Epilepsy Talk

Epilepsy and Encephalitis | September 18, 2013

Imagine an inflammation so powerful that it can play havoc with your brainstem, cerebrum, cerebellum, spinal cord, and peripheral nerves.

That’s the neurological damage that can happen as a result of encephalitis.

The good news is that it’s rare.

The bad news is that it causes the brain tissue to swell (cerebral edema), which may destroy nerve cells, cause bleeding in the brain (intracerebral hemorrhage), and brain damage.

Seizures are common during the initial stages of encephalitis.

And because they occur as a symptom, they’re referred to as “acute symptomatic seizures.”

Seizures may also occur at a later stage, as well, after the acute illness is over.

That’s because the after-effects of encephalitis’ inflammation may leave brain cells liable to the long-term “electrical storm” we know as epilepsy.

Those unlucky few who develop epilepsy after encephalitis will be plagued with what they call “unprovoked seizures”.

And there are others who may not have had any seizures at all, or maybe just a few which seemed to have settled down.

Suddenly they have the surprise of unwelcome unprovoked seizures, after the encephalitis seems to have exited.

The cumulative risk for later unprovoked seizures among those who had seizures during the initial acute stage of encephalitis is about 10% at 5 years and 22% by 20 years.

If there were no early seizures, the 20 year risk of unprovoked seizures is around 10%.

Up to 50% of people with encephalitis may have seizures at some point.

Of course, the question is WHEN?

The risk depends on the type of encephalitis involved.

Most people who develop epilepsy after encephalitis have focal or secondarily generalized seizures.

Because encephalitis is commonly a diffuse process involving both sides of the brain, seizures may sometimes arise from several different locations and result in multifocal epilepsy.

The goal of treatment is to achieve the best possible control of the seizures, while at the same time avoiding unacceptable side-effects from the medication.

Children aged one year or less and adults aged 55 years and over are more vulnerable to life threatening complications or chronic conditions from encephalitis.

And of course, one of these chronic conditions includes epilepsy.

Causes

There are two types of encephalitis — primary and secondary.

In primary encephalitis, a virus attacks the brain and spinal cord directly.

Secondary or post-infectious encephalitis, causes the virus to invade another part of your body and then travel to your brain.

Some of the reasons include:

Infectious — inflammation as a direct result of an infection, which is often viral
Post-infectious — inflammation is caused by the immune system reacting to a previous infection, and can occur days, weeks or sometimes months after the initial infection
Autoimmune — inflammation caused by the immune system reacting to a non-infectious cause, such as a tumor
Chronic — inflammation developing slowly over many months, and can be the result of a condition such as HIV, though in some cases there is no obvious cause

Other Causes

Aside from encephalitis being caused by inflammation, there are other possibilities:

Traveling to areas where viral encephalitis is common
An allergic reaction to vaccinations for polio, rabies and chickenpox
Bacteria, such as Lyme disease, syphilis, and tuberculosis
Parasites like roundworms
Mosquitoes, ticks and rabies

(Conversely, the introduction of the vaccination for measles, mumps and rubella has greatly lowered the rate of encephalitis from those diseases.)

Herpes Simplex Encephalitis and Epilepsy

HSE occurs at any age, to either sex and at any time of year.

Early in the infection, the virus shows a predisposition for certain parts of the brain.

Typically it goes to the limbic cortices.

It may then spread to the adjacent frontal and temporal lobes.

The destruction of tissue in these areas, together with brain swelling from the inflammation, causes many of the symptoms associated with HSE.

Seizures may occur in 50% patients with HSE, because of a degenerative condition in the front part of the brain.

Japanese Encephalitis (JE) is most common and is associated with acute symptomatic seizures, especially in children.

The prognosis is poor.

In addition, chronic and relapsing forms of HSE have been described and may be associated with antiepileptic drug-resistant seizures.

The reported frequency of acute symptomatic seizures in JE is 7-46%.

Symptoms

Some patients may have symptoms of a cold or stomach infection before encephalitis symptoms begin.

