Vaccination in Pediatric Movement Disorders, Immune-mediated/ Inflammatory Central Nervous System Disorders, and Developmental and Epileptic Encephalopathies: Current Evidence-Based Recommendations
DOI:
https://doi.org/10.31305/rrijm.2025.v10.n11.009Keywords:
Movement Disorders, Cerebral Palsy, progressive neurological disease, Anti-NMDA receptor encephalitis, Narcolepsy, Rasmussen encephalitis, Febrile Infection-Related Epilepsy Syndrome, Dravet Syndrome, Vaccine-Proximate Febrile Seizures, Children, Vaccination, RecommendationsAbstract
Certain vaccines themselves, or vaccine-proximate fevers have been reported to, or postulated to trigger or exacerbate Pediatric Movement Disorders (MDs) [including Acute Cerebellar Ataxia (ACA) and Opsoclonus-Myoclonus-Ataxia syndrome (OMA)]; Immune-mediated/inflammatory Central Nervous System (IICNS) disorders [including Narcolepsy, Anti-NMDA receptor encephalitis, Rasmussen encephalitis (RE) and Febrile Infection-Related Epilepsy Syndrome (FIRES)]; and Developmental and Epileptic Encephalopathies (DEE) including Dravet Syndrome (DS). The fear of triggering or exacerbating these conditions is an important reason for vaccine hesitancy, even with routine age-appropriate vaccines. This narrative review collates relevant level and grade evidence up to September 2025 pertaining to safety of various vaccines, and summarizes current recommendations for vaccination. Per current recommendations, in children with MDs, particularly in Cerebral Palsy, all vaccines are recommended, with no contraindication. Influenza and Pneumococcal vaccines are specifically recommended owing to vulnerability to respiratory infections; as also MMR, COVID-19 and Varicella vaccines. For ACA and OMS, epidemiologic evidence to establish a causal association with vaccination is lacking. For pertussis containing vaccines including acellular DTP, while the American CDC guidelines list progressive encephalopathy, infantile spasms and uncontrolled epilepsy as precautions and recommend deferment until neurologic status stabilization; the Australian guidelines recommend that these vaccines can be safely administered even to infants and children with active or progressive neurological diseases, since vaccination is the best prevention. The risk of narcolepsy has been definitely attributed to only one erstwhile Influenza vaccine brand (Pandemrix®). No convincing evidence implicates any vaccine in current use as directly causing any IICNS disorder. In the spectrum of DEEs, no consistent association with vaccination has been documented, other than in children with DS. Vaccine-Proximate Febrile Seizures (VP-FSs) could occur within 48 hours following inactivated (whole-cell DPT/influenza/Pneumococcal Conjugate) or 5–14 days following live-attenuated (MMR/varicella) vaccines, especially in DEE (DS); yet long-term neurodevelopmental outcomes are no different from unvaccinated. Overall, all scheduled vaccinations are recommended, but whole-cell DPT avoided and acellular DPT considered on case-to-case basis in progressive, unstable neurological disorders and VP-FSs/DS; and administered only under medical supervision. Vaccination during the phases of disease deterioration should be judiciously avoided.
References
Shekelle PG, Woolf SH, Eccles M, Grimshaw J. Developing clinical guidelines. West J Med. 1999 June;170(6):348–51.
Brandsma R, van Egmond ME, Tijssen MAJ. Diagnostic approach to paediatric movement disorders: a clinical practice guide. Dev Med Child Neurol. 2021 Mar;63(3):252–8.
Movement Disorders in Children [Internet]. [cited 2025 Aug 4]. Available from: https://www.indianpediatrics.net/sep2021/sep-861-870.htm
Carr LJ, Coghill J. Mimics of cerebral palsy. Paediatr Child Health. 2016 Sept 1;26(9):387–94.
