Long-term Outcomes of AcuteEncephalitis in Childhood
Åsa Fowler, Tommy Stödberg, Margareta Eriksson, ,Ronny Wickström,
OBJECTIVES The aims of this study were to investigate the long-term outcomes of childhood encephalitis and to examine possible prognostic factors.
METHODS Of 93 children who were treated for acuteencephalitis in 2000–2004, 71 were eligible for follow-up evaluations. A structured interview, using 2 questionnaires, was conducted with the parents. Fifteen of the children with the most-severe symptoms at the time ofdischarge also underwent electroencephalographic recording and tests of reaction times and working memory.
RESULTS Persisting symptoms were reported by 54% of children. The predominant symptoms were personality changes and cognitive problems. Children who made a complete recovery did so within 6 to 12 months. The only significant risk factor for sequelae was disease severityleading to admission to the ICU. The risk of subsequent epilepsy was increased for children with seizures at presentation. Most follow-up electroencephalograms showed improvement, but results had not normalized for 9 of 15 children. Children with encephalitis had slower reaction times, compared with control subjects, but no difference in working memory could be seen.
CONCLUSION Persisting symptoms after childhood encephalitis were present for a substantial number of children. Seizures increased the risk of subsequent epilepsy; the only other prognostic marker was admission to the ICU. Even children who were considered fully recovered at discharge reported persisting symptoms at follow-up evaluations. Children who made a full recovery did so within 6 to 12 months, which suggests that all children with encephalitis should be monitored for 1 year after the acute illness.
PEDIATRICS Vol. 126 No. 4 October 2010, pp. e828-e835
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
Encephalitis in children:
Arleta Starza-Smith 1, Emily Talbot1, and Cathy Grant2
1 Paediatric Neuropsychology Services, Nottingham University Hospital NHS
Trust, Nottingham, UK 2 Paediatric Psychology Department, Leicester Royal
Infirmary, Leicester, UK
Encephalitis is an inflammation of the brain tissue that can result from a number
of viruses and can be contracted at any age, with prevalence in children exceeding
adult incidence. In order to illustrate specific cognitive, behavioural and
service provision issues related to post- encephalitis rehabilitation of children,
this paper examines the pattern of referrals to a specialist regional paediatric
neuropsychological service in United Kingdom. Three case vignettes are presented to demonstrate the wide range of presentations
encountered in our service ranging from mild(10%) to moderate (65%) and severe (25%)
impairment with 80% of referrals relating to behaviour and educational concerns.
On average 13 new referrals are received annually resulting in a cumulative case-load
due to the need for serial assessment. The implications for patient care are discussed.
NEUROPSYCHOLOGICAL REHABILITATION 2007, 17 (4/5), 506-527
Functional Outcomes of school-age children with acquired brain injuries at discharge
from impatient rehabilitation
GARY M. BEDELL
Tufts University, Boston School of Occupational Therapy, Medford, MA, USA
(Received 30 May 2007 revised 7 February 2008 ; accepted11 February 2008)
Abstract
Objective: To examine functional outcomes of school-age children with acquired
brain injuries (ABI) at discharge from one inpatient rehabilitation programme in
the northeast,USA.
Methods: a cross – sectional design was used to examine admission and
discharge data on 176 children with ABI, aged 5-18 years. Functional outcomes included
discharged pediatric evaluation of disability inventory (PEDI) self-care, mobility,
social function scores and length of stay. General patterns of charge in PEDI scores
were analysed using paired t-test and effective sizes. Correlation analyses were
used to determine associations among continuous variables. Differences in outcomes
related to independent variables were examined using independent t-tests and analysis
of variance and covariance.
Results: PEDI scores improved significantly at discharge. Less improvement
was found in social function scores than mobility and self-care scores. Higher scores
were associated with shorter LOS. Differences in most outcomes were found related
to family’s primary language, race/ethnicity and primary insurance. Younger
children had significantly lower social function scores than older children.
Conclusions: findings provided insights about potential effects of selected
variables on functional outcomes and suggest where future inquiry and efforts might
be needed (e.g. Social function and socio-cultural variables). Information not recorded
in the programme’s database could offer additional insights to assist with
team decision-making.
Keywords: Pediatric, outcomes, functional status, length of stay, race/ethnicity,
insurance
Brain Injury, April 2008; 22(4): 313-324
Archives of Disease in Childhood
Long Term follow up after meningitis in infancy: behaviour of teenagers
Community child health, public health, and epidemiology: Original Article
Halket, S; de Louvois, J; Holt, D E; Harvey, D
Read the article . . .
Assessing Executive Functions in Children: Biological, Psychological and Developmental
Considerations.
Vicki Anderson (1998)
Neuropsychological Rehabilitation, 8 (3), 319-349
Publisher: Psychology Press, part of the Taylor & Francis Group
Issue: Volume 8, Number 3 / May 1, 1998 Pages: 319 - 349
Abstract:
Executive functions may be defined as those skills necessary for purposeful, goal-directed
activity, and are generally considered to be largely mediated by the frontal and
prefrontal cortices of the brain. These cerebral regions are relatively immature
during childhood, with development thought to be a protracted process which continues
into early adolescence. While early theorists suggested that executive skills were
not functional until cerebral maturity, recent research provides evidence that such
skills can be elicited in early childhood. The aim of this paper is to review current
theories of development of executive functions throughout childhood. In keeping
with contemporary approaches to child neuropsychology, three critical dimensions
will be evaluated; biological factors, psychological dimensions, and developmental
trajectories. In addition, the literature which addresses assessment of these functions
will be examined, with reference to developmental trajectories observed in normal
populations, and in brain-damaged samples, where there may be disruption to the
underlying neural substrates thought to be subsuming these functions.
www.taylorandfrancis.metapress.com
Autistic symptoms following herpes encephalitis
Ghaziuddin, I. Al-Khouri, N. Ghaziuddin
Abstract: Autism is a childhood onset neurodevelopmental disorder characterized
by reciprocal social deficits, communication impairment, and rigid ritualistic interests,
with the onset almost always before three years of age. Although the etiology of
the disorder is strongly influenced by genes, environmental factors are also important.
In this context, several reports have described it association with known medical conditions,
including infections affecting the central nervous system. In this report, we describe
an 11 year old Asian youngster who developed the symptoms of autism following an
episode of herpes encephalitis. In contrast to previous similar reports, imagine
studies reports, imaging studies suggested a predominant involvement of the frontal
lobes. At follow -up after three years, he continued to show the core deficits of
autism. This case further supports the role of environmental factors, such as infections,
in the etiology of autism, and suggests that in a minority of cases, autistic symptoms
can develop in later childhood.
Read the article . . .
Cognitive Dysfunction and Psychoeducational Assessment in Individuals with Acquired
Brain Injury
John E Obrzut and George W Hynd
Children and adolescents with learning and behavioural difficulties resulting from
head injuries share some common problems with individuals with learning difficulties.
A review of the literature regarding the effects of head injury in children reveals
important developmental considerations in terms of both outcome and treatment. This
article reviews these issues and focuses on appropriate assessment practices with
individuals who have acquired brain injury and who may have many difficulties in
learning that are similar to those of the learning disabled child.
Journal
of Learning Disabilities
Last modified: January 2012