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Jin H, Huang R, Li Z, Liu M, Zhao N, Zhang H, Lin Y. Acupuncture improves spatial learning and memory impairment caused by herpes simplex virus type-1 in rats through the p38 MAPK/CREB pathway. J Physiol Sci 2024; 74:49. [PMID: 39363248 PMCID: PMC11448188 DOI: 10.1186/s12576-024-00941-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 09/12/2024] [Indexed: 10/05/2024]
Abstract
BACKGROUND Acupuncture can improve herpes simplex encephalitis (HSE), but the underlying mechanism is not clear. Therefore, we evaluated the cognitive function and apoptosis in hippocampus caused by herpes simplex virus type-1 (HSV-1) in rats after acupuncture and described the molecular mechanism. METHODS Sprague-Dawley rats were induced into HSE models by HSV-1 infection. After 3 days, they received acupuncture at the acupoints of Xuanzhong (GB39), Baihui (GV20), Shenmen (HT7), Shenting (GV24), and Sanyinjiao (SP6), and/or intraperitoneal injection of the p38 MAPK inhibitor SB203580. Morris water maze test was performed on rats. The hippocampus of rats was obtained, and the expression of apoptosis-related genes in the tissues was detected by qRT-PCR. In addition, apoptosis-related proteins and proteins related to the p38 MAPK/CREB pathway in the tissues was detected by western blot. RESULTS After HSV-1 induction, the rat's escape latency was increased, the time spent on the platform in the target quadrant and the number of platform crossings significantly decreased. In addition, there was an increase in apoptosis in the hippocampus, accompanied by elevated levels of p-p38 and decreased levels of p-CREB. However, these effects could be improved by acupuncture treatment. Interestingly, SB203580 plays a similar role to acupuncture, and acupuncture could further enhance the impacts of SB203580 on cognitive function and apoptosis in hippocampus in HSE rats. CONCLUSION Acupuncture improves spatial learning and memory impairment caused by HSV-1 in rats. The functional mechanism of acupuncture may be through the p38 MAPK/CREB pathway.
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Affiliation(s)
- Hongjiao Jin
- The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), No. 98 Fenghuang Road, Huichuan District, Zunyi, 563000, Guizhou Province, People's Republic of China
| | - Rui Huang
- The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), No. 98 Fenghuang Road, Huichuan District, Zunyi, 563000, Guizhou Province, People's Republic of China
| | - Zhu Li
- The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), No. 98 Fenghuang Road, Huichuan District, Zunyi, 563000, Guizhou Province, People's Republic of China
| | - Mi Liu
- The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), No. 98 Fenghuang Road, Huichuan District, Zunyi, 563000, Guizhou Province, People's Republic of China
| | - Ning Zhao
- The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), No. 98 Fenghuang Road, Huichuan District, Zunyi, 563000, Guizhou Province, People's Republic of China
| | - Haiyan Zhang
- The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), No. 98 Fenghuang Road, Huichuan District, Zunyi, 563000, Guizhou Province, People's Republic of China
| | - Yong Lin
- The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), No. 98 Fenghuang Road, Huichuan District, Zunyi, 563000, Guizhou Province, People's Republic of China.
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Toomey D, Phan TL, Phan T, Hill JA, Zerr DM. Viral Encephalitis after Hematopoietic Cell Transplantation: A Systematic Review. Transplant Cell Ther 2023; 29:636.e1-636.e9. [PMID: 37422195 DOI: 10.1016/j.jtct.2023.06.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023]
Abstract
Viral encephalitis is a rare but serious complication after hematopoietic cell transplantation (HCT). The nonspecific early signs and symptoms and rapid progression can make it difficult to diagnose and treat in a timely fashion. To better inform clinical decision making in post-HCT viral encephalitis, a systematic review of prior studies of viral encephalitis was performed, with the goal of characterizing the frequency of various infectious etiologies and their clinical course, including treatments and outcomes. A systematic review of studies of viral encephalitis was performed. Studies were included if they described a cohort of HCT recipients who were tested for at least 1 pathogen. Of 1613 unique articles initially identified, 68 met the inclusion criteria, with a total of 72,423 patients studied. A total of 778 cases of encephalitis were reported (1.1%). Human herpesvirus 6 (HHV-6) (n = 596), Epstein-Barr virus (n = 76), and cytomegalovirus (n = 33) were the most commonly reported causes of encephalitis, and HHV-6 encephalitis tended to occur the earliest, accounting for most cases prior to day +100 post-transplantation. Of 29,671 patients with available transplantation data, encephalitis was diagnosed in 282 of 4707 (6.0%) cord blood transplantation (CBT) recipients, in 372 of 24,664 (1.5%) non-CBT allogeneic HCT recipients, and in 5 of 300 (1.7%) autologous HCT recipients. Of the 282 CBT encephalitis cases, 270 (95.7%) were caused by HHV-6. Overall, 288 (37.0%) of the 778 patients with encephalitis died, and 75 deaths were attributable to encephalitis, with the time between diagnosis and death ranging from 3 to 192 days. Viral encephalitis occurs in approximately 1% of HCT recipients, and HHV-6 is the most common cause. Mortality following encephalitis in HCT recipients is high, indicating an urgent need for advancement in preventive and therapeutic strategies.
