Long-term neurological complications commonly follow acute encephalitis

By Reuters Staff

NEW YORK (Reuters Health) - Most children with acute encephalitis will develop significant long-term motor or cognitive complications, researchers from Israel report.

Although data on long-term neurologic outcomes in children with encephalitis are limited, reported complications have included developmental delay, motor deficits, epilepsy, and learning and behavioral problems.

Dr. Sarit Ravid and colleagues from Meyer Children's Hospital in Haifa evaluated the sequelae of acute encephalitis in 46 children who underwent thorough neurological examination and neurocognitive assessment an average of 5.8 years (range, 1-11 years) after their acute illness.

At the original discharge, 27 children (58%) had normal neurological examinations; 33% showed focal motor deficits; and 15% had various levels of cognitive impairment.

At long-term follow-up, 23 children (50%) had persisting symptoms, most commonly behavioral problems, recurrent headaches, tic disorder, and sleeping problems, according to the February 17th Pediatrics online report.

Five children (11%) had long-standing epilepsy, and four (9%) had residual motor deficits.

Only 69% of children had a normal IQ (compared with 84% of the general population), and 22% had full-scale IQ of 70 or less (compared with 2.2% of the general population).

Half of the children fulfilled criteria for ADHD (a rate much higher than the 5-10% reported in the general population in Israel). Learning disorders were twice as common as in the general population, and 8 children (17%) required special education.

Seventeen children (37%) had full recovery, but 35% had only moderate outcomes, and 28% had poor outcomes.

Predictors of poor long-term outcome included long hospital stay, abnormal neurologic examination results at discharge, abnormal results of neuroimaging studies, and confirmed pathogens.

Six of 13 children with severe sequelae improved and three fully recovered. On the other hand, only 13 of 27 children with normal examinations at discharge maintained a good long-term outcome.

"Significant cognitive impairment, ADHD, and learning disabilities are common, and even children who were considered fully recovered at discharge may be significantly affected," the researchers concluded.

"Neuropsychological testing should be recommended for survivors of childhood encephalitis," they recommend.

Dr. Ravid did not respond to a request for comments.

SOURCE: http://bit.ly/1c5vTuJ

Pediatrics 2014;133:e546-e552.

(c) Copyright Thomson Reuters 2014. Click For Restrictions - http://about.reuters.com/fulllegal.asp