PMC9076349_01
(a) MR image using fluid-attenuated inversion recovery (FLAIR) at 9 years 4 months. (b) Repeat FLAIR image obtained at 15 years 11 months (on day 7 after infection onset). (c) Electroencephalogram obtained during sleep at 15 years 1 month. (d) Electroencephalogram obtained during the period of impaired consciousness at 15 years 11 months. MR, magnetic resonance.
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The electroencephalogram showed spikes and waves in the left frontal region, but the activity was suppressed compared to prior to disease onset (Figure 1).
Clinical course. The patient's fever resolved immediately after hospitalization but with persistence of the state of impaired consciousness. Perampanel concentration was elevated at the time of admission (1,300 ng/ml) and ultimately increasing to a maximum of 1,790 ng/ml. Cessation of perampanel treatment improved the level of consciousness. Seizures increased with decreasing plasma concentration of perampanel. Fosphenytoin was initially introduced for seizure control, which was then switched to oral carbamazepine. The patient was discharged without apparent sequelae. VPA, valproic acid; CLB, clobazam; LCM, lacosamide; PER, perampanel; CBZ, carbamazepine.
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He was discharged on postadmission day 24 (29 days after infection onset) with no apparent sequelae (Figure 2).