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Affiliation(s)
- Danny Toomey
- 1Day Sooner Research Team, Delaware; HHV-6 Foundation, Santa Barbara, California.
| | - Tuan L Phan
- HHV-6 Foundation, Santa Barbara, California; Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Thommas Phan
- Department of Statistics, University of California, Davis, California
| | - Joshua A Hill
- Department of Medicine, University of Washington, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center Seattle, Washington
| | - Danielle M Zerr
- Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington
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Jin B, Tang Y, Wu Y, Liu Z. Case report: Tongdu Xingshen acupuncture for a patient with persistent vegetative state after herpes simplex virus encephalitis. Front Neurol 2022; 13:896721. [PMID: 36262837 PMCID: PMC9576148 DOI: 10.3389/fneur.2022.896721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/04/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction A persistent vegetative state (PVS) can be caused by traumatic or non-traumatic brain injury. PVS is a complex clinical condition with numerous complications. Nursing care, medical treatment, and comprehensive rehabilitation are necessary to improve the outcomes of PVS. However, the prognosis remains unsatisfactory. Acupuncture therapy has been used as a rehabilitation strategy to treat patients with PVS in China, showing better results in the recovery of consciousness, intellectual capability, and motor function. Case description We present the case of a 4-month-long PVS after herpes simplex virus encephalitis (HSVE) in a 3.5-year-old boy who underwent Tongdu Xingshen acupuncture integrated with Western medicine and rehabilitation. The patient regained consciousness post-treatment. His intelligence and motor function gradually recovered after seven treatment sessions. Conclusion Tongdu Xingshen acupuncture is a potential complementary therapy to optimize clinical outcomes in PVS.
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Affiliation(s)
- Bingxu Jin
- Department of Rehabilitation, Panyu Hospital of Chinese Medicine, Guangzhou, China
| | - Yuyuan Tang
- Clinical Research and Big Data Laboratory, South China Research Center for Acupuncture and Moxibustion, Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yunyun Wu
- Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhenhuan Liu
- Department of Children Rehabilitation, Nanhai Maternity and Children Hospital, Guangzhou University of Chinese Medicine, Foshan, China
- *Correspondence: Zhenhuan Liu
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Herpesvirus Infections in the Human Brain: A Neural Cell Model of the Complement System Derived from Induced Pluripotent Stem Cells. Curr Top Behav Neurosci 2022; 61:243-264. [PMID: 36059003 DOI: 10.1007/7854_2022_383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Herpesviruses alter cognitive functions in humans following acute infections; progressive cognitive decline and dementia have also been suggested. It is important to understand the pathogenic mechanisms of such infections. The complement system - comprising functionally related proteins integral for systemic innate and adaptive immunity - is an important component of host responses. The complement system has specialized functions in the brain. Still, the dynamics of the brain complement system are still poorly understood. Many complement proteins have limited access to the brain from plasma, necessitating synthesis and specific regulation of expression in the brain; thus, complement protein synthesis, activation, regulation, and signaling should be investigated in human brain-relevant cellular models. Cells derived from human-induced pluripotent stem cells (hiPSCs) could enable tractable models. METHODS Human-induced pluripotent stem cells were differentiated into neuronal (hi-N) and microglial (hi-M) cells that were cultured with primary culture human astrocyte-like cells (ha-D). Gene expression analyses and complement protein levels were analyzed in mono- and co-cultures. RESULTS Transcript levels of complement proteins differ by cell type and co-culture conditions, with evidence for cellular crosstalk in co-cultures. Hi-N and hi-M cells have distinct patterns of expression of complement receptors, soluble factors, and regulatory proteins. hi-N cells produce complement factor 4 (C4) and factor B (FB), whereas hi-M cells produce complement factor 2 (C2) and complement factor 3 (C3). Thus, neither hi-N nor hi-M cells can form either of the C3-convertases - C4bC2a and C3bBb. However, when hi-N and hi-M cells are combined in co-cultures, both types of functional C3 convertase are produced, indicated by elevated levels of the cleaved C3 protein, C3a. CONCLUSIONS hiPSC-derived co-culture models can be used to study viral infection in the brain, particularly complement receptor and function in relation to cellular "crosstalk." The models could be refined to further investigate pathogenic mechanisms.
