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Cited by 45Infectious Encephalopathies and EncephalitisMosquito-borne diseases and controlVirology and Viral Diseases

Japanese encephalitis (JE) part II: 14 Years’ follow-up of survivors

Sarkari, N. B. S., Thacker, A. K., Barthwal, S. P., Mishra, V. K., Prapann, Shiv, Srivastava, Deepak, Sarkari, M.·2012·Journal of Neurology
DOI 10.1007/s00415-011-6131-9
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Abstract

Japanese encephalitis, the commonest Arbovirus encephalitis, has been endemic in many parts of Asia, the Pacific Islands, and India; also, there have been many epidemics. Most of the post JE cases have been associated with neurological and neuropsychiatric deficits but have not been properly classified and followed. Practically all the previous studies were in children or young adults. The aim of this study, involving only adult cases, the largest ever being reported, has been to follow the 688/1,199 survivors of JE patients out of 1,282 of acute cases admitted during four epidemics for a period of 14 years after properly classifying the sequelae. This prospective study was conducted in B.R.D. Medical College Gorakhpur (India), involving 665/688 post JE cases with neuropsychiatric deficits from four epidemics of 1978, 1980, 1988 and 1989 which were properly classified in nine groups. While the first epidemic of 1978 was being studied, more disastrous episodes flared up and the patients were subsequently added. Hence, the total duration of this prospective study was from November 1978 to December 2003. There were 14 defaulted initially from 688 followed (23/688 without sequelae and 665/688 with neuropsychiatric deficits), and later 130 were lost from time to time at various stages of follow up. Four out of 23/688 discharged without any deficit had to be readmitted for bizarre movements, assaultative behaviour and euphoria without fever and altered sensorium. All of them improved by symptomatic treatment. Progressive improvement occurred in all the parameters consisting of psychological disturbances, higher cerebral dysfunction, speech disorders (dysphonia, dysarthria, dysphasias, apraxia and agnosia), extra pyramidal, pyramidal features, and hypothalamic disturbances, cranial nerves including pupils and fundi and seizures. Maximum cases improved between 6 months (55%) to 1 year (78%). Only some features improved between 5 to 14 years. Four patients of hemiplegia remained bed ridden. Some non disabling features like dysarthria and corticospinal features without paralysis persisted in 5% (95% improved) and 74% (26% improved) respectively. One patient with bizarre movement and nine with marked tremors could not regain normalcy. A large number of patients of JE are left with several minor or gross residual neuropsychiatric and neurological features after the acute phase. In this series also the discharged patients with neurological deficits who were quite disabled initially and needed constant care by family members and also those who required some help intermittently improved with passage of time and eventually returned to normal life. Some of them were left with non-disabling residual neurological signs even after 14 years. Fourteen of 544 (3%) could not return to their livelihood.

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Authors
Sarkari, N. B. S., Thacker, A. K., Barthwal, S. P., Mishra, V. K., Prapann, S., Srivastava, D., & Sarkari, M.
Affiliations
  • Baba Raghav Das Medical College (IN)
  • Motilal Nehru Medical College (IN)
Corresponding author
  • Sarkari, N. B. S.
  • Thacker, A. K.
  • Barthwal, S. P.
  • Mishra, V. K.
  • Prapann, Shiv
  • Srivastava, Deepak
  • Sarkari, M.
ORCID
Venue
Journal of Neurology
Publisher
Springer Science and Business Media LLC
Published
2011-06-18
Volume
259
Issue
1
Pages
58-69
ISSN
  • 0012-1037 (ISSN-L)
  • 0340-5354
  • 1432-1459
DOI
10.1007/s00415-011-6131-9
OpenAlex
W1968008550
Cited by
45
References
31
Citations by year
2026: 2 · 2025: 4 · 2024: 2 · 2023: 5 · 2022: 4 · 2021: 3 · 2020: 5 · 2019: 3 · 2018: 2 · 2017: 2 · 2016: 1 · 2015: 5 · 2014: 5 · 2013: 1 · 2012: 1
FWCI
1.51
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Journal of Neurology (publishedVersion)
  • PubMed (publishedVersion)
Funders
University of Oxford
Topics
  • Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Mosquito-borne diseases and control
  • Health Sciences › Medicine › Epidemiology › Virology and Viral Diseases
Keywords
Japanese encephalitis, long-term follow-up, neuropsychiatric sequelae, adult survivors, arboviral encephalitis, post-encephalitic sequelae, speech disorders, seizures, hemiplegia, altered sensorium
MeSH terms
Adolescent, Adult, Age Factors, Aged, Anti-Inflammatory Agents, Dexamethasone, Encephalitis Virus, Japanese, Encephalitis, Japanese, Enzyme-Linked Immunosorbent Assay, Female, Follow-Up Studies, Hospitalization, Humans, Immunoglobulin M, India, Length of Stay, Male, Middle Aged, Nervous System Diseases, Prospective Studies, Sex Factors, Glasgow Coma Scale, Treatment Outcome, Survivors, Young Adult, Epidemics

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