Long-term Outcomes of Acute Encephalitis in Childhood

Fowler, Åsa; Stödberg, Tommy; Eriksson, Margareta; Wickström, Ronny

doi:10.1542/peds.2009-3188

Cited by 88 publications

(89 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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: 66%

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

et al. 2015

View full text Add to dashboard Cite

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...

show abstract

Section: Discussionmentioning

confidence: 66%

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

et al. 2015

View full text Add to dashboard Cite

show abstract

“…This finding is consistent with previous studies, in which an etiologic diagnosis was made in 31% to 75% of cases. [9][10][11]14,15 The most common pathogens in our study were enterovirus, HSV, and West Nile virus. Children with HSV encephalitis had the worst outcome.…”

Section: Figurementioning

confidence: 80%

“…27 After tick-borne encephalitis, children had lower scores than control subjects and relative impairment on several attention/concentration tests. 13 Impaired memory function and reduced ability to concentrate was reported by Fowler et al 14 in children who survived encephalitis. When assessed by using computerized cognitive tests, these children had slower reaction times but no differences in working memory compared with control subjects.…”

Section: Figurementioning

confidence: 82%

“…Similar late-onset cognitive sequelae were also seen in other studies. 14,28,29 Epilepsy is a known sequelae of CNS infections. Furthermore, between 1% and 5% of epilepsy causes have been presumed to be due to CNS infections.…”

Section: Figurementioning

confidence: 99%

“…[11][12][13] Previously reported neurologic sequelae include developmental delay, motor deficits, epilepsy, and learning and behavioral problems. 9,10,14 Information regarding prognostic factors of acute encephalitis in children is sparse, and data vary between studies. Several factors have been suggested as indicative of poor outcome, such as young age, 8,11 deteriorating electroencephalography (EEG) findings, 11 focal neurologic signs at discharge, 9 low Glasgow Coma Scale score on admission, 8,15 and abnormal neuroimaging results.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Long-term Motor and Cognitive Outcome of Acute Encephalitis

Michaeli¹,

Kassis²,

Shachor-Meyouhas³

et al. 2014

Pediatrics

View full text Add to dashboard Cite

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.

show abstract