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

Background: 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, phenytoin, 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.