When a case of encephalitis is not very severe, the symptoms may be similar to those of other illnesses, including:

Fever that is not very high
Mild headache
Low energy and a poor appetite
Clumsiness, unsteady gait
Confusion, disorientation
Drowsiness
Irritability or poor temper control
Light sensitivity
Stiff neck and back (occasionally)

Symptoms in NEWBORNS and younger infants may not be as easy to recognize, such as:

Body stiffness
Irritability and crying more often (these symptoms may get worse when the baby is picked up)
Poor feeding..
Soft spot on the top of the head may bulge out more
Vomiting

Emergency symptoms

Seizures
Memory loss (amnesia), impaired short-term or long-term memory
Loss of consciousness, poor responsiveness, stupor, coma
Severe headache
Sudden change in mood and mental functions
Impaired judgment
Inflexibility, extreme self-centeredness, inability to make a decision
Less interest in daily activities
Withdrawal from social interaction
Muscle weakness or paralysis

Complications with Encephalitis

The complications resulting from encephalitis depend on several factors, including age, the cause of the infection, the severity of the initial illness and the time from disease onset to treatment.

In most cases, people with relatively mild form of the illness recover within a few weeks with no long-term complications.

Complications of severe illness:

Injury to the brain from inflammation
Respiratory arrest
Coma
Death

Some complications — may persist for many months or be permanent, like:

Fatigue
Weakness
Mood disorders
Personality changes
Memory problems
Intellectual disabilities
Lack of muscle coordination
Paralysis
Hearing or vision defects
Speech impairments

The inflammation that is associated with encephalitis can also result in what’s known as Aquired Brain Injury which can lead to long-term complications, including:

Epilepsy with repeated seizures
Developmental difficulties
Attention, concentration and problem solving problems
Memory loss
Behavioral and personality problems
Psychiatric problems
Autistic-like behavior
Physical and motor difficulties
Sleep disorders

An examination may show:

Abnormal reflexes
Increased intracranial pressure
Mental confusion
Mouth ulcers
Muscle weakness
Neck stiffness
Signs in other organs, such as the liver and lungs
Skin rash
Speech problems

Diagnostic tests for encephatlitis

X-ray — which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

Magnetic resonance imaging (MRI) — using a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

Computed tomography scan (CAT or CT scan) — an imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body.

A CAT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CAT scans are more detailed than general x-rays.

Blood tests, urine and stool tests.

Sputum culture — performed on the material that is coughed up from the lungs and into the mouth. A sputum culture is often performed to determine if an infection is present.

Electroencephalogram (EEG) — recording the brain’s continuous, electrical activity by means of electrodes attached to the scalp.

Spinal tap (or lumbar puncture) — a special needle is placed into the lower back, around the spinal cord. The pressure in the spinal canal and brain can then be measured.

Cerebral spinal fluid (CSF) is the fluid that bathes the brain and spinal cord. A small amount of it can be removed and sent for testing to determine if there is an infection or other problems.

Brain biopsy — involves removing tissue or cells from the body for examination under a microscope. In rare cases, a biopsy of affected brain tissue may be removed for diagnosis.

Intracranial pressure monitoring (ICP) — measuring the pressure inside the skull. If there is a severe brain injury, head surgery, brain infection, or other problems, the brain may swell.

Since the brain is covered by the skull, there is only a small amount of room for it to swell.

This means that, as the brain swells, the pressure inside the skull increases.

If the pressure gets significantly higher than normal, it can cause damage to the brain.

People who have hydrocephalus or brain tumors may also have their intracranial pressure monitored.

Prevention from encephalitis

The most effective way to protect against encephalitis is to make sure that you receive the MMR vaccine (for measles, mumps and rubella).

The first MMR vaccination should be given to all children at around 13 months of age, with a booster dose given before they start school (between three and five years old).

Between 5 and 10% of children are not fully immune after the first dose, so the booster increases protection and results in less than 1% of children remaining at risk.

Vaccinations are also available for Japanese encephalitis, tick-borne encephalitis and encephalitis caused by rabies.