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Damiano RF, Guedes BF, de Rocca CC, de Pádua Serafim A, Castro LHM, Munhoz CD, Nitrini R, Filho GB, Miguel EC, Lucchetti G, Forlenza O. Cognitive decline following acute viral infections: literature review and projections for post-COVID-19. Eur Arch Psychiatry Clin Neurosci 2022; 272:139-154. [PMID: 34173049 PMCID: PMC8231753 DOI: 10.1007/s00406-021-01286-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 06/21/2021] [Indexed: 12/15/2022]
Abstract
Recently, much attention has been drawn to the importance of the impact of infectious disease on human cognition. Several theories have been proposed, to explain the cognitive decline following an infection as well as to understand better the pathogenesis of human dementia, especially Alzheimer's disease. This article aims to review the state of the art regarding the knowledge about the impact of acute viral infections on human cognition, laying a foundation to explore the possible cognitive decline followed coronavirus disease 2019 (COVID-19). To reach this goal, we conducted a narrative review systematizing six acute viral infections as well as the current knowledge about COVID-19 and its impact on human cognition. Recent findings suggest probable short- and long-term COVID-19 impacts in cognition, even in asymptomatic individuals, which could be accounted for by direct and indirect pathways to brain dysfunction. Understanding this scenario might help clinicians and health leaders to deal better with a wave of neuropsychiatric issues that may arise following COVID-19 pandemic as well as with other acute viral infections, to alleviate the cognitive sequelae of these infections around the world.
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Affiliation(s)
- Rodolfo Furlan Damiano
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP, 05403-903, Brazil.
| | - Bruno F. Guedes
- Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Cristiana Castanho de Rocca
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | - Antonio de Pádua Serafim
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | | | - Carolina Demarchi Munhoz
- Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Geraldo Busatto Filho
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | - Eurípedes Constantino Miguel
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
| | - Giancarlo Lucchetti
- Department of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Orestes Forlenza
- Departamento E Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, São Paulo, SP 05403-903 Brazil
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Medhi G, Kapadia A, Parida S, C D, Bagepalli BS, M N, Kumar K, Gupta AK, Saini J. Long-term sequelae of herpes simplex virus encephalitis-related white matter injury: correlation of neuropsychological outcome and diffusion tensor imaging. J Neurovirol 2021; 27:601-608. [PMID: 34398444 DOI: 10.1007/s13365-021-01000-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022]
Abstract
The pathophysiology of the memory impairment following Herpes Simplex virus encephalitis is not yet established and understood. This study attempts to elucidate the role of white matter injury and its impact on neuropsychological outcome in patients with history of Herpes Simplex virus encephalitis. This is a single-institution prospective study assessing 9 patients and 15 matched controls utilizing a combination of MRI with diffusion tensor imaging and neuropsychological testing. Tract-based spatial statistics analysis was performed and correlated with neuropsychological outcomes. Significantly decreased fractional anisotropy (FA) values were noted in corpus callosum, corona radiata, left posterior thalamic radiation, cingulum, superior longitudinal fasciculus, fornix, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, and uncinated fasciculus. Impaired facial recognition significantly correlated with reduction in FA of right uncinate fasciculus, right inferior longitudinal fasciculus, and splenium genu of corpus callosum. FA value of left cingulum significantly correlated with logical memory, auditory verbal learning. FA value of fornix correlated with visual recognition; FA value of left uncinate fasciculus with auditory verbal learning and delayed recall. In conclusion, this study demonstrates microstructural abnormalities involving several white matter tracts corresponding to neuropsychological deficits.
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Affiliation(s)
- Gorky Medhi
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India.,Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Anish Kapadia
- Department of Medical Imaging, University of Toronto, Toronto, Canada.
| | - Subhendu Parida
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Dhanya C
- Department of Neuropsychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - B S Bagepalli
- ICMR National Institute of Epidemiology, Chennai, India
| | - Netravathi M
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Keshav Kumar
- Department of Neuropsychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Arun Kumar Gupta
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
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7
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Zečević I. Behavioral Management in Encephalitis Rehabilitation: Review of Clinical Research with Clinical Recommendations. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2021. [DOI: 10.1007/s10942-021-00390-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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Spanò G, Pizzamiglio G, McCormick C, Clark IA, De Felice S, Miller TD, Edgin JO, Rosenthal CR, Maguire EA. Dreaming with hippocampal damage. eLife 2020; 9:e56211. [PMID: 32508305 PMCID: PMC7279885 DOI: 10.7554/elife.56211] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/05/2020] [Indexed: 01/20/2023] Open
Abstract
The hippocampus is linked with both sleep and memory, but there is debate about whether a salient aspect of sleep - dreaming - requires its input. To address this question, we investigated if human patients with focal bilateral hippocampal damage and amnesia engaged in dreaming. We employed a provoked awakening protocol where participants were woken up at various points throughout the night, including during non-rapid eye movement and rapid eye movement sleep, to report their thoughts in that moment. Despite being roused a similar number of times, dream frequency was reduced in the patients compared to control participants, and the few dreams they reported were less episodic-like in nature and lacked content. These results suggest that hippocampal integrity may be necessary for typical dreaming to occur, and aligns dreaming with other hippocampal-dependent processes such as episodic memory that are central to supporting our mental life.
