Encephalitis Seminar published in The Lancet

A landmark ‘Seminar’ paper on encephalitis has been published in The Lancet by members of Encephalitis International’s Scientific Advisory Panel (see below for further information), including CEO Dr Ava Easton MBE.

Introduction

Encephalitis is a global emergency that kills an estimated 100,000 people every year and leaves many survivors with lifelong disabilities. The World Health Organization has described it as an ‘increasing global threat’. The condition also incurs a substantial economic cost, with hospitalisation estimates in the USA alone at approximately US$2 billion.

The Lancet Seminar, written by some of the world’s foremost experts on encephalitis, lays out a practical roadmap for clinicians to improve recognition and treatment of different types of encephalitis. This multimedia work also includes videos of clinical presentations of encephalitis, providing a holistic and comprehensive tool for clinicians.

Early diagnosis and misdiagnosis

The researchers highlight clinical approaches to recognise and distinguish the most common pathogenic viruses and emerging range of autoantibodies encountered in routine practice. They also describe therapeutic approaches, measurements of clinical outcomes, and strategies to improve prevention, diagnosis, and care for patients.

One of the most important takeaways from the seminar is the need for speed. In herpes simplex virus encephalitis, for example, prompt diagnosis, and treatment with acyclovir cuts mortality from around 70% to 20%. In autoimmune encephalitis, which is frequently misdiagnosed, each day of delayed immunotherapy can worsen the outcome.

The authors stress the importance of distinguishing between infectious and autoimmune encephalitis as the two require entirely different treatment approaches. Diagnostics such as MRI (magnetic resonance imaging) patterns and cerebrospinal fluid (CSF) results can point clinicians towards the correct diagnosis.

Prevention and vaccination

Several forms of infectious encephalitis are preventable, and the authors emphasise that improved vaccine confidence and well-run vaccination programmes are paramount to reducing incidence, death, and disability.

Vaccination is the most effective preventive measure against Japanese encephalitis, recommended by the World Health Organization for those living in or travelling to endemic areas, and can offer long-lasting protection. Tick-borne encephalitis vaccines similarly cut disease burden.

The paper warns, however, that falling vaccine coverage corresponds to rising cases of measles encephalitis for example, illustrating the serious consequences of vaccine hesitancy. For pathogens without a vaccine, such as West Nile virus, prevention relies on mosquito control and personal protective measures.

Encephalitis International’s Scientific Advisory Panel Involvement

Most of authors of the work are members of Encephalitis International’s Scientific Advisory Panel, which provides expert professional guidance to inform Encephalitis International’s research strategy, information resources, and support services. In addition to Encephalitis International’s CEO Dr Ava Easton MBE, the members of the scientific panel who were involved in this work are:

• Dr Sophie Binks, Clinical Lecturer and Honorary Neurology SpR at Nuffield Department of Clinical Neurosciences, University of Oxford.
• Associate Professor Kiran Thakur, Vicechair of the Scientific Advisory Panel; Herbert Irving Associate Professor of Neurology at Columbia University Irving Medical Center – New York Presbyterian Hospital.
• Professor Sarosh R Irani BMBCh MA (Oxon) DPhil FRCP FEAN, Neurologist and Scientist at the Mayo Clinic Florida, Professor of Autoimmune Neurology at the University of Oxford and Adjunct Professor of Neurology at the University of Southern Denmark.

Looking ahead

Sadly, climate change is expanding mosquito-borne threats of certain types of infectious encephalitis. Moreover, vaccine hesitancy is causing the revival of certain vaccine-preventable forms of encephalitis. Both are causes for concern.

However, the authors conclude that the past few years have seen positive developments, such as the reclassification of many previously poorly understood types of encephalitis by using molecular techniques. Yet there remains a need for improved physician education with respect to clinical presentations as well as funding to improve diagnostic capacities. Encephalitis International has, to this end, developed Global Training Modules on Encephalitis, providing a free training opportunity for doctors, with special encouragement for clinicians in low-resource settings.

By addressing these concerns, it is hoped that the World Health Organization-designated aim to reduce overall encephalitis burden for survivors and their caregivers can be achieved.

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To read the original paper, click here.