Long-term Motor and Cognitive Outcome of Acute Encephalitis

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Encephalitis in children can cause significant neurologic sequelae, such as motor and cognitive impairment. Previous reported data are based mostly on questionnaires and clinical assessments.WHAT THIS STUDY ADDS: Significant cognitive impairment, attention-deficit/hyperactivity disorder, and learning disabilities are common after childhood encephalitis. Even children who were considered fully recovered may be significantly affected. Identifiable pathogens, abnormal neuroimaging, and abnormal neurologic examination on discharge are risk factors of poor outcome.abstract OBJECTIVES: To examine the long-term motor and neurocognitive outcome of children with acute encephalitis and to look at possible prognostic factors. METHODS:Children who were treated for acute encephalitis in 2000-2010 were reevaluated. All children and their parents were interviewed by using structured questionnaires, and the children underwent full neurologic examinations, along with comprehensive neurocognitive, attention, and behavioral assessments. RESULTS:Of the 47 children enrolled, 1 died and 29 had neurologic sequelae, including motor impairment, mental retardation, epilepsy, and attention and learning disorders. Children with encephalitis had a significantly higher prevalence of attention-deficit/hyperactivity disorder (50%) and learning disabilities (20%) compared with the reported rate (5%-10%) in the general population of Israel (P , .05) and lower IQ scores. Lower intelligence scores and significantly impaired attention and learning were found even in children who were considered fully recovered at the time of discharge. Risk factors for long-term severe neurologic sequelae were focal signs in the neurologic examination and abnormal neuroimaging on admission, confirmed infectious cause, and long hospital stay.CONCLUSIONS: Encephalitis in children may be associated with significant long-term neurologic sequelae. Significant cognitive impairment, attention-deficit/hyperactivity disorder, and learning disabilities are common, and even children who were considered fully recovered at discharge may be significantly affected. Neuropsychological testing should be recommended for survivors of childhood encephalitis.

Long‐term outcomes of infective encephalitis in children: a systematic review and meta‐analysis

“…30 Four studies reported mixed cases of infective encephalitis (e.g. 7,33,35,41 Long-term sequelae A total of 1018 (934 with complete follow-up) survivors of childhood infective encephalitis were evaluated for sequelae; 57.6% (500/868) were male. 7,33,35,41 Long-term sequelae A total of 1018 (934 with complete follow-up) survivors of childhood infective encephalitis were evaluated for sequelae; 57.6% (500/868) were male.…”

Postencephalitic epilepsy and drug‐resistant epilepsy after infectious and antibody‐associated encephalitis in childhood: Clinical and etiologic risk factors

“…Despite seizures/epilepsy being commonly reported (6–11%) following acute childhood encephalitis, there remains no consensus definition for PE . Most recent studies applied duration of AED usage, although different time thresholds were used including >6 months, >12 months, and ≥3 years .…”

“…Despite seizures/epilepsy being commonly reported (6-11%) following acute childhood encephalitis, there remains no consensus definition for PE. [2][3][4] Most recent studies applied duration of AED usage, although different time thresholds were used including >6 months, >12 months, and ≥3 years. 5,6,9 Because most patients with acute symptomatic seizures are treated with AEDs for 3-6 months and weaned by 12 months, we chose a time threshold of AED use of 24 months.…”

“…Postencephalitic epilepsy (PE) following acute childhood encephalitis has been reported in 6.1-16.4% of cohorts with variable definitions of encephalitis, PE, and length of follow-up. [1][2][3][4][5] Previous studies in childhood cohorts have reported the following features during acute encephalitis as risk factors for PE and intractable epilepsy: acute seizures (focal, generalized), status epilepticus, severe encephalopathy, medically induced coma, focal neurologic deficits, number of antiepileptic drugs (AEDs), prolonged hospitalization, abnormal electroencephalography (EEG; slowing, multifocal, or focal spikes), magnetic resonance imaging (MRI) involvement of cortical and subcortical areas, and infectious etiology (herpes simplex virus [HSV], Mycoplasma pneumoniae). 1,2,4-7 However, these studies were performed mostly in East Asia, were focused mainly on infectious encephalitis, excluded acute disseminated encephalomyelitis (ADEM), and did not include autoantibody-associated syndromes such as N-methyl-D-aspartate receptor (NMDAR) encephalitis.…”

Acute encephalitis in children: Progress and priorities from an Australasian perspective

“…The long‐term outcome of encephalitis in children has not been well characterized; however, the evidence is concerning for high rates of neurocognitive and behavioural sequelae. A study from Finland showed cognitive and personality problems in over half, and an Israeli study showed moderate to severe sequelae in 63% of children with high rates of behavioural problems; low IQ scores, attention deficit hyperactivity disorder and learning disorders were overrepresented …”