Paradigm Shift in the Etiology of Encephalopathy in Children from Infectious to Non-infectious Causes – A Single-Center Experience

Objectives Among children admitted with acute non-traumatic encephalopathies, non-infectious etiologies are emerging as important causes. The objective of this study was to analyze the clinical features, etiologies, and outcome of children presenting with acute non traumatic encephalopathies. Material and Methods This was a hospital-based descriptive study. Children aged 1 month to 18 years admitted during the period from 2019 to 2023 with altered sensorium for >12 hours were included in the study. Data on clinical, laboratory findings, management, diagnosis, outcomes at discharge, and follow-up were retrieved from the case records of children selected based on preset criteria. Children with a history of trauma and seizure disorder/epileptic encephalopathy were excluded from the study. Data was analyzed and projected as descriptive statistics and comparison of groups done with tests of significance, as applicable. Results Seventy children were included in the study. Immune etiologies contributed to 20 (28.58%) cases and central nervous system infections for 16 (22.86%) cases. Seventy (100%) children had altered sensorium, 51 (72.8%) children had fever and 46 children (65.7%) children had seizures. Two (2.8%) children expired (one in each of tuberculous meningitis and autoimmune encephalitis). Among those who survived, 2 (2.9%) children had moderately severe disability, 8 (11.7%) had slight disability and 7 (10.2%) were symptomatic but without significant disability at discharge. On follow-up, the majority of patients had a Gross Motor Function Classification/Manual Ability Classification System score of 1 and a favorable epilepsy score on the Early Childhood Epilepsy Severity Scale. The average social quotient was found to be 95.60. Conclusion Autoimmune encephalitis and acute disseminated encephalomyelitis are emerging as important causes of acute non-traumatic encephalopathies. Awareness among health care providers will help in early diagnosis, management, and better outcomes in such children.