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

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 underdescribed longitudinally. Case: We followed a female with neonatal-onset OS and suppression-burst EEG to the age of seven. Despite combination antiseizure therapy (phenobarbital, levetiracetam, vigabatrin, and clonazepam), she had breakthrough events and severe developmental impairment. Between the ages 1 and 7 years, she experienced ≥ 15 documented hospitalizations for recurrent bronchopneumonia, frequently with hypoxemia requiring supplemental oxygen; several episodes were accompanied by seizure exacerbations and clinical aspiration or choking events. Management and Outcomes: Admissions were managed with supportive respiratory care (oxygen, bronchodilators, and 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 complications, 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.