Epidemiology, Outcomes and Predictors of Recovery in Childhood Encephalitis

DuBray, Kara; Anglemyer, Andrew; LaBeaud, A. Desirée; Flori, Heidi R.; Bloch, Karen C.; Joaquin, Kara San; Messenger, Sharon; Preas, Chris; Sheriff, Heather; Glaser, Carol

doi:10.1097/inf.0b013e318290614f

Cited by 38 publications

(41 citation statements)

References 21 publications

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“…9 Long hospital stay was also associated with poor prognosis in the present study and most likely reflects the severity of the disease. Other factors that reflect severity of disease, such as low Glasgow Coma Scale score on admission, 15,28,37 deep coma, 28 and ICU admission, 14 were previously found as poor prognostic factors in other studies (although not in the present study). Several authors have suggested that young age is associated with a poor long-term prognosis in children with encephalitis.…”

Section: Figurementioning

confidence: 37%

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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Section: Figurementioning

confidence: 37%

Long-term Motor and Cognitive Outcome of Acute Encephalitis

Michaeli¹,

Kassis²,

Shachor-Meyouhas³

et al. 2014

Pediatrics

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“…In general, the predictors of poor outcomes were ICU admission and status epilepticus, as in previous studies. [40][41][42] In addition, we found diffusion restriction on MRI, a marker of cytotoxic injury, correlated with abnormal outcomes. The use of immunotherapy was not associated with better outcomes, but the patients receiving immune therapy had longer admissions, suggesting that these patients had a more complicated course.…”

Section: Discussionmentioning

confidence: 84%

“…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: 99%

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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“…The epidemiology of childhood infectious encephalitis has been reported in a number of large series from around the world [3,4,12,[23][24][25][26][27][28][29][30][31][32][33]. Recent publications have provided new information.…”

Section: Infectious Encephalitis Epidemiology Clinical Characteristicsmentioning

confidence: 98%

“…There are also toxic and metabolic syndromes that cause brain inflammation and can mimic infectious encephalitis [8], including Mild Encephalopathy with Reversible Splenial Lesions [9]. It is also well established that a high proportion of cases (between 30 and 70 % depending on the population studied) will not have an aetiology identified despite extensive investigation [1,4,5 •• ], although this proportion can be reduced with rigorous application of consensus guidelines [10,11].…”

Section: Introductionmentioning

confidence: 99%

Paediatric Acute Encephalitis: Infection and Inflammation

Jones

2015

Curr Pediatr Rep

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Encephalitis is a multifaceted syndrome with a myriad of clinical presentations. It is defined as inflammation of the brain with functional disturbance. Infectious diseases, particularly viruses, and autoimmune disorders are the commonest causes in children. Young infants have the highest burden of disease for most infectious causes. Recent advances include the publication of international consensus guidelines, emergence of new aetiologies including human parechoviruses and better characterisation of known infectious causes, including enterovirus 71, which continue to cause large epidemics, death and impairment in children although a number promising vaccines are on the horizon; and neurological syndromes associated with influenza which occur most commonly in children who are not immunised against the virus. Understanding of childhood autoimmune encephalopathies is also rapidly expanding including responses to immunomodulation and prognosis. Future research should see better understanding of the pathogenesis of all forms of encephalitis, with hope for advances in therapy and prevention.

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Epidemiology, Outcomes and Predictors of Recovery in Childhood Encephalitis

Abstract: This study is unique in identification of race/ethnicity as an independent predictor of pediatric encephalitis outcomes. Additional variables may be useful ancillary tools in determining prognosis.

Cited by 38 publications

References 21 publications

Long-term Motor and Cognitive Outcome of Acute Encephalitis

Long-term Motor and Cognitive Outcome of Acute Encephalitis

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

Paediatric Acute Encephalitis: Infection and Inflammation

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