Treatment

The key to treating encephalitis properly is early detection and treatment.

A person with encephalitis requires immediate hospitalization and close monitoring.

The goal of treatment is to reduce the swelling in the head and to prevent other related complications.

Medications to control the infection, seizures, fever, or other conditions may be used.

The extent of the problem is dependent on the severity of the encephalitis and the presence of other organ system problems that could affect the person.

In severe cases, a breathing machine may be required to help you breathe easier.

As you recover, physical, occupational, or speech therapy may be necessary to help regain muscle strength and/or speech skills.

The healthcare team will educate your family after hospitalization on how to best care for you at home, and outline specific clinical problems that require immediate medical attention by your physician.

Reorientation and emotional support for confused or delirious people may be helpful.

Medications

Treatment depends on the type of encephalitis you have, but may include:

Anti-seizure medications (such as phenytoin) — to prevent seizures
Immunosuppressants — medicines that stop the immune system from attacking healthy tissue
Immunoglobulin therapy — a type of donated blood product that contains a number of specific antibodies, which help regulate the immune system’s abnormal function
Steroid injections (such as dexamethasone) — to reduce brain swelling
Antiviral medications, like acyclovir (Zovirax) and foscarnet (Foscavir) — to treat herpes encephalitis or other severe viral infections (however, no specific antiviral drugs are available to fight encephalitis)
Plasmapharesis — removing the blood and discarding the parts that contain antibodies. After the blood has been treated, it is returned to your body
Antibiotics — if the infection is caused by certain bacteria
Sedatives — to treat irritability or restlessness
Acetaminophen —for fever and headaches

Prognosis

According to the CDC (Centers for Disease Control and Prevention), USA, encephalitis occurs in approximately 0.5 in every 1000,000 individuals, most of them children, elderly people and individuals with weakened immune systems.

And the outcome varies. Some cases are mild and short, and the person fully recovers.

Other cases are severe, and permanent impairment or death is possible.

The acute phase normally lasts for 1-2 weeks. Fever and symptoms gradually or suddenly disappear. Some people may take several months to fully recover.

Research

Research is an important priority towards of the treatment of the epileptic encephalopathies, since these patients may not respond to standard anti-seizure medications.

Research scientists are studying the effects of high-dose benzodiazepines and pulse intravenous corticosteroids on the EEG, the neuropsychologic manifestations of electrical status, epilepticus of sleep, and the genetics of the epileptic encephalopathies.

Hopefully, a clinical treatment will be available in the near future.

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Resources:
http://health.nytimes.com/health/guides/disease/encephalitis
http://www.epilepsyletstalkaboutit.com/EPILEPSY___ENCEPHALITIS.html
http://www.encephalitis.info/files/9813/4012/7811/FS028_Old_Version.pdf
http://www.nhs.uk/Conditions/Encephalitis/Pages/Introduction.aspx
http://www.medicalnewstoday.com/articles/168997.php
http://epilepsy.med.nyu.edu/our-center/epileptic-encephalopathies-cee
http://www.webmd.com/a-to-z-guides/understanding-encephalitis-basics
http://www.hse.ie/eng/health/az/E/Encephalitis/Causes-of-encephalitis.html
https://www.clinicalkey.com/topics/neurology/encephalitis.html


28 Comments »

  1. Mine was meningitis. I’m guessing infection of the meninges would give a similar article?

    Like

    Comment by Paul — September 22, 2013 @ 11:52 AM

  2. Unfortunately, it appears so.

    “Infection of the nervous system can involve the meninges (meningitis) or the brain substance itself (encephalitis), or both (meningoencephalitis).

    Additionally, infections can be acute or chronic.

    The organisms that are involved in infection are bacterial, parasitic or viral.

    Additionally, prions represent an unusual class of infectious agent that can damage the brain.”

    http://www.dartmouth.edu/~dons/part_3/chapter_25.html

    Like

    Comment by Phylis Feiner Johnson — September 22, 2013 @ 1:07 PM

  3. WOW good to know that I am not alone with suffering a seizure post E. My battle with HSE was in 2006 and I’d never had a seizure until this past April then a 2nd one in October 2013. It took me 7 years post E to have to be on anti-seizure medications.