Matthews AM, Blydt-Hansen I, Al-Jabri B, Andersen J, Tarailo-Graovac M, Price M, et al. Atypical cerebral palsy: genomics analysis enables precision medicine. Genet Med. 2019 July 1;21(7):1621–8.
Yang L, Peng J, Deng J, He F, Chen C, Yin F, et al. Vaccination Status of Children With Epilepsy or Cerebral Palsy in Hunan Rural Area and a Relative KAP Survey of Vaccinators. Front Pediatr. 2019 Mar 26;7:84.
Greenwood VJ, Crawford NW, Walstab JE, Reddihough DS. Immunisation coverage in children with cerebral palsy compared with the general population. J Paediatr Child Health. 2013 Feb;49(2):E137-141.
Groce NE, Ayora P, Kaplan LC. Immunization rates among disabled children in Ecuador: unanticipated findings. J Pediatr. 2007 Aug;151(2):218–20.
Dinleyici M, Carman KB, Kilic O, Laciner Gurlevik S, Yarar C, Dinleyici EC. The immunization status of children with chronic neurological disease and serological assessment of vaccine-preventable diseases. Hum Vaccines Immunother. 2018;14(8):1970–6.
Connolly AM, Dodson WE, Prensky AL, Rust RS. Course and outcome of acute cerebellar ataxia. Ann Neurol. 1994 June;35(6):673–9.
Salas AA, Nava A. Acute cerebellar ataxia in childhood: initial approach in the emergency department. Emerg Med J EMJ. 2010 Dec;27(12):956–7.
Plesner AM, Hansen FJ, Taudorf K, Nielsen LH, Larsen CB, Pedersen E. Gait disturbance interpreted as cerebellar ataxia after MMR vaccination at 15 months of age: a follow-up study. Acta Paediatr Oslo Nor 1992. 2000 Jan;89(1):58–63.
Van der Maas NAT, Bondt PEV de, de Melker H, Kemmeren JM. Acute cerebellar ataxia in the Netherlands: A study on the association with vaccinations and varicella zoster infection. Vaccine. 2009 Mar 18;27(13):1970–3.
Geier DA, Geier MR. An evaluation of serious neurological disorders following immunization: a comparison of whole-cell pertussis and acellular pertussis vaccines. Brain Dev. 2004 Aug 1;26(5):296–300.
Emelifeonwu JA, Shetty J, Kaliaperumal C, Gallo P, Sokol D, Soleiman H, et al. Acute Cerebellitis in Children: A Variable Clinical Entity. J Child Neurol [Internet]. 2018 June 11 [cited 2025 Aug 5]; Available from: https://journals.sagepub.com/doi/10.1177/0883073818777673
Huddar A, Bindu PS, Nagappa M, Bharath RD, Sinha S, Mathuranath PS, et al. Pediatric opsoclonus-myoclonus-ataxia syndrome: Experience from a tertiary care university hospital. Neurol India. 2018;66(5):1332–7.
Hasegawa S, Matsushige T, Kajimoto M, Inoue H, Momonaka H, Oka M, et al. A nationwide survey of opsoclonus-myoclonus syndrome in Japanese children. Brain Dev. 2015 Aug;37(7):656–60.
Morgan TM, Schlegel C, Edwards KM, Welch-Burke T, Zhu Y, Sparks R, et al. Vaccines are not associated with metabolic events in children with urea cycle disorders. Pediatrics. 2011 May;127(5):e1147-1153.
Liba Z, Kraus J, Necas T, Necas J, Klugar M, Krsek P. Movement disorders, cerebral palsy and vaccination. Eur J Paediatr Neurol. 2022 Jan 1;36:143–50.
