Treatment of Viral Encephalitis Organic Personality Disorder and Autistic Features with Propranolol: A Case Report
John G. Schmidt, Mary L. Dombovy , Kimberlee Watkins
Abstract
Objective : To observe and describe the clinical effects of propranolol in an agitated and violent patient with postviral encephalitis organic personality disorder. Background: Cognitive and behavioral deficits are common in patients with viral encephalitis. Methods to modify behavior by a behavior program and medication have reported limited success. Case: A sixteen-year-old girl developed progressive violent and sexually dis inhibited behavior five weeks following acute viral encephalitis (presumed herpes simplex encephalitis). Three weeks of high dose lorazepam (6mg/d) failed to control her symptoms. Intensive behavioral therapy was also ineffective and violent behavior increased during structured treatment hours. Benzodiazepines and low dose haloperidol were ineffective over the subsequent two weeks in a neurorehabilitation unit. Propranolol was then given (10 mg b.i.d. to 20 mg t.i.d.) and she had a dramatic change in behavior with less violence and less agitation after one day of treatment with propranolol. Her short-term memory improved. Decreased dosage of propranolol was associated with the return of violent behavior. Maintenance propranolol was effective in con trolling her symptoms and led to the resumption of her multidisciplinary rehabilitation program. Conclusion: Violent and autistic behavior due to viral (herpes) encephalitis may respond to propranolol.
NEUROREHABIL NEURAL REPAIR 1995 9: 41-45
No one listens to me, nobody believes me: Self management
and the experience of living with encephalitis
Karl Atkin , Sally Stapley, Ava Easton
Summary
Over the past twenty years, there has been considerable interest in individuals’ experience of chronic illness. In addition to the more established concerns of medical sociology, recent policy reflects an interest in how individuals manage their condition. Using material from qualitative interviews with 23 individuals carried out in the United Kingdom, this paper examines a person’s experience following encephalitis, as a way of exploring the potential value of current policy initiatives associated with self-management. Our findings suggest that individuals’ illness experiences become embedded in conditional acceptance derived from and sustained through their social relationships. This raises a fundamental policy tension: is the purpose of current self-management strategies to help individuals cope better with illness or with the context in which their illness experience is realised? We conclude that policy needs to
question how it ‘imagines’ long-standing conditions, without recourse to generalised notions of coping and adjustment. This, in turn, means adapting a less instrumental and more contextualised approach to self-management.
SOCIAL SCIENCE & MEDICINE (2010) 1-8
Modification of severe behaviour problems following herpes simplex encephalitis.
McMillan TM, Papadopoulos H, Cornall C, Greenwood RJ.
Abstract
Violent and sexually disinhibited behaviour together with poor self-care developed
in a 38-year-old teacher following herpes simplex encephalitis. These behaviours
were sufficiently severe to make rehabilitation difficult and return to the community
impossible. Initially, only violent behaviour was treated, both by medication and
a behaviour programme, and sexual disinhibition subsequently by the latter. In order
to implement the programme a special (psychiatric) nurse was required on a 24 h
basis. The incidence of violent behaviour was reduced from up to 55 times per day
to zero over a period of 2 months. Whether this was affected by medication or behaviour
management, or by spontaneous recovery, is discussed. Sexual disinhibition was eliminated
in supervised settings, but continued to occur if left unsupervised and this improvement
resulted from behaviour management. Poor personal hygiene also improved markedly
over the 6-month period. The goal of returning the patient home to live with her
family was achieved and she remained there at follow-up. This intervention was carried
out in a rehabilitation unit that does not specialize in the treatment of such cases;
clearly this has implications for cost and quality of care.
BRAIN INJ. 1990 Oct-Dec;4(4):399-406.
Mentoring Programme for Adolescent Survivors of Acquired Brain Injury
MICHAEL FRAAS & AMANDA BELLEROSE
Abstract
Primary objective: To report the findings of a mentor–adolescent relationship between
two survivors of acquired brain injury (ABI).
Research design: Case study report.
Methods and procedures: The adolescent, a survivor of Eastern Equine Encephalitis,
was paired with an adult mentor, a survivor of a TBI. Baseline scores on the Youth
Quality of Life (YQOL), Wisconsin Quality of Life Index (WQLI) and the Mayo-Portland
Adaptability Index-4 (MPAI-4) were recorded.
Experimental interventions: The mentor provided support to the adolescent during
the 10-week relationship conducted as a community-based programme for adults with
acquired brain injury. In addition, both participants attended group activities
that address the long-term needs of survivors of ABI. Post-programme scores were
recorded on the YQOL, WQLI, MPAI-4 and a retrospective questionnaire.
Main outcomes and results: The adolescent demonstrated improved quality of life
on the YQOL and improved ability, adjustment and participation on the MPAI-4. The
mentor demonstrated improved quality of life on the WQLI and improved adjustment
and participation on the MPAI-4. Both participants indicated satisfaction with the
programme on the retrospective questionnaire.
Conclusions: The mentor programme provided enhanced quality of life and psycho-social
support to both participants. The authors do caution, however, that these findings
are preliminary and examination of the efficacy of such programming is ongoing.