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Affiliation(s)
- Goffredina Spanò
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College LondonLondonUnited Kingdom
| | - Gloria Pizzamiglio
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College LondonLondonUnited Kingdom
| | - Cornelia McCormick
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital BonnBonnGermany
| | - Ian A Clark
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College LondonLondonUnited Kingdom
| | - Sara De Felice
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College LondonLondonUnited Kingdom
| | - Thomas D Miller
- Department of Neurology, Royal Free HospitalLondonUnited Kingdom
| | - Jamie O Edgin
- Department of Psychology, University of ArizonaTucsonUnited States
| | - Clive R Rosenthal
- Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Eleanor A Maguire
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College LondonLondonUnited Kingdom
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9
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Spanò G, Weber FD, Pizzamiglio G, McCormick C, Miller TD, Rosenthal CR, Edgin JO, Maguire EA. Sleeping with Hippocampal Damage. Curr Biol 2020; 30:523-529.e3. [PMID: 31956024 PMCID: PMC6997880 DOI: 10.1016/j.cub.2019.11.072] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/16/2019] [Accepted: 11/25/2019] [Indexed: 12/22/2022]
Abstract
The hippocampus plays a critical role in sleep-related memory processes [1-3], but it is unclear which specific sleep features are dependent upon this brain structure. The examination of sleep physiology in patients with focal bilateral hippocampal damage and amnesia could supply important evidence regarding these links. However, there is a dearth of such studies, despite these patients providing compelling insights into awake cognition [4, 5]. Here, we sought to identify the contribution of the hippocampus to the sleep phenotype by characterizing sleep via comprehensive qualitative and quantitative analyses in memory-impaired patients with selective bilateral hippocampal damage and matched control participants using in-home polysomnography on 4 nights. We found that, compared to control participants, patients had significantly reduced slow-wave sleep-likely due to decreased density of slow waves-as well as slow-wave activity. In contrast, slow and fast spindles were indistinguishable from those of control participants. Moreover, patients expressed slow oscillations (SOs), and SO-fast spindle coupling was observed. However, on closer scrutiny, we noted that the timing of spindles within the SO cycle was delayed in the patients. The shift of patients' spindles into the later phase of the up-state within the SO cycle may indicate a mismatch in timing across the SO-spindle-ripple events that are associated with memory consolidation [6, 7]. The substantial effect of selective bilateral hippocampal damage on large-scale oscillatory activity in the cortex suggests that, as with awake cognition, the hippocampus plays a significant role in sleep physiology, which may, in turn, be necessary for efficacious episodic memory.
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Affiliation(s)
- Goffredina Spanò
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Frederik D Weber
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen 6525 EN, the Netherlands
| | - Gloria Pizzamiglio
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Cornelia McCormick
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn 53127, Germany
| | - Thomas D Miller
- Department of Neurology, Royal Free Hospital, London NW3 2QG, UK
| | - Clive R Rosenthal
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Jamie O Edgin
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA
| | - Eleanor A Maguire
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK.
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Miller TD, Chong TTJ, Aimola Davies AM, Johnson MR, Irani SR, Husain M, Ng TWC, Jacob S, Maddison P, Kennard C, Gowland PA, Rosenthal CR. Human hippocampal CA3 damage disrupts both recent and remote episodic memories. eLife 2020; 9:e41836. [PMID: 31976861 PMCID: PMC6980860 DOI: 10.7554/elife.41836] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 12/05/2019] [Indexed: 12/31/2022] Open
Abstract
Neocortical-hippocampal interactions support new episodic (event) memories, but there is conflicting evidence about the dependence of remote episodic memories on the hippocampus. In line with systems consolidation and computational theories of episodic memory, evidence from model organisms suggests that the cornu ammonis 3 (CA3) hippocampal subfield supports recent, but not remote, episodic retrieval. In this study, we demonstrated that recent and remote memories were susceptible to a loss of episodic detail in human participants with focal bilateral damage to CA3. Graph theoretic analyses of 7.0-Tesla resting-state fMRI data revealed that CA3 damage disrupted functional integration across the medial temporal lobe (MTL) subsystem of the default network. The loss of functional integration in MTL subsystem regions was predictive of autobiographical episodic retrieval performance. We conclude that human CA3 is necessary for the retrieval of episodic memories long after their initial acquisition and functional integration of the default network is important for autobiographical episodic memory performance.