European Centre for Disease Prevention and Control [Internet]. 2017 [cited 2025 Aug 5]. Childhood immunisation. Available from: https://www.ecdc.europa.eu/en/immunisation-vaccines/childhood-vaccination
CDC. Vaccines & Immunizations. 2024 [cited 2025 Aug 5]. Contraindications and Precautions. Available from: https://www.cdc.gov/vaccines/hcp/imz-best-practices/contraindications-precautions.html
Pertussis (whooping cough) | The Australian Immunisation Handbook [Internet]. 2024 [cited 2025 Aug 5]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/pertussis-whooping-cough
Havers F, Fry A, Peacock G, Finelli L. Influenza vaccination and treatment in children with neurologic disorders. Ther Adv Vaccines. 2014 July;2(4):95–105.
Richard JP, Kiruthika S, Sharon JA, Prasad L, Kompithra RZ. Immunization in Pediatric Neurodevelopmental disorders: Current Evidence-Based Recommendations. Res Rev Int J Multidiscip. 2025 Oct 15;10(10):24–34.
Chung IH, Chin WC, Huang YS, Wang CH. Pediatric Narcolepsy—A Practical Review. Children. 2022 June 29;9(7):974.
Bacelar A, Fernandez O, Paradella E, Rodrigues RN, Moreno CR de C, Alvarenga R. Association between human leukocyte antigen class II-DR-DQ and narcolepsy: a case control study. J Clin Sleep Med [Internet]. 2024 Dec 1 [cited 2025 Aug 5]; Available from: https://jcsm.aasm.org/doi/10.5664/jcsm.11300
De la Herrán-Arita AK, García-García F. Narcolepsy as an Immune-Mediated Disease. Sleep Disord. 2014;2014:792687.
Bonvalet M, Ollila HM, Ambati A, Mignot E. Autoimmunity in narcolepsy. Curr Opin Pulm Med. 2017 Nov;23(6):522–9.
Samanta D, Lui F. Anti-NMDAR Encephalitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Aug 5]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK551672/
Garg D, Mohammad SS, Sharma S. Autoimmune Encephalitis in Children: An Update. Indian Pediatr. 2020 July 15;57(7):662–70.
Varadkar S, Bien CG, Kruse CA, Jensen FE, Bauer J, Pardo CA, et al. Rasmussen’s encephalitis: clinical features, pathobiology, and treatment advances. Lancet Neurol. 2014 Feb;13(2):195–205.
Caraballo RH, Reyes G, Avaria MFL, Buompadre MC, Gonzalez M, Fortini S, et al. Febrile infection-related epilepsy syndrome: A study of 12 patients. Seizure - Eur J Epilepsy. 2013 Sept 1;22(7):553–9.
Gaspar NS, Melo C, Fonseca J, Sousa R, Sampaio M. Early Successful Treatment in a Child with Febrile Infection-Related Epilepsy Syndrome Epilepsy Syndrome. Ann Child Neurol. 2023 July 1;31(3):215–8.
Specchio N, Wirrell EC, Scheffer IE, Nabbout R, Riney K, Samia P, et al. International League Against Epilepsy classification and definition of epilepsy syndromes with onset in childhood: Position paper by the ILAE Task Force on Nosology and Definitions. Epilepsia. 2022 June;63(6):1398–442.
Manokaran RK, Sharma S, Ramachandrannair R. The 2022 International League Against Epilepsy Classification and Definition of Childhood Epilepsy Syndromes: An Update for Pediatricians. Indian Pediatr. 2024 Feb 15;61(2):179–83.
Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017 Apr;58(4):512–21.
MedLink Neurology [Internet]. [cited 2025 Nov 10]. Pertussis encephalopathy. Available from: https://www.medlink.com/articles/pertussis-encephalopathy
Institute of Medicine (US) Committee to Review the Adverse Consequences of Pertussis and Rubella Vaccines; Howson CP, Howe CJ, Fineberg HV, editors. Evidence Concerning Pertussis Vaccines and Central Nervous System Disorders, Including Infantile Spasms, Hypsarrhythmia, Aseptic Meningitis, and Encephalopathy. In: Adverse Effects of Pertussis and Rubella Vaccines: A Report of the Committee to Review the Adverse Consequences of Pertussis and Rubella Vaccines [Internet]. National Academies Press (US); 1991 [cited 2025 Nov 10]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK234367/
Craiu D, Rener Primec Z, Lagae L, Vigevano F, Trinka E, Specchio N, et al. Vaccination and childhood epilepsies. Eur J Paediatr Neurol EJPN Off J Eur Paediatr Neurol Soc. 2022 Jan;36:57–68.
