Encephalitis essentially means inflammation of the brain. The inflammation can cause the brain to swell, which can lead to changes in how a child’s brain is functioning.
For children in the UK, the average number of hospital admissions for Encephalitis per year is around 6 in every 100 000.
It is usually caused by a virus (such as herpes simplex, chicken pox, flu and other viruses) or a bacterial infection, or by the body’s own immune system (autoimmune encephalitis) becoming confused and attacking the brain. Sometimes, a cause cannot be identified.
Indicators of Encephalitis in children include flu-like symptoms, such as a high temperature, severe headache, and nausea/vomiting, but these symptoms do not always occur.
Some children can develop more severe symptoms over hours, days, or even weeks, including: reduced level of consciousness, hallucinations, movement/speech difficulties, behavioural changes, confusion and seizures.
Childhood Encephalitis can be difficult to diagnose as some symptoms can be similar to other medical conditions. To identify Encephalitis doctors carry out a number of different tests, including blood tests, spinal fluid tests (lumbar puncture), brain wave tests (EEG), and brain scans (such as CT or MRI scans). It is important that if Encephalitis is suspected in a child, that these tests are carried out as soon as possible so that the correct treatment can be started as soon as possible.
The type of treatment a child receives for Encephalitis depends on the individual case. Treatments can include antiviral medication (for viral encephalitis), antibiotics (for bacterial/viral encephalitis) or immunomodulatory drugs (for autoimmune encephalitis such as immunoglobulin treatment, steroids and or plasma exchange). Sometimes treatments are started before a definite cause is established, as delays can result in further inflammation therefore increasing the risk of a worse outcome and sadly in some cases death.
Additional treatments for children with Encephalitis may also be required to manage some symptoms, such as anti-seizure medications and/or ventilation if the child is to be placed in an induced coma to prevent further brain damage.
Once the acute illness has subsided children can still have a number of difficulties that require ongoing rehabilitation. They may need to stay in hospital for a few days, weeks, or months.
The effects are different for each child. Some children recover well, whilst others can experience long term changes. Childhood Encephalitis can often result in an acquired brain injury (ABI) to different degrees, as cells in the brain can be irreparably damaged.
Physical problems can occur, with symptoms including headaches, seizures, fatigue, weakness, loss of sensation, difficulties controlling bodily functions, and movement problems which can include loss or an impaired functional ability, along with sleeping difficulties.
Cognitive/thinking problems can also occur. Such symptoms include difficulties with memory, attention and concentration, information processing speed, speech and language difficulties, changes in behaviour and personality, and difficulties with learning and carrying out day-to-day activities. Longer-term follow-up is usually required, as other problems may also develop as a child gets older.
Psychologically, coming to terms with the longer-term changes associated with childhood Encephalitis can be extremely difficult for the child and their family and friends.
The main purpose of rehabilitation is to help the child and family work on regaining skills and developing new strategies for managing any ongoing difficulties. Rehabilitation usually begins in hospital and often continues once the child has been discharged home.
A range of professionals are available to support children and families, including physiotherapists, occupational therapists, neuropsychologists, educational psychologists, speech and language therapists, dietitians, and paediatricians.
The child may experience difficulties in returning to school due to these new cognitive difficulties/differences and therefore a planned supportive phased return to school is imperative with peer/teacher education.
Source information for ‘What is Encephalitis?’ NHS: https://www.nhs.uk/conditions/encephalitis/