis, hemianopia, and aphasia and MRI evidence of a contralateral hemicerebral atrophy. RE is thought to be an immune mediated disorder, and immunological abnormalities include elevated antinuclear antibodies, especially autoantibodies to the glutamate receptor subunit 3 (GluR3), CSF oligoclonal bands, elevated immunoglobulins, and cytotoxic T cells in brain tissue specimens.
Bed rest following lumbar puncture was studied at the Pediatric Hospital, University of Heidelberg, Germany, in 111 patients aged 2 to 17 years. Significantly more head or backaches were encountered in the group kept at 24-hour strict bed rest than in patients allowed free mobility (headaches 39 vs 21%; backaches 42 vs 23%, respectively). Prophylactic bed rest following lumbar puncture in children and adolescents is of no benefit and may increase the risk of headache or backache. [2]