Poke G, Stanley J, Scheffer IE, Sadleir LG. Epidemiology of Developmental and Epileptic Encephalopathy and of Intellectual Disability and Epilepsy in Children. Neurology. 2023 Mar 28;100(13):e1363–75.
Liu YH, Kuo CY, Chou IC, Hsu TR, Lin KL, Disorders-Taiwan S for NR. Dravet Syndrome: Past, Present, and Future. Acta Neurol Taiwanica. 2025 Sept;34(3):125.
Bryson A, Petrou S. SCN1A channelopathies: Navigating from genotype to neural circuit dysfunction. Front Neurol [Internet]. 2023 Apr 17 [cited 2025 Oct 29];14. Available from: https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1173460/full
Philadelphia TCH of. PCDH19-Epilepsy | Children’s Hospital of Philadelphia [Internet]. [cited 2025 Oct 29]. Available from: https://www.chop.edu/conditions-diseases/pcdh19-epilepsy
Smith L, Singhal N, El Achkar CM, Truglio G, Beth RS, Sullivan J, et al. PCDH19-Related Epilepsy is Associated with a Broad Neurodevelopmental Spectrum. Epilepsia. 2018 Mar;59(3):679–89.
Sakauchi M, Oguni H, Kato I, Osawa M, Hirose S, Kaneko S, et al. Retrospective multiinstitutional study of the prevalence of early death in Dravet syndrome. Epilepsia. 2011 June;52(6):1144–9.
Dhir P, Prakash K, Negi S, Maurya AP, Bhatia P, Madaan P, et al. Evaluation of autonomic tone and cerebral hemodynamics in children with Dravet syndrome. Seizure. 2025 Sept;131:193–9.
Partinen M, Kornum BR, Plazzi G, Jennum P, Julkunen I, Vaarala O. Narcolepsy as an autoimmune disease: the role of H1N1 infection and vaccination. Lancet Neurol. 2014 June;13(6):600–13.
Sturkenboom MCJM. The narcolepsy-pandemic influenza story: can the truth ever be unraveled? Vaccine. 2015 June 8;33 Suppl 2:B6–13.
Nohynek H, Jokinen J, Partinen M, Vaarala O, Kirjavainen T, Sundman J, et al. AS03 adjuvanted AH1N1 vaccine associated with an abrupt increase in the incidence of childhood narcolepsy in Finland. PloS One. 2012;7(3):e33536.
Sarkanen TO, Alakuijala APE, Dauvilliers YA, Partinen MM. Incidence of narcolepsy after H1N1 influenza and vaccinations: Systematic review and meta-analysis. Sleep Med Rev. 2018 Apr;38:177–86.
Barker CIS, Snape MD. Pandemic influenza A H1N1 vaccines and narcolepsy: vaccine safety surveillance in action. Lancet Infect Dis. 2014 Mar;14(3):227–38.
Weibel D, Sturkenboom M, Black S, de Ridder M, Dodd C, Bonhoeffer J, et al. Narcolepsy and adjuvanted pandemic influenza A (H1N1) 2009 vaccines – Multi-country assessment. Vaccine. 2018 Oct 1;36(41):6202–11.
CDC. Vaccine Safety. 2024 [cited 2025 Aug 5]. Historical Vaccine Concerns. Available from: https://www.cdc.gov/vaccine-safety/historical-concerns/index.html
Buonocore SM, van der Most RG. Narcolepsy and H1N1 influenza immunology a decade later: What have we learned? Front Immunol. 2022 Oct 12;13:902840.
