Seven-Year Longitudinal Respiratory Morbidity in Ohtahara Syndrome: A Case Emphasizing Integrated Airway and Seizure Care in a Resource-Limited Setting

Seven-Year Longitudinal Respiratory Morbidity in Ohtahara Syndrome: A Case Emphasizing Integrated Airway and Seizure Care in a Resource-Limited Setting | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Seven-Year Longitudinal Respiratory Morbidity in Ohtahara Syndrome: A Case Emphasizing Integrated Airway and Seizure Care in a Resource-Limited Setting Fadi Abualhommos, Moath Hattab, Masara Samara, Mahmoud Suleiman, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8508222/v2 This work is licensed under a CC BY 4.0 License Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Abstract Introduction: Ohtahara syndrome (OS) features neonatal-onset tonic spasms with suppression–burst EEG, high early mortality, and evolution to other epileptic encephalopathies. Respiratory complications are frequent yet under-described longitudinally. Case: We followed a female with neonatal-onset OS and suppression–burst EEG to age seven. Despite combination antiseizure therapy (phenobarbital, levetiracetam, vigabatrin, clonazepam), she had breakthrough events and severe developmental impairment. From ages 1–7 years, she experienced ≥15 documented hospitalizations for recurrent pneumonia/bronchopneumonia, frequently with hypoxemia requiring supplemental oxygen; several episodes were accompanied by seizure exacerbations and clinical aspiration/choking events. Management and outcomes: Admissions were managed with supportive respiratory care (oxygen, bronchodilators, corticosteroids when indicated) and broad-spectrum antimicrobials alongside ongoing seizure management, enabling survival to school age in a resource-limited context. Conclusions: In OS, respiratory disease, often driven by aspiration risk and impaired airway clearance, can become a dominant source of morbidity and should be addressed with the same priority as antiseizure therapy. We highlight practical pillars for long-term care: proactive infection prevention and early treatment pathways; aspiration-risk assessment with feeding/swallow support when feasible; airway-clearance planning with bronchodilator trials during illnesses; judicious corticosteroid use; and caregiver education with explicit thresholds for escalation. Ohtahara syndrome Developmental and epileptic encephalopathy Recurrent pneumonia Case report Full Text Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8508222","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":600239652,"identity":"fbb40adc-4bb9-4cc5-85c5-ef6788ca0843","order_by":0,"name":"Fadi Abualhommos","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Fadi","middleName":"","lastName":"Abualhommos","suffix":""},{"id":600239653,"identity":"155f949c-0eb7-4933-8789-ec27862489b1","order_by":1,"name":"Moath Hattab","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIie3PMUvDQBTA8XccvC7P7pIhXyGHECkY8lUsHVxSqJNLh8BBshydKw5+BafOlQfJkg8QyCIU7JogiFtNNkG56OZw/+kN9+O9A3C5/mHBHkDCFQ8zQrtmwMkIme1BaCAGQkCxLY6AcoTEX4k8S0/DUnthqY+HFbEf+/r1EKWNP5Ug2i6xkKpQeksnZRAvL5ZpozIJ8vx+ZyH1tdJELAxC6C03jehJf6GFBPVNN5DY4OTdm2Uc/4Ik/RbDc4MUeiLj+TipqtsHqnlhiuROmYIXmRTa+pegzJ/eaMVRrsvdy8eao8dcP7edhfyUSP/23uVyuVzf+gR1PFVTOtPFUAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0009-0005-2835-0429","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Moath","middleName":"","lastName":"Hattab","suffix":""},{"id":600239654,"identity":"b3ade559-b391-4b49-a6ed-71ec8222e112","order_by":2,"name":"Masara Samara","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Masara","middleName":"","lastName":"Samara","suffix":""},{"id":600239655,"identity":"afd359f4-4c46-4d84-8a39-5abe0cf3a9b6","order_by":3,"name":"Mahmoud Suleiman","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Mahmoud","middleName":"","lastName":"Suleiman","suffix":""},{"id":600239656,"identity":"7fe630c8-6969-4f8b-bb65-e774bdd792b0","order_by":4,"name":"Enas Samara","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Enas","middleName":"","lastName":"Samara","suffix":""},{"id":600239657,"identity":"bc29fc9c-fb40-4b32-9d1b-9953b612b21a","order_by":5,"name":"Abdallah