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

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.