Martin S, Azzouz B, Morel A, Trenque T. Anti-NMDA receptor encephalitis and vaccination: A disproportionality analysis. Front Pharmacol. 2022 Aug 17;13:940780.
Wang H. Anti-NMDA Receptor Encephalitis and Vaccination. Int J Mol Sci. 2017 Jan 18;18(1):193.
Takahashi Y, Matsuda K, Kubota Y, Shimomura J, Yamasaki E, Kudo T, et al. Vaccination and infection as causative factors in Japanese patients with Rasmussen syndrome: molecular mimicry and HLA class I. Clin Dev Immunol. 2006;13(2–4):381–7.
Deng L, Wood N, Macartney K, Gold M, Crawford N, Buttery J, et al. Developmental outcomes following vaccine-proximate febrile seizures in children. Neurology. 2020 July 21;95(3):e226–38.
Deng L, Gidding H, Macartney K, Crawford N, Buttery J, Gold M, et al. Postvaccination Febrile Seizure Severity and Outcome. Pediatrics. 2019 May 1;143(5):e20182120.
Deng L, Danchin M, Lewis G, Cheung A, Campbell AJ, Wadia U, et al. Revaccination outcomes of children with vaccine proximate seizures. Vaccine. 2021 Mar 12;39(11):1565–71.
Verbeek NE, van der Maas NAT, Sonsma ACM, Ippel E, Vermeer-de Bondt PE, Hagebeuk E, et al. Effect of vaccinations on seizure risk and disease course in Dravet syndrome. Neurology. 2015 Aug 18;85(7):596–603.
Negi S, Sahu JK, Bhatia P, Kaur A, Malhi P, Singh G, et al. Exploring the genetic landscape of diphtheria, tetanus and pertussis vaccination-associated seizures or subsequent epilepsies. Lancet Reg Health Southeast Asia. 2023 Jan;8:100094.
Hood V, Berg AT, Knupp KG, Koh S, Laux L, Meskis MA, et al. COVID‐19 vaccine in patients with Dravet syndrome: Observations and real‐world experiences. Epilepsia. 2022 July;63(7):1778–86.
Chen C, Chen N, Xie L, Luo Y, Ma J, Li T. Vaccination against COVID-19 and potential protective effects on seizure recurrence in children with epilepsy: A cross-sectional survey. Epilepsia Open. 2023 Sept;8(3):1133–41.
Ito S, Nishikawa A, Kuroiwa R, Honda K, Nagata S. COVID-19 infection and vaccination in children with Dravet syndrome or infantile epileptic spasms syndrome: An internet survey in Japan. Brain Dev [Internet]. 2025 June 1 [cited 2025 Nov 7];47(3). Available from: https://www.brainanddevelopment.com/article/S0387-7604(25)00034-8/abstract
Australian Journal of General Practice [Internet]. [cited 2025 Aug 5]. Seizures following vaccination in children. Available from: https://www1.racgp.org.au/ajgp/2020/october/seizures-following-vaccination-in-children
Bakhtadze S, Lim M, Craiu D, Cazacu C. Vaccination in acute immune-mediated/inflammatory disorders of the central nervous system. Eur J Paediatr Neurol EJPN Off J Eur Paediatr Neurol Soc. 2021 Sept;34:118–22.
Deng L, Wood N, Danchin M. Seizures following vaccination in children: Risks, outcomes and management of subsequent revaccination. Aust J Gen Pract. 2020 Oct;49(10):644–9.
Sharma S, Dhamne C, Bhosale S, Parambil B, Divatia J, Chinnaswamy G, et al. Epilepsia Partialis Continua as a Sequelae of Measles Infection in Children With Hematolymphoid Malignancies. JCO Glob Oncol. 2024 Feb 29;10:e2300399.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an open access article under the CC BY-NC-ND license Creative Commons Attribution-Noncommercial 4.0 International (CC BY-NC 4.0).