    Like

    Comment by Murray — December 14, 2013 @ 6:50 AM

  4. Murray, it must be such a disappointment.

    First a triumph. Then a kick in the teeth. (Head?)

    We have a guy who had completely successful brain surgery four years ago and has been seizure free ever since.

    But he still goes to the neuro every four months — gets an EEG and is on Phenobarbital and Dilantin as a “safety” measure.

    Is it a possibility that yours were “break-through” seizures?

    Like

    Comment by Phylis Feiner Johnson — December 14, 2013 @ 10:49 AM

  5. Since June ’64, I’m getting seizures; once fell down a mountain. Doctors have tested me on medicines like Delantin-Mysolin-Tegratol-and another, all made me lose my temper. Some new medicines prescribed are controlling the seizures. These went on increasing on each visit to the doctor but on decreasing two of the medicines, the the No. of gaps, in days, my remaining free of the seizures has increased from an average of getting them on every 5th day, to an average of every 40th day. At present I’m taking 12 prescribed tabs. daily which give me 10 to 12 hrs. sleep daily. No longer am I short tempered, no longer I fall, whether walking or standing, as I used to before, no longer saliva comes of my mouth. neither do I bite the inner portions of my cheeks. Spinal tap was given on the 1st day of the very 1st convulsion I had in 1964. Mysoline was the medicine that suited me best, gave me a gap of 3 and a half years. At present I’m taking 2 tabs. of Gardinal, 1 each of Fresium 10 and 5, 4.5 tabs, of Lamez 100, 1 tab. Lamez 5, and 3 tabs. of Eptoin. People in the church and the care cell I go to are praying for me so to get healed completely, which have made me better. I too pray for all of you to get better and completely healed, as I feel that there is no other medicine better than prayer, not only I, but all of you would get healed cent percent through prayer.

    Like

    Comment by Jatinder Kumar Ahooja — June 4, 2015 @ 3:54 PM

  6. Jatinder, I am touched and encouraged to hear from you. Although modern medicine has helped your case, I think that — in the absence of a “cure” — faith will get you through.

    Like

    Comment by Phylis Feiner Johnson — June 4, 2015 @ 4:25 PM

  7. My daugther also experience that sickness but all the test are negative made to her are negative. It is possible to her childhood trauma?

    Like

    Comment by Eugene Lumague — January 31, 2016 @ 7:29 PM

  8. “The most common cause of encephalitis is infection by a virus.

    In very rare cases, encephalitis can also be caused by bacterial infection, parasites, or complications from other infectious diseases.

    Many viruses can cause encephalitis.

    The West Nile virus, for example, has been responsible for well-publicized outbreaks in the U.S.

    Most people exposed to encephalitis-causing viruses have no symptoms.

    Others may experience a mild flu-like illness, but do not develop full-blown encephalitis.”

    http://www.nytimes.com/health/guides/disease/encephalitis/print.html

    New research shows evidence of altered brain functioning as a result of early abuse and neglect.

    These changes are associated with adult anxiety, depression and personality disorders.

    Basically, abuse releases a cascade of stress hormones which produces a lasting effect on brain signals.

    Experiments at McLean Hospital, for example, show that patients with a history of abuse are twice as likely to show abnormal electrical activity as non abused people.

    And this abnormal electrical brain activity, in turn, resembles a seizure state, but doesn’t actually produce epilepsy.

    In short, encephalitis is a viral infection, while childhood trauma can result in seizure or seizure like activity.

    Like

    Comment by Phylis Feiner Johnson — January 31, 2016 @ 8:02 PM

  9. Your advice will be a great peace of mind for us and to me as well and to my daugther.

    Like

    Comment by Eugene Lumague — January 31, 2016 @ 8:20 PM

  10. Glad I could help in any way.

    Like

    Comment by Phylis Feiner Johnson — February 1, 2016 @ 9:46 AM

  11. Encephalitis is a known “rare” side effect of injecting weakened live virus into lab rats . Post vaccine encephalitis is not that rare. It is simply renamed.