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Affiliation(s)
- Thomas D Miller
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUnited Kingdom
- Department of NeurologyRoyal Free HospitalLondonUnited Kingdom
| | - Trevor T-J Chong
- Monash Institute of Cognitive and Clinical NeurosciencesMonash UniversityClaytonAustralia
| | - Anne M Aimola Davies
- Department of Experimental PsychologyUniversity of OxfordOxfordUnited Kingdom
- Research School of PsychologyAustralian National UniversityCanberraAustralia
| | - Michael R Johnson
- Division of Brain SciencesImperial College LondonLondonUnited Kingdom
| | - Sarosh R Irani
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUnited Kingdom
| | - Masud Husain
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUnited Kingdom
- Department of Experimental PsychologyUniversity of OxfordOxfordUnited Kingdom
| | - Tammy WC Ng
- Department of AnaesthesticsRoyal Free HospitalLondonUnited Kingdom
| | - Saiju Jacob
- Neurology Department, Queen Elizabeth Neuroscience CentreUniversity Hospitals of BirminghamBirminghamUnited Kingdom
| | - Paul Maddison
- Neurology DepartmentQueen’s Medical CentreNottinghamUnited Kingdom
| | - Christopher Kennard
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUnited Kingdom
| | - Penny A Gowland
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and AstronomyUniversity of NottinghamNottinghamUnited Kingdom
| | - Clive R Rosenthal
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUnited Kingdom
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11
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Nimgaonkar VL, Bhatia T, Mansour A, Wesesky MA, Deshpande S. Herpes Simplex Virus Type-1 Infection: Associations with Inflammation and Cognitive Aging in Relation to Schizophrenia. Curr Top Behav Neurosci 2020; 44:125-139. [PMID: 31049838 DOI: 10.1007/7854_2018_86] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Most persons experience cognitive decline as they grow older. The term "cognitive aging," coined to describe milder varieties of cognitive decline, is likely to be due to multiple causes. Persistent or repeated infections of the central nervous system (whether subclinical or diagnosable) can cause damage to neurons directly or indirectly through inflammation resulting in incremental neuronal damage, thus eroding cognitive reserve. This possibility has not been considered widely. We evaluated the data linking persistent infection with herpes simplex virus type 1 (HSV-1) and cognitive aging by applying the Bradford Hill criteria. Despite inherent problems in establishing causal relations for chronic disorders, our analyses suggest plausible links. These studies are pertinent for patients with schizophrenia, who are particularly vulnerable due to disorder-related cognitive impairment. Further investigations are warranted to test a causal hypothesis, particularly prospective studies and intervention studies.
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Affiliation(s)
- Vishwajit L Nimgaonkar
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Triptish Bhatia
- Training Program for Psychiatric Genetics in India, Post-graduate Institute for Medical Education and Research, Dr Ram Manohar Lohia Hospital, Delhi, India
| | - Abdelaziz Mansour
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Maribeth A Wesesky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Smita Deshpande
- Post-graduate Institute for Medical Education and Research, Dr Ram Manohar Lohia Hospital, New Delhi, India
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Postels DG, Soldatos A, LaRovere KL. Outcomes measures in children after acute central nervous system infections and malaria. Curr Opin Pediatr 2019; 31:756-762. [PMID: 31693584 DOI: 10.1097/mop.0000000000000823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW Acute central nervous system (CNS) infections in children result in significant mortality and neurologic morbidity worldwide. This article summarizes the recent pediatric literature published on outcomes measures used after acute infectious meningitis, encephalitis, and cerebral malaria, and highlights ongoing research efforts to standardize outcomes measurements. Search terms were geared toward functional, cognitive, behavioral, and other outcome assessments. RECENT FINDINGS Recent data suggest that, depending on microbiological cause, there are differences in currently used outcome measures following acute CNS infections. Outcomes assessments include a variety of formal psychological tests (structured interviews and neuropsychological tests of cognitive and motor functioning) and dichotomized or ordinal scales. Standardization of outcome measures, however, is lacking. Global efforts to standardize outcomes that encompass both the child and family are ongoing. SUMMARY Centers worldwide can track and measure a variety of cognitive, behavioral, and functional outcomes after acute CNS infections. Standardized documentation and coding of clinically important outcomes is needed. Further research to evaluate effective practices using acute adjunctive and rehabilitation therapies will be aided by outcome measure standardization.
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Affiliation(s)
- Douglas G Postels
- Department of Neurology, Children's National Health System, Washington, District of Columbia
| | - Ariane Soldatos
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Kerri L LaRovere
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
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Encephalitis and aseptic meningitis: short-term and long-term outcome, quality of life and neuropsychological functioning. Sci Rep 2019; 9:16158. [PMID: 31695095 PMCID: PMC6834582 DOI: 10.1038/s41598-019-52570-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/21/2019] [Indexed: 12/20/2022] Open
Abstract
For those surviving encephalitis, the influence on daily life of patients and their relatives may be substantial. In contrast, the prognosis after aseptic meningitis (ASM) is considered good. In this prospective study in patients with encephalitis (n = 20) and ASM (n = 46), we show that both groups experienced reduced Health Related Quality of Life (HRQoL) at two months after discharge, and that workability was reduced in 37% of the patients with ASM. However, 12 months after discharge no neuropsychological deficits were detected in the ASM group, whereas patients with encephalitis had lower scores on tests of fine motor and psychomotor skills as well as on learning and memory. We also found that for patients with encephalitis, neopterin, as a marker of Th1 cell induced macrophage activation, and a putatively neurotoxic ratio of the kynurenine pathway (KP) measured during the acute phase was associated with lower HRQoL. Our data show that not only encephalitis, but also ASM has substantial short-term influence on HRQoL and workability. For patients with encephalitis we suggest a link between immune activation and activation of the KP during the acute phase with impaired HRQoL.
