Neuropediatrics 2005; 36 - P47
DOI: 10.1055/s-2005-868032

Difficult to treat temporal lobe seizures during human parvovirus B19 encephalitis in a 3 5/12-year-old immunocompetent girl – a case report

E Reiter 1, M Freilinger 1, H Boigner 2, M Feucht 1, R Seidl 1
  • 1Univ. Klinik für Kinder- u. Jugendheilkunde Wien, Department für Allgemeine Pädiatrie, Wien, Österreich
  • 2Univ. Klinik für Kinder- u. Jugendheilkunde Wien, Department für Neonatologie u. Intensivmedizin, Wien, Österreich

Human parvovirus B19 (HPV B19) encephalitis is a rare complication associated with erythema infectiosum in children (Balfour, 1970). We report a 3 5/12-year-old girl who developed difficult-to-treat temporal lobe seizures during HPV B19 encephalitis.

Few weeks after erythema infectiosum the following clinical signs appeared: personality change, fever, unresponsiveness, status epilepticus. HPV B19 positive samples of CSF (PCR: 61 C/ml) and serum (ELISA IgG positive,-IgM negative,-PCR 169 C/ml) were found, without any immune defect. Our patient carried none of the HLA alleles found by Kerr et al. (2002) in association with HPV B19 meningoencephalitis. Status epilepticus could be stopped finally with midazolam and valproic acid i.v. and our patient presented with the following neurological signs: tremor, ataxia, fine motor problems and autistoid features. Treatment with i.v. immune globulin was done two times, because it is at present the only specific treatment for HPV B19 infection (Barah,2001). It was given a third time due to higher serological titer of HPV B19-PCR (1570 C/ml) 4 weeks later.

Complex focal seizures appeared -during reduction of midazolam- presenting clinical (ictual vomiting, starring, oral automatism) and electroencephalographically (diffuse slowing, interictual bilateral right > left-sided temporal spikes; ictual 2 right-sided temporal lobe seizures with clinical correlation) as temporal lobe seizures, partly with secondary generalisation, with a high seizure frequency. MRI showed minimal cerebral atrophy without focal enhancement concerning hippocampus or amygdala. Add-on therapy with oxcarbazepin, initially with clobazam orally, was started. Valproic acid was given orally.

Temporal lobe seizures during HPV B19 encephalitis in children are not mentioned in the literature, till now. The development of partial epilepsy (frontal lobe seizures) associated with acute HPV B19 infection was described in a 5-year-old girl (Hsu, 2004). The treatability of the epilepsy will influence the outcome of our patient essentially.