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Data on post-encephalitic epilepsy (PEE) incidence and optimal management remain scarce. We prospectively investigated the frequency, characteristics, and risk factors of PEE after autoimmune encephalitis (AE) and infectious encephalitis (IE) in three Austrian tertiary care hospitals over ten years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials &amp; methods<\/jats:title>\n                    <jats:p>We included patients\u2009\u2265\u200918 years diagnosed according to internationally recognized encephalitis algorithms or verification of well-characterized antineuronal autoantibodies (AE) or pathogens (IE). Epilepsy diagnosis followed International League Against Epilepsy criteria. All available clinical data were collected from electronic patient files. A prospective follow-up was conducted via structured interviews and clinical visits. Statistical analyses included Kaplan-Meier plots, correlation analyses, and regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 149 patients, 26 (17%) had AE, 108 (73%) IE, and 15 (10%) encephalitis of unknown etiology. Prospective follow-up was achieved in 74% of cases. Median follow-up was 2304 days (IQR 1433; 3274). Acute symptomatic seizures (ASS), acute symptomatic status epilepticus and PEE are significantly more frequent in AE than in IE (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Antiseizure medication (ASM) use persisted in 85% of AE and 30% of IE patients at last follow-up, despite only 12% meeting PEE criteria. In both types of encephalitis, we see a shift from focal-to-bilateral semiology. Difficult-to-treat seizures during initial hospitalization correlated with PEE risk (rho\u2009=\u20090.317;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Our study provides insights into PEE characteristics, management, and prognosis. It highlights the prevalence of ASM overuse in the wake of encephalitis and provides a prognostic tool assessing the individual PEE risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12883-026-04680-4","type":"journal-article","created":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T13:25:50Z","timestamp":1770470750000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Characteristics of and risk factors for epilepsy after autoimmune and infectious encephalitis"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0776-6821","authenticated-orcid":false,"given":"Judith N.","family":"Wagner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Moser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Gruber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eirini","family":"Mylonaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"B\u00f6hm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Schwarzenhofer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna R.","family":"Tr\u00f6scher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Lenzenweger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingomar","family":"Krehan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"S\u00f6llradl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Leitinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raimund","family":"Helbok","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugen","family":"Trinka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim J.","family":"von Oertzen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,7]]},"reference":[{"key":"4680_CR1","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1007\/s10072-015-2333-8","volume":"36","author":"L Zhao","year":"2015","unstructured":"Zhao L, Zhou M, Wang B, et al. 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Informed patient consent for participation was sought for prospective follow-up. No experiments on humans were performed for this study, nor were human tissue samples used. The study was performed in accordance with the 2024 Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Participants\/ patients gave written informed consent for their personal and clinical details to be published.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Tim J von Oertzen has received payment or honoraria for lectures, presentations, or manuscript writing support from Angelini Pharma, Eisai, GW Pharmaceuticals, Jazz Pharma, Livanova, and UCB Pharma and has served on advisory boards for Angelini Pharma, Arvelle Therapeutics, GW Pharmaceuticals, Jazz Pharma, and Zogenix Pharma outside the submitted work. Judith Wagner has received payment or honoraria for lectures, presentations, or travel grants from Boehringer Ingelheim, Janssen-Cilag GmbH, Pfizer Pharma GmbH, Novartis Pharma GmbH, Roche Austria GmbH, and UCB Pharma AG and has served on advisory boards for Janssen-Cilag GmbH and Novartis Pharma GmbH outside the submitted work. Daniel Schwarzenhofer reports an unrestricted grant by Boehringer Ingelheim RCV GmbH & Co. Eugen Trinka reports personal fees from EVER Pharma, Marinus, Arvelle, Angelini, Argenx, Medtronic, Biocodex, Bial-Portela & C\u00aa, NewBridge, GL Pharma, GlaxoSmithKline, Boehringer Ingelheim, LivaNova, Eisai, Epilog, UCB, Biogen, Sanofi, Jazz Pharmaceuticals, and Actavis. His institution received grants from Biogen, UCB Pharma, Eisai, Red Bull, Merck, Bayer, the European Union, FWF \u00d6sterreichischer Fond zur Wissenschaftsforderung, Bundesministerium fu\u0308r Wissenschaft und Forschung, and Jubil\u00e4umsfond der \u00d6sterreichischen Nationalbank.All other authors report no conflicts of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"133"}}