Background

Encephalitis means simply “inflammation of the brain”.1 It can have two main causes; these are primary, where the virus directly invades the brain and secondary, where the virus first invades another part of the body. Encephalitis is best treated rapidly, to reduce any long-term effects on the person, especially in the case of children.

This paper aims to increase parent/carer and professional awareness around the child, of the causes of encephalitis, to enable them to reduce the risk of long-term effects. It also aims to enable parents/carers and professionals to be aware of the symptoms and to seek medical attention at the earliest stages to reduce the risks of long-term effects.

History of the illness

In April 1917, Constantin Von Economo first described witnessing an illness he described as “encephalitis lathar-gica”, when he reported on 11 cases in Vienna.2 In 1933, there was an epidemic outbreak of sleepy sickness (Encephalitis lathargica) in St. Louis, with 1095 cases recorded.3 In 1929, the Matheson Commission was underway; this would bring the first breakthrough in understanding the make-up of encephalitis. To date, we have a reasonable understanding of encephalitis and its long-term impacts on health, standard of living and wellbeing.

Encephalitis: causes and treatment

In the UK the most common cause of encephalitis is herpes simplex type, 1,4 but globally the most frequent cause is Japanese encephalitis virus.5 In the early stages of herpes simplex affecting the brain, it can take several days for the virus to show on a spinal tap and therefore, it is essential that other tests are run, and when symptoms present, they are treated at the earliest opportunity. Early recognition, appropriate investigation and efficient management are essential in encephalitis because of the highly devastating nature of the condition.4 Japanese encephalitis can take 1-6 days to show and there is no treatment per se, though treatments used normally include breathing aides, seizure control and temperature management.6

This review provides an overview of recent research and developments in the diagnosis, treatment and impact of treatment on children’s wellbeing.

Encephalitis is still evolving, this is because of an increase in migration patterns, leading to arboviruses spreading to new areas; the number of immunocompromised patients have increased due to HIV infection, cancer treatments and transplant surgery.7 These patients have been placed at risk due  to a lower immune system. Since encephalitis was first documented there have been sudden epidemics.8 On the positive side, vaccination has helped to reduce encephalitis, where the cause was due to measles and mumps viruses.9

Presentation of encephalitis may begin with brief flu-like symptoms, followed by severe headaches, nausea and altered consciousness.4 There may be seizures, swelling of the meninges and other neurological signs. It is essential that a comprehensive history of the patient be obtained in order to make the best and most effective diagnosis. If encephalitis is caught in the early stages, prognosis is excellent as swift treatment can be given, however, if there are delays, it can be fatal.

Encephalitis: Outcomes

In most forms, the acute phase of encephalitis (when symptoms are the most severe) usually lasts up to a week. Full recovery can take much longer, often several weeks or months. Children may need rehabilitation, this should be fully assessed and a package of treatment and therapies offered.

Difficulties during recovery and afterwards may include post-encephalitic seizures (this could remain as epilepsy) and severe disturbance of conscious.

The flow chart through the illness helps explain the process from the first symptoms developing, through to discharge, and support from professionals. This flow chart illustrates the possibilities of what may happen next in order to aid access to support at the level that may be needed, and to gain quicker access to the professionals who can help.

© Cerebra 2010

It is important to note here that although the flow chart does show progress through the system and addresses full recovery and the possibility of longer term implications, it does not cover the possibility of “bereavement”.

It is anticipated that this project will aid understanding of the illness, encephalitis, and its short- and long-term implications for the child, family and the systems that the child is included in, thereby raising awareness of the need for early diagnosis for swift recovery and reducing the possibility of long-term implications.

Examples of some of the symptoms, diagnosis and treatment:

Risk factors and prevention 

Conclusions

Encephalitis, when caught early, has a good prognosis and excellent recovery rates; however, if diagnosis and treatment are delayed it can often be catastrophic, and even fatal. The studies reviewed were specific to encephalitis, its causes and its implications. Things have changed dramatically since the condition was first identified and there have been many discoveries to help manage the illness, in the forms of anti-viral medication and antibiotics, alongside many of the treatments for other symptoms such as seizures (anti-convulsants). Corticosteroids may be used in some cases to reduce brain swelling. This, alongside developments in MRI and CT scans, and the continued pursuit of other ways of treating this illness, gives much hope for the future.

The studies looked at children who had been admitted into hospitals with symptoms of encephalitis and how each case was managed, as well as the outcomes.9 It was shown that older children were able to maintain some of their executive skills functions and younger children appear to sustain less impact in this area, as they are yet to gain these skills.1 Where there were ongoing implications, these were recorded as physical changes such as weakness in one side of the body and co-ordination problems, or behavioural changes such as a very placid child becoming more demanding. Enabling the child to meet their own needs through practice and learning new skills will help, and will boost confidence in the child. Parents of these children had many coping strategies to improve their child’s everyday life. Many children found comfort and support within an environment where their needs could be met, such as where patience was shown and time was set aside for recovery and rest, along with a nutritional balanced diet to support and help recovery.

There is still much to be learned about encephalitis, but the research papers have shown many developments to help improve our understanding of this illness, its causes and its treatment. More importantly, for those involved in the care of a child with encephalitis, it enables them to access information to help, support and to provide guidance for their child.7

Project design

Research papers on encephalitis and children were looked at to ascertain the overall developments of encephalitis, and how it is diagnosed and treated. These papers focused on two types of encephalitis; primary such as that caused by measles, mumps and rubella and secondary; mosquito and tick-borne viruses. Once these were separated, the causes and effects were established and any patterns gathered together. The effects of both had a similar course of events, and these are commented on above. Studies that were resourced by pharmaceuticals have been sifted out, because of the implications of the possibility of biased research.

References

1 Dowell, E. (2005). Encephalitis – A Parent’s Handbook. The Encephalitis Society

2 Reid, A.H. et al. (2001). Experimenting on the Past: The Enigma of von Economo’s Encephalitis Lethargica. Journal of Neuropathology and Experimental Neurology 60, (7): 663-670

3 Luby, J.P. (1979). St. Louis encephalitis. Epidemiol Rev. 1:55–73

4 Kneen, R. and Solomon, T. (2008). Management and outcome of viral encephalitis in children. Paediatrics and Child Care. 18, (1): 7-16

5 Solomon T, Dung NM, Wills B, et al. (2003). Interferon alfa-2a in Japanese encephalitis: a randomised double-blind placebo-controlled trial. Lancet; 361: 821–826

6 Weaver, S., Rosenblum, M.K. and DeAngelis, L.M. (1999). Herpes varicella zoster encephalitis in immunocompromised patients. Neurology. 52 (1): 193-5

7 Vilensky, J.A., Foley, P., Gilman, S. (2007). Children and Encephalitis Lethargica: A Historical Review. Paediatric Neurology. 37 (2): 79-84

8 Kanra G, Isik P, Kara A, Cengiz AB, Secmeer G, Ceyhan M (2004). “Complementary findings in clinical and epidemiologic features of mumps and mumps meningoencephalitis in children without mumps vaccination”. Pediatr Int 46 (6): 663–8

9 Elbers, J. M. Et al., (2007). A 12-year Prospective Study of Childhood Herpes Simplex Encephalitis: Is There a Broader Spectrum of Disease? Paediatrics. 119 (2): 399-407 9

This information is not meant to replace the advice of any physician or qualified health professional. The information provided by Cerebra is for information purposes only and is not a substitute for medical advice or treatment for any medical condition. You should promptly seek professional medical assistance if you have concerns regarding any health issue.