BRAIN INJURY( 2010); 24(1): 50–61
Behavioral Consequences of Infections of the Central Nervous System: with Emphasis
on Viral Infections
Alex Tselis, MD, PhD, and John Booss, MD
Infections of the central nervous system can damage the brain and cause abnormal
behavior. In this article, the authors examine how behavior is affected by damage
to different parts of the brain. They then focus on damage caused by specific infections
of the brain and how these can result in abnormal behavior with legal consequences.
Examples of such infections include neurosyphilis, encephalitis lethargica, herpes
simplex encephalitis, and various other viral encephalitides, both acute and chronic.
The AIDS dementia complex, which results from HIV infection of the brain, causes
behavioral abnormalities in addition to motor and cognitive impairments. In some
cases of violence and other criminal behavior, this can be a consequence of central
nervous system infection, and the authors suggest that criminal sanctions in such
events are inappropriate in the absence of volitional criminal intent.
J Am Acad Psychiatry Law 31:289–98, 2003
Rehabilitation outcomes in encephalitis – a retrospective study 1990 – 1997
Sathia Moorthi, William N. Scheider and Mary Dombovy
The purpose of this study are to 1) describe the outcome following in-patient rehabilitation
in a cohort of patients with encephalitis, and 2) develop preliminary criteria to
guide the selection of patients with encephalitis who may benefit from inpatient
rehabilitation.
BRAIN INJURY, 1999, vol 13, No 2, 139-146
Viral encephalitis and epilepsy
Usha Kant Misra, Chong Tin Tan and Jayantee Kalita
Viral encephalitis presents with seizures not only in the acute stage but also increases
the risk of late unprovoked seizures and epilepsy. Acute symptomatic and late unprovoked
seizures in different viral encephalitides are reviewed here. Among the sporadic
viral encephalitides, Herpes simplex encephalitis (HSE) is perhaps most frequently
associated with epilepsy, which may often be severe. Seizures may be the presenting
feature in 50% patients with HSE because of involvement of the highly epileptogenic
frontotemporal cortex. The occurrence of seizures in HSE is associated with poor
prognosis. In addition, chronic and relapsing forms of HSE have been described and
these may be associated with antiepileptic drug-resistant seizures. Among the epidemic
(usually due to flaviviruses) viral encephalitides, Japanese encephalitis (JE) is
most common and is associated with acute symptomatic seizures, especially in children.
The reported frequency of acute symptomatic seizures in JE is 7–46%. Encephalitis
due to other flaviviruses such as equine, St. Louis, and West Nile viruses may also
manifest with acute symptomatic seizures. In Nipah virus encephalitis, seizures
are more common in relapsed and late-onset encephalitis in comparison to acute encephalitis
(4% vs. 1.8%). Other viruses like measles, varicella, mumps, influenza, and entero-viruses
may cause seizures depending on the area of brain involved. There is no comprehensive
data regarding late unprovoked seizures in different viral encephalitides. Prospective
studies are required to document the risk of late unprovoked seizures and epilepsy
following viral encephalitis due to different viruses as well as to determine the
clinical characteristics, course, and outcome of post-encephalitic epilepsy.
EPILEPSIA 49 (Suppl 6): 13-18, 2008
“Am not was”: Cognitive-behavioural therapy for adjustment and identity
change following herpes simplex encephalitis
Bonnie-Kate Dewar1, and Fergus Gracey2
1 MRC Cognition and Brain Sciences Unit, Cambridge 2Oliver
Zangwill Centre for Neuropsychological rehabilitation, Ely, Cambridgeshire, UK
The cognitive sequelae of encephalitis are well documented, and it is increasingly
recognised that disorders of mood and anxiety can accompany these sequelae. Loss
of identity is emerging as a key theme in psychotherapeutic interventions in adjustment
following acquired brain injury (ABI). Cognitive behavioural therapy can be applied
to construct a new model of the self in the context of behavioural, cognitive and
social sequelae of the ABI, with consideration of pre-illness identity. Behavioural
experiments, in particular, may be an effective means of redefining the meaning
of current situations to create a positive sense of self. In the current paper we
describe the therapeutic intervention to address anxiety and changes in identity
in a woman recovering from herpes simplex viral encephalitis. The intervention highlights
the need to take into accounts the interplay between cognitive changes, such as
memory and executive function, with emotion in adjustment following herpes simplex
viral encephalitis.