Abukhater","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Abdallah","middleName":"","lastName":"Abukhater","suffix":""},{"id":600239658,"identity":"23e8f215-cb29-440b-aebc-aedcc383907e","order_by":6,"name":"Isra Salman","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Isra","middleName":"","lastName":"Salman","suffix":""}],"badges":[],"createdAt":"2026-01-03 16:53:14","currentVersionCode":2,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-8508222/v2","doiUrl":"https://doi.org/10.21203/rs.3.rs-8508222/v2","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106961909,"identity":"0cf43028-7dfe-4c18-95cc-7ac97232010a","added_by":"auto","created_at":"2026-04-15 09:27:41","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":312766,"visible":true,"origin":"","legend":"","description":"","filename":"OhtaharasyndromesubV03N.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8508222/v2_covered_4882983a-8f6b-4616-a6b9-a34dab3fe582.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"Seven-Year Longitudinal Respiratory Morbidity in Ohtahara Syndrome: A Case Emphasizing Integrated Airway and Seizure Care in a Resource-Limited Setting","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Ohtahara syndrome, Developmental and epileptic encephalopathy, Recurrent pneumonia, Case report","lastPublishedDoi":"10.21203/rs.3.rs-8508222/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8508222/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction: Ohtahara syndrome (OS) features neonatal-onset tonic spasms with suppression–burst EEG, high early mortality, and evolution to other epileptic encephalopathies. Respiratory complications are frequent yet under-described longitudinally.\u003c/p\u003e\n\u003cp\u003eCase: We followed a female with neonatal-onset OS and suppression–burst EEG to age seven. Despite combination antiseizure therapy (phenobarbital, levetiracetam, vigabatrin, clonazepam), she had breakthrough events and severe developmental impairment. From ages 1–7 years, she experienced ≥15 documented hospitalizations for recurrent pneumonia/bronchopneumonia, frequently with hypoxemia requiring supplemental oxygen; several episodes were accompanied by seizure exacerbations and clinical aspiration/choking events.\u003c/p\u003e\n\u003cp\u003eManagement and outcomes: Admissions were managed with supportive respiratory care (oxygen, bronchodilators, corticosteroids when indicated) and broad-spectrum antimicrobials alongside ongoing seizure management, enabling survival to school age in a resource-limited context.\u003c/p\u003e\n\u003cp\u003eConclusions: In OS, respiratory disease, often driven by aspiration risk and impaired airway clearance, can become a dominant source of morbidity and should be addressed with the same priority as antiseizure therapy. We highlight practical pillars for long-term care: proactive infection prevention and early treatment pathways; aspiration-risk assessment with feeding/swallow support when feasible; airway-clearance planning with bronchodilator trials during illnesses; judicious corticosteroid use; and caregiver education with explicit thresholds for escalation.\u003c/p\u003e","manuscriptTitle":"Seven-Year Longitudinal Respiratory Morbidity in Ohtahara Syndrome: A Case Emphasizing Integrated Airway and Seizure Care in a Resource-Limited Setting","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2026-04-14 17:40:33","doi":"10.21203/rs.3.rs-8508222/v2","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2026-01-09 07:10:46","doi":"10.21203/rs.3.rs-8508222/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fecb3a19-7c08-400d-a7ec-4e808f6f1770","owner":[],"postedDate":"April 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-23T11:24:13+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-14 17:40:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v2","identity":"rs-8508222","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8508222","identity":"rs-8508222","version":["v2"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}