Epidemiology of encephalitis in children. A prospective multicentre study

Koskiniemi, Marjaleena; Korppi, Matti; Mustonen, Kirsi; Rantala, Heikki; Muttilainen, M.; Herrgård, Eila; Ukkonen, Pentti; Vaheri, A

doi:10.1007/s004310050658

Cited by 122 publications

(87 citation statements)

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“…Immunotherapy has only recently become established in the treatment of autoantibody-associated encephalitis (other than ADEM), 3 and prospective studies are needed to determine the benefit of immunotherapy in patients with encephalitis irrespective of whether an autoantibody is detected. The percentage of unknown encephalitis (28%) in this study is the lowest among substantial pediatric cohorts, [6][7][8]40,41 but it represents an important subgroup that is comparable in size to the prospective UK cohort in adults and children. 5 There were no distinguishing clinical or radiologic characteristics of the unknown subgroup, mainly because of the likely heterogenous etiologies.…”

Section: Discussionmentioning

confidence: 56%

“…Although by definition ADEM is an encephalomyelitis, it is notable that many previous encephalitis cohorts do not include ADEM but generally focus on infectious encephalitis alone. [6][7][8]21 NMDAR-Ab encephalitis was diagnosed in 6% of patients, who had typical clinical features of the disease, with dominant movement, psychiatric, sleep, speech, and autonomic features. The number could be an underestimate, because serum testing was performed on only 103 out of 129 (81%) of the patients without ADEM.…”

Section: Discussionmentioning

confidence: 99%

“…5 However, most of the previous larger studies of encephalitis in children were undertaken before the advent of neuronal autoantibody testing. [6][7][8] We studied clinical and radiologic features, serum autoantibodies in acute archived samples, and longterm outcomes in a large retrospective cohort of pediatric encephalitis from a single center. …”

Section: What This Study Addsmentioning

confidence: 99%

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Infectious and Autoantibody-Associated Encephalitis: Clinical Features and Long-term Outcome

et al. 2015

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BACKGROUND AND OBJECTIVES: Pediatric encephalitis has a wide range of etiologies, clinical presentations, and outcomes. This study seeks to classify and characterize infectious, immunemediated/autoantibody-associated and unknown forms of encephalitis, including relative frequencies, clinical and radiologic phenotypes, and long-term outcome.METHODS: By using consensus definitions and a retrospective single-center cohort of 164 Australian children, we performed clinical and radiologic phenotyping blinded to etiology and outcomes, and we tested archived acute sera for autoantibodies to N-methyl-D-aspartate receptor, voltage-gated potassium channel complex, and other neuronal antigens. Through telephone interviews, we defined outcomes by using the Liverpool Outcome Score (for encephalitis).RESULTS: An infectious encephalitis occurred in 30%, infection-associated encephalopathy in 8%, immune-mediated/autoantibody-associated encephalitis in 34%, and unknown encephalitis in 28%. In descending order of frequency, the larger subgroups were acute disseminated encephalomyelitis (21%), enterovirus (12%), Mycoplasma pneumoniae (7%), N-methyl-D-aspartate receptor antibody (6%), herpes simplex virus (5%), and voltage-gated potassium channel complex antibody (4%). Movement disorders, psychiatric symptoms, agitation, speech dysfunction, cerebrospinal fluid oligoclonal bands, MRI limbic encephalitis, and clinical relapse were more common in patients with autoantibodies. An abnormal outcome occurred in 49% of patients after a median follow-up of 5.8 years. Herpes simplex virus and unknown forms had the worst outcomes. According to our multivariate analysis, an abnormal outcome was more common in patients with status epilepticus, magnetic resonance diffusion restriction, and ICU admission. CONCLUSIONS:We have defined clinical and radiologic phenotypes of infectious and immunemediated/autoantibody-associated encephalitis. In this resource-rich cohort, immune-mediated/ autoantibody-associated etiologies are common, and the recognition and treatment of these entities should be a clinical priority. WHAT'S KNOWN ON THIS SUBJECT:Encephalitis is a serious and disabling condition. There are infectious and immune-mediated causes of encephalitis, but many cases remain undiagnosed. WHAT THIS STUDY ADDS:This large single-center study on childhood encephalitis provides insight into the relative frequency and clinicoradiologic phenotypes of infectious, autoantibody-associated, and unknown encephalitis. Risk factors for an abnormal outcome are also defined. 4 and a prospective study of adults (n = 134) and children (n = 69) with encephalitis found that infectious encephalitis and immunemediated forms were identified in 42% and 21% of the cohort, respectively. 5 However, most of the previous larger studies of encephalitis in children were undertaken before the advent of neuronal autoantibody testing. [6][7][8] We studied clinical and radiologic features, serum autoantibodies in acute archived samples, and longterm outcomes in a large ret...

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

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Infectious and Autoantibody-Associated Encephalitis: Clinical Features and Long-term Outcome

et al. 2015

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“…5 Tickborne encephalitis virus and enterovirus are common in the Western world. 6,7 Data on long-term neurologic outcomes in children with encephalitis are limited and vary depending on the different geographic areas and endemic agents. In the majority of studies, data were determined by using clinical follow-up assessments at outpatient clinics 8,9 and structured questionnaires 10 ; only a few studies used standardized cognitive and behavioral tests.…”

mentioning

confidence: 99%

Long-term Motor and Cognitive Outcome of Acute Encephalitis

Michaeli¹,

Kassis²,

Shachor-Meyouhas³

et al. 2014

Pediatrics

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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.

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“…) Hier ein paar Literaturhinweise [6][7][8][9][10], von denen zwei aus Finnland hervorgehoben seien: Trotz Elimination der Masern durch die Kleinkinderimpfung konnte keine Abnahme der Gesamtzahl von Defektheilungen nach viraler Enzephalitis festgestellt werden [11,12]. Im selben Masse, wie die invasiven HIB-Infekte durch die Säuglingsimpfung abgenommen hatten, musste eine Zunahme invasiver Pneumokokken-Infekte verzeichnet werden [13].…”

Section: Kern Des Problemsunclassified

Impfpromotion in der Schweiz: von der Fragmentierung des Denkens und Handelns

2001

PrimaryCare (fr)

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Epidemiology of encephalitis in children. A prospective multicentre study

Abstract: The spectrum of encephalitis in children has changed due to vaccination programs. The incidence, however, appears to be about the same due to increasing frequency of other associated old and new microbes.

Cited by 122 publications

References 16 publications

Infectious and Autoantibody-Associated Encephalitis: Clinical Features and Long-term Outcome

Infectious and Autoantibody-Associated Encephalitis: Clinical Features and Long-term Outcome

Long-term Motor and Cognitive Outcome of Acute Encephalitis

Impfpromotion in der Schweiz: von der Fragmentierung des Denkens und Handelns

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