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Corallo F, Lo Buono V, Di Cara M, De Salvo S, Formica C, Morabito R, Floridia D, Pastura C, Rifici C, D’Aleo G, Sessa E, Bramanti P, Marino S. The role of cognitive rehabilitation in limbic encephalitis: A case report. Medicine (Baltimore) 2018; 97:e13223. [PMID: 30508904 PMCID: PMC6283188 DOI: 10.1097/md.0000000000013223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Limbic encephalitis is a parenchymal inflammation caused by viral, bacterial, or other microbial and postinfectious agents, which is usually expressed by multifocal neurological signs and cognitive impairment. PATIENT CONCERNS A 50-year-old female was admitted in postacute phase, at our rehabilitative Center, to undertake neuro-motor treatment for a period of 4 months. DIAGNOSES The patient was affected by limbic encephalitis. Clinical presentation revealed attention, memory and executive dysfunctions, as well as behavioral changes, emotional dysregulation and reduction of self-awareness. INTERVENTIONS The patients received an intensive cognitive and motor rehabilitation training. OUTCOMES Neuropsychological assessment and magnetic resonance imaging were performed before and after rehabilitative training to evaluate the cognitive and cerebral changes induced by treatment. The patient showed an improvement in cognitive performances and behavioral aspects. LESSONS The reducing cognitive deficits, especially memory deficits, could improve quality of life by using available cognitive resources.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Silvia Marino
- IRCCS Centro Neurolesi “Bonino-Pulejo,” Messina
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
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Chen T, Liu G. Long-term outcome of acute central nervous system infection in children. Pediatr Investig 2018; 2:155-163. [PMID: 32851253 PMCID: PMC7331314 DOI: 10.1002/ped4.12054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 08/14/2018] [Indexed: 01/25/2023] Open
Abstract
IMPORTANCE Central nervous system infection is a severe illness in children. Little is known about the long-term outcome in children with central nervous system infection of various etiologies. OBJECTIVE The aims of this study were to investigate the long-term outcomes of childhood acute central nervous system infection and to examine possible prognostic factors. METHODS Of 172 children who were treated for acute central nervous system infection from January 2009 through December 2009, 139 were eligible for follow-up evaluations. A structured interview was conducted with the parents 3.8-4.7 years after hospital discharge. The global outcome was determined in all patients using the Pediatric Version of the Glasgow Outcome Scale-Extended. Clinical features of the acute episode were retrieved from medical records. RESULTS The outcome was favorable in 109 of 139 patients (78%), 38 (27%) were mildly impaired, six (4%) were moderately impaired, 14 (10%) were severely impaired and two (1%) were in a vegetative state. There were eight deaths. The most frequent symptoms were difficulty concentrating (16%), epilepsy (12%), limb paralysis (12%), memory impairment (10%), speech disorders (9%), irritability (9%). Significant risk factors for epilepsy included the presence of recurrent seizures or status epilepticus, the existence of pure spikes in the electroencephalogram, brain parenchyma abnormalities on neuroimaging and herpes simplex virus encephalitis (HSVE). A multivariate analysis identified three factors that were independently associated with poor outcome: coma, brain parenchyma abnormalities on neuroimaging and HSVE. INTERPRETATION Most children with acute central nervous system infection experienced a favorable outcome 3.8-4.7 years after discharge from the hospital. Minor to severe disability persists in a high proportion of cases. Coma, brain parenchymal abnormalities on neuroimaging and HSVE may predict poor long-term outcome.
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Affiliation(s)
- Tianming Chen
- Department of Infectious DiseasesBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Gang Liu
- Department of Infectious DiseasesBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
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Emotion discrimination in humans: Its association with HSV-1 infection and its improvement with antiviral treatment. Schizophr Res 2018; 193:161-167. [PMID: 28830742 PMCID: PMC5818324 DOI: 10.1016/j.schres.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/03/2017] [Accepted: 08/03/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Herpes simplex virus, type 1 (HSV-1) infects over 3.4 billion people, world-wide. Though it can cause encephalitis, in the vast majority it is asymptomatic, with lifelong latent infection in neurons. HSV-1 infected individuals have greater cognitive dysfunction than uninfected individuals, particularly persons with schizophrenia - even without encephalitis. We investigated whether HSV-1 related cognitive dysfunction is progressive or remediable. METHODS In a prospective naturalistic follow up sample (PNFU), temporal changes in cognitive functions were analyzed in relation to baseline HSV-1 infection in persons with/without schizophrenia (N=226). Independently, in a randomized controlled trial (RCT), HSV-1 infected, clinically stabilized SZ outpatients received Valacyclovir (VAL, an HSV-1 specific antiviral, 1.5G twice daily for 16weeks) or placebo (PLA) added to standard antipsychotic treatment, using a stratified randomization design, following placebo run-in (N=67). In both samples, HSV-1 infection (seropositivity) was estimated using serum IgG antibodies. Clinical evaluations were blinded to HSV-1 or treatment status. Standardized Z scores for accuracy on eight cognitive domains were analyzed for temporal trajectories using generalized linear models (PNFU) and VAL/PLA differences compared with intent to treat analyses (RCT). RESULTS PNFU: At baseline, HSV-1 infected participants had significantly lower accuracy scores for Emotion Identification and Discrimination (EMOD), Spatial memory and Spatial ability, regardless of SZ diagnosis (p=0.025, 0.029, 0.046, respectively). They also had significantly steeper temporal worsening for EMOD (p=0.03). RCT: EMOD improved in VAL-treated patients (p=0.048, Cohen's d=0.43). CONCLUSIONS A proportion of age related decline in EMOD is attributable to HSV-1 infection.
