Encephalitis

Dear Lisa,

My daughter was diagnosed about 6 weeks ago with viral meningoencephalitis. She is 14 years old. Although the initial recovery period was going well she has seemed to have lingering continuous headaches as well as short term memory loss and loss of sense of smell. At what point in time should we become more concerned. Everyone keeps saying that this is just part of the recovery and she is just slow to recover. It has impacted her grades as she can't concentrate as well. When would you recommend becoming more concerned? Currently she has tried multiple meds for the headaches including Depakote, Elavil, Diamox, Dexamethalosone, Darvocet, Ibuprophen, and Tylenol. None have shown much improvement. She is scheduled to be assessed at a mild- TBI clinic to help her cope with the disabilities whether they be short or long term situations. Any other input on whether this is normal or whom to contact would be appreciated.

“Daughter had Encephalitis”

Dear “Daughter had Encephalitis”,

I’m sorry to hear about your daughter’s illness. I am glad to hear that she is recovering.

Encephalitis is a very serious condition. It is an inflammation of the brain that sometimes includes the meninges (the lining of the spinal cord). Encephalits can be caused by a virus or a vector borne illness(a disease transmitted through an insect bite). In the past Enteroviruses have been the most frequent cause of Encephalitis in the United States. (1)

Vector borne illnesses have become a concern in the United States since the emergence of the West Nile Virus in 1999.(2) From the years 1999 to 2005, there have been 19,600 cases of West Nile Virus reported to the Centers for Disease Control in the United States. (2) In the year 2005, there were 1288 cases of West Nile Viruses in the United States that caused West Nile neuroinvasive diseases such as Meningitis, Encephalitis or acute flaccid paralysis.(2) Other causes of Encephalitis include Arboviruses, Chicken Pox, Infectious Mononucleosis and the Eastern Equine Encephalitis Virus (EEEV).(1,3)

The disease course for Encephalitis can vary depending upon the cause of the Encephalitis. The disease course can also be variable from one child to the next. Your doctor can tell you the cause of your daughter’s Encephalitis and his impression of your daughter’s condition and residual symptoms.

The sequelae or residual symptoms that linger after having Encephalitis also can vary from child to child. The symptoms that your daughter is experiencing; headaches, short term memory loss, difficulty concentrating and loss of sense of smell are some of the neurological symptoms that children can experience. On going treatment with support services can help her recovery. Close follow up with your neurologist should be continued in order to treat your daughter’s headaches and monitor her cognitive functioning, short term memory loss and problems concentrating.

Your daughter may benefit from a consultation with a Neurodevelopmental specialist who can assess her learning ability and guide you in regards to a tutoring program. A Neurodevelopmental Specialist is a Neurologist that specializes in development and learning. An evaluation by a Neurodevelopmental specialist can assess and treat your daughter’s memory loss, difficulty concentrating and any other learning issues that may arise. You can ask the clinic that you have an appointment with if they have a Neurodevelopmental specialist on staff. If not, one can be found on staff at a pediatric rehabilitation hospital.

The public school systems in the United States have Child Study teams which provide evaluations and treatment for children with potential problems learning. The team is typically comprised of a group of specialists including, learning specialists, educators, psychologists, social workers, speech therapists and occupational therapists. Since your daughter’s symptoms are affecting her grades an evaluation by the Child Study Team at her school is an option that you can explore. If you contact your daughter’s school system or the department of education in your town they will be able to tell you about the services that she qualifies for.

As a parent it must be very difficult to see your daughter suffer from residual effects of her illness. Sometimes, it may be easier to cope with an illness and the way it impacts your family's life if you take one step at a time. The first step is realizing how lucky you are that you have your daughter and that she is recovering. Some parents are not that fortunate because Encephalitis can be fatal and many children do not survive. Knowing this may help you deal with the difficulties that your daughter is experiencing.

The next step is to take one day at a time and concentrate on the issues at hand. Right now your daughter’s headaches and difficulty learning are the problems that need addressing. Rather then wait and see how long these issues will last and how they will impact her life, it would be better to address the issues now that they are present. You can discuss these concerns with your Pediatrician and during the clinic appointment that you have. Recruiting help from specialists in these two areas can also help your daughter’s recovery.

I wish you and your daughter well.

References:
(1) Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:1799-1800.
(2)Grassia T. West Nile Virus shifts to the western states. Infectious Diseases in Children. 2006. May44,47.
(3)Grassia T. CDC evaluates EEEV outbreak in New Hampshire. Infectious Diseases in Children. 2006. May:43.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice Website