    Like

    Comment by alittlebirdy — May 21, 2016 @ 2:23 AM

    • What is the medicines for that sickness and how can be prevented? Is there herbal medicine for that sickness.?

      Like

      Comment by eugene lumague — May 22, 2016 @ 9:18 PM

      • “Complications with encephalitis can include epilepsy.

        The majority of patients who have encephalitis go on to have at least one complication, especially elderly patients, those who had symptoms of coma, and individuals who did not receive prompt treatment.

        Complications may include:

        Loss of memory – especially among those who had herpes simplex virus encephalitis.

        Behavioral or personality changes – such as mood swings, bouts of frustration and anger, and anxiety

        Epilepsy

        Aphasia – language and speech problems.

        Prevention of encephalitis:

        Vaccines – keeping up-to-date with vaccines is the most effective way of reducing the risk of developing encephalitis.

        These include vaccines for measles, mumps, rubella, and if the virus exists in those areas, Japanese encephalitis and tick-borne encephalitis.”

        http://www.medicalnewstoday.com/articles/168997.php?page=2#treatments_for_encephalitis

        Like

        Comment by Phylis Feiner Johnson — May 23, 2016 @ 9:18 AM

      • Good evening we had already take the test of all you said even japanese virus and the result are negative we don’t even know what is the real cause of her sickness and we under go mri test nd lumbar test and the result are negative and also eeg. Please give us real details or you may call us through this number we buy medicines for her sickness taking phenobarbital 60mg nd valproic valpross. I’am wondering she got too much of this medicines and affect her brain losses.

        Like

        Comment by eugene lumague — May 24, 2016 @ 7:51 PM

  12. Thanks very much for the clarification.

    Like

    Comment by Phylis Feiner Johnson — May 21, 2016 @ 9:14 AM

  13. Eugene, I don’t think it’s the medicines, I think it’s deeper than that.

    Have you been to a rheumatologist?

    Like

    Comment by Phylis Feiner Johnson — May 25, 2016 @ 10:16 AM

    • Good day! We didn’t go to the rheumatologist ever since. Why is it possible that rheumatologist can detect the main cause of it? Why our neurologist didn’t recommend to examine it before it was treated? We spend half a million pesos but we didn’t noticed the result what is her diagnosed what is the root cause of her sickness where it comes from. We are from the Philippines. My daughter stopped on her school because she always trigger that seizures attack when the stress and tensions occur. We don’t know really why it’s happen. As you can see she is normal in emotion. Please see here picture as a fine lady. During after she was confined and hospitalized and her present status. Before and after. This is my number if you want to contact me, +639053837525 Eugene Lumague and Patricia Marie Lumague

      Like

      Comment by eugene lumague — May 25, 2016 @ 12:10 PM

  14. Eugene, I just don’t know what to say.

    You’ve exhausted all my knowledge and I’m so very sorry I can’t help you. 😦

    Like

    Comment by Phylis Feiner Johnson — May 25, 2016 @ 12:57 PM

    • Good morning please help me or refer us to the better neurologist and tell them what we discuss the pictures I’ve sent is the proof that she was hospitalized. Please help me and my daughter she is the only girl among my children and she is the oldest of my 4 children. Please don’t leave us like this. I know you better doctors in your country. I almost gather donors outside our country but need someone or a specialist who answer neither help my daughter about her sickness. Actually she seizures again this morning. After 1 month interval, her last seizures is April. Kindly give us strength to over come all of this.

      Thanks you. Eugene Lumague

      Like

      Comment by eugene lumague — May 25, 2016 @ 11:07 PM

  15. Dear Eugene, I can refer you to doctors and hospitals in the U.S. where you’d make an appointment and bring all of your daughter’s previous films, records, etc.

    But you must remember, I am not a doctor!

    Below is a compilation by website forum members who have had positive personal experiences with docs over the years.