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Cooper J, Kierans C, Defres S, Easton A, Kneen R, Solomon T. Care beyond the hospital ward: understanding the socio-medical trajectory of herpes simplex virus encephalitis. BMC Health Serv Res 2017; 17:646. [PMID: 28899392 PMCID: PMC5596960 DOI: 10.1186/s12913-017-2608-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Herpes simplex virus (HSV) encephalitis is a life-threatening infection of the brain, which has significant physical, cognitive and social consequences for survivors. Despite increasing recognition of the long-term effects of encephalitis, research and policy remains largely focused on its acute management, meaning there is little understanding of the difficulties people face after discharge from acute care. This paper aims to chart the problems and challenges which people encounter when they return home after treatment for HSV encephalitis. METHODS The paper reports on data from 30 narrative interviews with 45 people affected by HSV encephalitis and their significant others. The study was conducted as part of the ENCEPH-UK programme grant on Understanding and Improving the Outcome of Encephalitis. RESULTS The findings show the diverse challenges which are experienced by people after treatment for HSV encephalitis. We first chart how peoples' everyday lives are fragmented following their discharge from hospital. Second, we document the social consequences which result from the longer-term effects of encephalitis. Finally, we show how the above struggles are exacerbated by the lack of support systems for the post-acute effects of encephalitis, and describe how people are consequently forced to devise their own care routines and strategies for managing their problems. CONCLUSION The paper argues that in order to improve long-term outcomes in encephalitis, it is vital that we develop pathways of support for the condition beyond the acute hospital setting. We conclude by making recommendations to enhance communication and care for the post-acute consequences of encephalitis, to ensure those affected are fully supported through the chronic effects of this devastating disease.
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Affiliation(s)
- Jessie Cooper
- Division of Health Services Research & Management, City, University of London, London, UK
| | - Ciara Kierans
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Sylviane Defres
- Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Tropical and infectious diseases Unit, The Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
- NIHR HPRU in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Ava Easton
- Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- The Encephalitis Society, Malton, North Yorkshire, UK
| | - Rachel Kneen
- Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Department of Neurology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Tom Solomon
- Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- NIHR HPRU in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
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18
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Defres S, Keller SS, Das K, Vidyasagar R, Parkes LM, Burnside G, Griffiths M, Kopelman M, Roberts N, Solomon T. A Feasibility Study of Quantifying Longitudinal Brain Changes in Herpes Simplex Virus (HSV) Encephalitis Using Magnetic Resonance Imaging (MRI) and Stereology. PLoS One 2017; 12:e0170215. [PMID: 28125598 PMCID: PMC5268482 DOI: 10.1371/journal.pone.0170215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 01/02/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To assess whether it is feasible to quantify acute change in temporal lobe volume and total oedema volumes in herpes simplex virus (HSV) encephalitis as a preliminary to a trial of corticosteroid therapy. METHODS The study analysed serially acquired magnetic resonance images (MRI), of patients with acute HSV encephalitis who had neuroimaging repeated within four weeks of the first scan. We performed volumetric measurements of the left and right temporal lobes and of cerebral oedema visible on T2 weighted Fluid Attenuated Inversion Recovery (FLAIR) images using stereology in conjunction with point counting. RESULTS Temporal lobe volumes increased on average by 1.6% (standard deviation (SD 11%) in five patients who had not received corticosteroid therapy and decreased in two patients who had received corticosteroids by 8.5%. FLAIR hyperintensity volumes increased by 9% in patients not receiving treatment with corticosteroids and decreased by 29% in the two patients that had received corticosteroids. CONCLUSIONS This study has shown it is feasible to quantify acute change in temporal lobe and total oedema volumes in HSV encephalitis and suggests a potential resolution of swelling in response to corticosteroid therapy. These techniques could be used as part of a randomized control trial to investigate the efficacy of corticosteroids for treating HSV encephalitis in conjunction with assessing clinical outcomes and could be of potential value in helping to predict the clinical outcomes of patients with HSV encephalitis.