NEUROPSYCHOLOGICAL REHABILITATION 2007, 17 (4/5), 602-620
Pain News - A Publication of The British Pain Society
Post Encephalitis Pain(page 44)
Dr Sally Stapley, Dr Karl Atkin, University of York & Ms Ava Easton - The Encephalitis Society
Pain News
The use of a wearable camera, SenseCam, as a pictorial diary to improve autobiographical
memory in a patient with limbic encephalitis: A preliminary report
Emma Berry1, Narinder Kapur1, Lyndsay Williams2,
Steve Hodges2, Peter Watson3, Gavin Smyth2, James Srinivasan2,
Reg Smith, Barbara Wilson3,4, and Ken Wood2
1 Neuropsychology Department, Clinical Neurosciences, Addenbrooke’s
Hospital, Cambridge, 2 Microsoft Research Cambridge, 3MRC
Cognition and Brain Sciences Unit, Cambridge 4 Oliver Zangwill Centre,
Princess Of Wales Hospital, Ely, Cambridgeshire, UK
This case study describes the use of a wearable camera, SenseCam, which automatically
captures several hundred images per day, to aid autobiographical memory in a patient,
Mrs B, with severe memory impairment following limbic encephalitis. By using SenseCam
to record personally experienced events we intended that SenseCam pictures would
form a pictorial diary to cue and consolidate autobiographical memories. After wearing
SenseCam, Mrs B, plugged the camera into a pc which uploaded the recorded images
and allowed them to be viewed at speed, like watching a movie. In the control condition,
a written diary was used to record and remind her of autobiographical events. After
viewing SenseCam images, Mrs B was able to recall approximately 80% of recent, personally
experienced events. Retention of events was maintained in the long term, 11 months
afterwards, and without viewing SenseCam images for three months. After using the
written diary, Mrs B was able to remember around 49% of an event; after one month
with no diary.
NEUROPSYCHOLOGICAL REHABILITATION 2007, 17 (4/5), 582-601
Using a paging systems in the rehabilitation of encephalitis patients
H. Emslie1, B. A. Wilson1, 2, K. Quirk2, J. J. Evans3,
and P. Watson1
1MRC Cognitive and Brain Sciences Unit, Cambridge, UK, 2The
Oliver Zanglill Centre for Neuropsychological Rehabilitation, Ely, UK, 3Section
of Psychological Medicine, University Of Glasgow, UK
Memory and executive problems following encephalitis are common yet there are few
published papers in the successful rehabilitation of such patients. We recently
demonstrated (Wilson, Emslie, Quirk, Evans, & Watson, 2005) that a paging system
could reduce the everyday memory and planning problems for people with non-progressive
brain injury. Among the 143 patients who participated in the 2001 study were four
people who had survived encephalitis. Their results are reported here. During a
2 week baseline, the successful task achievement of our four clients ranged from
2-81%. They then received a pager for 7 weeks and tasks achievement was documented
in weeks 6 and 7. all were significantly more successful with the pager than they
had been at baseline with success rates ranging from 45-96%. Five weeks after returning
to their pagers they were monitored once more. One if the encephalitis patients
failed to achieve any of his target tasks, returning to baseline level, the other
three dropped back a little but were still significantly more successful than at
baseline. It is concluded that the paging system can reduce everyday memory and
planning problems of patients with encephalitis.
NEUROPSYCHOLOGICAL REHABILITATION 2007,17 (4/5), 567-581
Cognitive recovery instead of decline after acute encephalitis: a prospective follow
up study
Laura Hokkanen, Jyrki Launes
Institute of Neuroscience, Department of Neurology, University of Helsinki, Finland
Abstract
OBJECTIVE
Follow up of cognitive sequelae of acute encephalitis and estimation of the
frequency of persisting dementia.
METHODS
Out of a series of 45 consecutive patients with acute encephalitis prospectively
studied in 1990-95, 40 were screened for difficulty in everyday life using the Blessed
dementia scale (BDS) 3.7 (1.4), mean (SD), years after onset. Eight patients had
had herpes simplex encephalitis (HSVE), 16 some other identified aetiology, and
in 21 the aetiology was unknown. All, except two patients with a non-herpetic encephalitis,
were treated with acyclovir. All patients with disability in BDS (12/40), were invited
to a neuropsychological reassessment, and the results of this assessment were compared
with those of a similar assessment done after the acute stage. At follow up one
patient could not complete the tests due to intractable epilepsy.
RESULTS
In six of 11 cases the symptoms causing disability were mainly psychiatric. Five
patients (two with HSVE) had a pronounced memory impairment together with other
cognitive deficits, indicating dementia (frequency of 12.8%). In eight of the 11
testable cases cognitive performance had improved over the years, in two cases a
decline was found and one patient with severe deficits showed no change. Intractable
epilepsy was found in four of 12 cases.
CONCLUSION
Cognitive decline had taken place already at the acute stage, and further deterioration
was uncommon. Considerable improvement occurred in most patients during follow up.
Also in patients with HSVE treated with acyclovir the cognitive recovery was substantial
and of a magnitude not expected based on previous literature. Intractable epilepsy
contributed to the cognitive deterioration in some cases. Affective disorders also
had a surprisingly important role for the long term outcome.
Keywords: encephalitis; herpes simplex; cognitive performance; psychiatric sequelae
J Neurol Neurosurg
Psychiatry 1997;63:222-227 ( August )
Received 28 October 1996 and in revised form 3 April 1997; Accepted 4 April 1997
Long term neurological outcome of herpes encephalitis.
Lahat, E., Barkai, G., Paret, G., Brand N. and Barzilai, A. (1999)
Arch Dis Child, 80, 69-71
Last modified: August 2010