    This list is based on recommendations and, of course, is purely subjective. But it might be helpful for anyone looking for a good Neurologist…Epileptologist…Neurosurgeon…or Pediatric Doctor.

    NOTE: The National Association of Epilepsy Centers (NAEC) provides a directory of specialized epilepsy centers in the U.S. along with other useful information about epilepsy. http://www.naeclocator.org/find.htm

    2016 Comprehensive List of GOOD Neurologists…Epileptologists… Neurosurgeons…and Pediatric Doctors

    https://epilepsytalk.com/2016/01/03/2016-comprehensive-list-of-good-neurologistsepileptologists-neurosurgeonsand-pediatric-doctors/

    Also:

    2016 Top Ranked Hospitals for Neurology and Neurosurgery

    https://epilepsytalk.com/2016/01/10/2016-top-ranked-hospitals-for-neurology-and-neurosurgery/

    Like

    Comment by Phylis Feiner Johnson — May 26, 2016 @ 10:27 AM

    • Okay thank you very much for your generously offer. Okay i will photo all the medical records of my daughter and then i will send it all to you right away. Ms Phyllis i also apply for go fund there at US for her medical expenses but unfortunately i cannot connect please do all this help for my daughter need for the good guidance of God’s will.

      Thanks Eugene Lumague

      Like

      Comment by eugene lumague — May 28, 2016 @ 2:43 AM

  16. Eugene, I meant to give all these medical records to another DOCTOR (for another opinion) not ME.

    I wish there was more I can do for you, but I can’t.

    Like

    Comment by Phylis Feiner Johnson — May 28, 2016 @ 8:55 AM

    • Yes my dear Ms Phyllis i will and just be patient because my daughter has another check up for the latest result of her EEG test after that that i send to you the latest result OK. Thank you again and God bless you and your family.

      Thanks Eugene

      Like

      Comment by eugene lumague — May 29, 2016 @ 8:56 AM

  17. Has she had more in-depth testing than the EEG?

    If not, this article may interest you:

    Beyond EEGs…Diagnostic Tools for Epilepsy

    https://epilepsytalk.com/2010/09/13/beyond-eegs%E2%80%A6diagnostic-tools-for-epilepsy-2/

    Like

    Comment by Phylis Feiner Johnson — May 29, 2016 @ 12:12 PM

    • Good day !

      I don’t know yet but as soon as it already may the test i will send it to you right away.

      Thanks: Eugene

      Like

      Comment by eugene lumague — May 30, 2016 @ 1:32 AM

  18. Eugene please understand I can’t read the results (I’m not a doctor and I don’t know how) but I’ll be happy to know how the test went.

    Like

    Comment by Phylis Feiner Johnson — May 30, 2016 @ 9:25 AM

  19. I am Sarah Robinson from USA. Dr. kasmo God will continue to bless you more
    abundantly, for the good works you are
    doing in peoples life, I will keep on testifying
    about your good work, I was healed from
    HERPES VIRUS through the help of Dr kasmo. I
    saw a blog on how Dr kasmo known as “LORD
    SPIRITUAL” cured people with his herbal
    treatment, i did not believe but i just decided
    to give him a try, I contacted him and he
    prepare the herbs for me which i took, after
    taking it, he told me to go for check up, could
    you believe that i was confirm herpes
    negative after the test, and i went to a
    different hospital and it was also negative, i
    am so happy. If you have any problem or
    you are also infected with any disease, kindly
    contact him now with his Email:
    Drkasmotemple@gmail.com

    Like

    Comment by Sarah Robinson — October 14, 2016 @ 6:11 PM

  20. Sarah, thanks so much for the information and the link. What kind of herbs did you take?

    Like

    Comment by Phylis Feiner Johnson — October 14, 2016 @ 6:48 PM


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    About the author

    Phylis Feiner Johnson

    Phylis Feiner Johnson

    I've been a professional copywriter for over 35 years. I also had epilepsy for decades. My mission is advocacy; to increase education, awareness and funding for epilepsy research. Together, we can make a huge difference. If not changing the world, at least helping each other, with wisdom, compassion and sharing.

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