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Tick-borne encephalitis carries a high risk of incomplete recovery in children

Åsa Fowler1, Lea Forsman, Margareta Eriksson

  • 1Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. asa.fowler@ki.se

The Journal of Pediatrics
|March 5, 2013
PubMed

Insights

Many children experience long-term cognitive deficits, including executive functioning and working memory issues, after tick-borne encephalitis (TBE) affecting the central nervous system. Continued monitoring is recommended for these children.

Area of Science:

  • Pediatric Neurology
  • Infectious Diseases
  • Neuroscience

Background:

  • Tick-borne encephalitis (TBE) is a viral infection that can affect the central nervous system.
  • Children are susceptible to TBE, and understanding long-term outcomes is crucial for effective management.
  • Previous studies have highlighted the potential for neurological sequelae following TBE.

Purpose of the Study:

  • To evaluate the long-term neurological and cognitive outcomes in children following TBE with central nervous system involvement.
  • To identify specific areas of cognitive deficit, particularly in executive functioning and working memory.
  • To inform clinical follow-up protocols for children recovering from TBE.

Main Methods:

  • A population-based cohort study of 55 children diagnosed with TBE and central nervous system involvement between 2004-2008.
  • Long-term follow-up assessments conducted 2-7 years post-infection.
  • Utilized the Rivermead post-concussion symptoms questionnaire and the Behavior Rating Inventory of Executive Functioning (BRIEF) for parents and teachers.
  • Assessed general cognitive ability and working memory using the Wechsler Intelligence Scale for Children, 4th edition (WISC-IV) in a subgroup.

Main Results:

  • Two-thirds of children reported persistent symptoms, including cognitive problems, headaches, fatigue, and irritability.
  • Over one-third of children exhibited executive functioning deficits, particularly in activity initiation, organization, and working memory, as reported by parents and teachers.
  • Children assessed with the WISC-IV demonstrated significantly lower working memory index scores compared to normative data.

Conclusions:

  • A significant proportion of children experience incomplete recovery from TBE affecting the central nervous system.
  • Cognitive impairments, especially in executive functions and working memory, are the most common long-term sequelae.
  • Despite low mortality and severe sequelae rates, all children with TBE should undergo follow-up to detect potential cognitive deficits.
Abstract

Keywords:
BRIEFBehavior Rating Inventory of Executive FunctionCNSCSFCentral nervous systemCerebrospinal fluidEEGElectroencephalogramRPQRivermead post-concussion symptoms questionnaireTBETBE virusTBEvTick-borne encephalitisWBCWISC-IVWechsler Intelligence Scale for Children, 4th editionWhite blood cells

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