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Chen et al. Characteristics of viral encephalitis with epilepsy

examination. Treatment and prognosis: all the patients were given antiviral treatment. Twenty-eight cases of the patients with epilepsy
(71.79%) are used of antiepileptic drugs. The prognosis of patients with epilepsy was poor (P < 0.05). Conclusion: Viral encephalitis
frequently manifests with seizures in its acute phase, and the incidence of seizures in our study was 33.62%. The main form was
generalized seizures (64.10%), which could occur at any age; patients with epilepsy had a higher cortical involvement on imaging and
a higher degree of EEG abnormalities than patients without; patients with epilepsy had a higher level of glucose in the CSF; an episode
of viral encephalitis complicated with seizures could aggravate disturbances of consciousness and cognitive impairment. The prognosis
of patients with epilepsy was poor.

INTRODUCTION most cases. The numeration of leukocyte is (50-500) ×
10 /L in the cytological examination and most of them
6
Viral encephalitis refers to an acute inflammatory are lymphocytes. Cerebrospinal fluid examination has
process of the brain parenchyma due to direct viral important significance for distinguishing other types
infection. The estimated incidence of clinically- of encephalitis. The appearances on early EEG are
[3]
diagnosed viral encephalitis is 3.5-7.4/100,000/year. mainly abnormal rhythm and increased slow wave
[1]
At present, we have found more than 130 viruses that in viral encephalitis patients. CT shows foci mainly
[4]
can cause viral encephalitis. The common viruses located in one or both temporal lobes and single or
found in the clinic are the herpes simplex virus Type-I, multiple low density foci. CT is currently used only
Type-II (HSV-I, II), varicella-zoster virus, Japanese for infant patients and patients who do not cooperate
encephalitis virus, and enterovirus (mainly for ECHO or who move restlessly. MRI is the most important
virus and Coxsackie virus). Among the sporadic viral imaging examination. The edge of an abnormal area
encephalitides, herpes simplex encephalitis (HSE) is on a routine MRI scan is often unclear and may
perhaps the most frequently associated with epilepsy, include lesions and peripheral edema. It will show
which may often be severe. Among the epidemic a long T1 and long T2 signal and a short T1 and
(usually due to flaviviruses) viral encephalitides, long T2 when it is accompanied by hemorrhage.
Japanese encephalitis (JE) is the most common Lesions also show high signal on diffusion weighted
and is associated with acute symptomatic seizures, imaging (DWI). An enhanced MRI may have a higher
especially in children. [2] sensitivity for immune compromised patients and mild
patients and may include blood brain barrier damage
There are many methods for detection of viral [Figures 1 and 2]. [5]
encephalitis, but they all have advantages and
disadvantages. Even with the best efforts, 30-60% Viral encephalitis frequently manifests with seizures in
of patients with clinically suspected viral encephalitis its acute phase with an incidence of 19.0-62.69%. [6,7]
still cannot be diagnosed. Virological diagnosis is the Epileptic seizures may aggravate brain parenchyma
“gold standard.” But isolation of the virus is seldom damage and induce many severe complications that
accomplished due to the difficulty in obtaining brain affect prognosis and quality of life, such as: pulmonary
tissue through biopsy and a lack of specialized infectious disease; respiration-circulation failure;
facilities for viral cultures in many places. Moreover, fractures and tongue biting in patients with general
there were greater complications of brain biopsy. Virus tonic-clonic seizures; and water-electrolyte imbalance
antibody testing in serum or cerebrospinal fluid (CSF) in patients with status epilepticus. So far the researches
are simpler to perform and more widely available than of viral encephalitis complicated with epilepsy are
brain biopsy, but it has low sensitivity because many not completely consistent. Herein, we retrospectively
viruses do not express specific antibodies. Virus nucleic studied 116 cases of viral encephalitis and compared
acid testing has higher sensitivity and specificity. the difference between those complicated with epilepsy
Polymerase chain reaction (PCR) technology and those without. As a result, we are able to diagnosis
has significantly improved virological diagnosis. early and take effective treatment to reduce mortality
But many laboratories fail to meet the technical and improve prognosis.
requirements and, thus, restrict the widespread
application in this area of clinical microbiology. METHODS
Therefore, the diagnosis of viral encephalitis currently
depends on cerebrospinal fluid examination, brain Subject investigated
magnetic resonance imaging (MRI) or computed We retrospectively studied 116 cases of viral
tomography (CT), and electroencephalogram (EEG). encephalitis admitted to the General Hospital of Ningxia
Cerebrospinal fluid examination manifests with normal Medical University and the Cardio-Cerebrovascular
or elevated encephalic pressure, normal or mildly Disease Hospital of Ningxia Medical University from
elevated protein, and normal sugar and chloride in January 2011 to December 2016. The inclusion
Neuroimmunology and Neuroinflammation ¦ Volume 4 ¦ July 11, 2017 125