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Affiliation(s)
- Sylviane Defres
- Clinical Infection, microbiology and immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Tropical and Infectious diseases Unit, Liverpool and Broadgreen University Hospital Trust, Liverpool, United Kingdom
- NIHR HPRU in Emerging and Zoonotic Infections, University of Liverpool, Institute of infection and Global Health, Waterhouse Building, Liverpool, United Kingdom
| | - Simon S. Keller
- The Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- The Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, Liverpool, United Kingdom
| | - Kumar Das
- The Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, Liverpool, United Kingdom
| | - Rishma Vidyasagar
- Florey Institute of Neuroscience and mental health, Heidelberg, Victoria, Australia
- Department of Anatomy and Neuroscience, University of Melbourne, Victoria, Australia
| | - Laura M. Parkes
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Girvan Burnside
- The department of Biostatistics, Institute of translational medicine, University of Liverpool, Liverpool, United Kingdom
| | - Michael Griffiths
- Clinical Infection, microbiology and immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Michael Kopelman
- Institute of Psychiatry, Kings College London, London, United Kingdom
| | - Neil Roberts
- Medical Physics and Imaging Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Tom Solomon
- Clinical Infection, microbiology and immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- NIHR HPRU in Emerging and Zoonotic Infections, University of Liverpool, Institute of infection and Global Health, Waterhouse Building, Liverpool, United Kingdom
- The Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, Liverpool, United Kingdom
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Ballesteros S, Mayas J, Ruiz-Marquez E, Prieto A, Toril P, Ponce de Leon L, de Ceballos ML, Reales Avilés JM. Effects of Video Game Training on Behavioral and Electrophysiological Measures of Attention and Memory: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e8. [PMID: 28119279 PMCID: PMC5296621 DOI: 10.2196/resprot.6570] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 12/13/2016] [Accepted: 12/18/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Neuroplasticity-based approaches seem to offer promising ways of maintaining cognitive health in older adults and postponing the onset of cognitive decline symptoms. Although previous research suggests that training can produce transfer effects, this study was designed to overcome some limitations of previous studies by incorporating an active control group and the assessment of training expectations. OBJECTIVE The main objectives of this study are (1) to evaluate the effects of a randomized computer-based intervention consisting of training older adults with nonaction video games on brain and cognitive functions that decline with age, including attention and spatial working memory, using behavioral measures and electrophysiological recordings (event-related potentials [ERPs]) just after training and after a 6-month no-contact period; (2) to explore whether motivation, engagement, or expectations might account for possible training-related improvements; and (3) to examine whether inflammatory mechanisms assessed with noninvasive measurement of C-reactive protein in saliva impair cognitive training-induced effects. A better understanding of these mechanisms could elucidate pathways that could be targeted in the future by either behavioral or neuropsychological interventions. METHODS A single-blinded randomized controlled trial with an experimental group and an active control group, pretest, posttest, and 6-month follow-up repeated measures design is used in this study. A total of 75 cognitively healthy older adults were randomly distributed into experimental and active control groups. Participants in the experimental group received 16 1-hour training sessions with cognitive nonaction video games selected from Lumosity, a commercial brain training package. The active control group received the same number of training sessions with The Sims and SimCity, a simulation strategy game. RESULTS We have recruited participants, have conducted the training protocol and pretest assessments, and are currently conducting posttest evaluations. The study will conclude in the first semester of 2017. Data analysis will take place during 2017. The primary outcome is transfer of benefit from training to attention and working memory functions and the neural mechanisms underlying possible cognitive improvements. CONCLUSIONS We expect that mental stimulation with video games will improve attention and memory both at the behavioral level and in ERP components promoting brain and mental health and extending independence among elderly people by avoiding the negative personal and economic consequences of long-term care. TRIAL REGISTRATION Clinicaltrials.gov NCT02796508; https://clinicaltrials.gov/ct2/show/NCT02796508 (archived by WebCite at http://www.webcitation.org/6nFeKeFNB).
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Affiliation(s)
- Soledad Ballesteros
- Studies on Aging and Neurodegenerative Diseases Research Group, Department of Basic Psychology II, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Julia Mayas
- Studies on Aging and Neurodegenerative Diseases Research Group, Department of Basic Psychology II, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Eloisa Ruiz-Marquez
- Studies on Aging and Neurodegenerative Diseases Research Group, Department of Basic Psychology II, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Antonio Prieto
- Studies on Aging and Neurodegenerative Diseases Research Group, Department of Basic Psychology II, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Pilar Toril
- Studies on Aging and Neurodegenerative Diseases Research Group, Department of Basic Psychology II, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Laura Ponce de Leon
- Facultad de Derecho, Department of Social Work, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Maria L de Ceballos
- Cajal Institute, Neurodegeneration Group, Departament of Translational Neurobiology and Biomedicine Research Center for Neurodegenerative Diseases, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - José Manuel Reales Avilés
- Facultad de Psicología, Departamento Methodology of the Behavioral Sciences, Universidad Nacional de Educación a Distancia, Madrid, Spain
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Cooper J, Kierans C, Defres S, Easton A, Kneen R, Solomon T. Diagnostic Pathways as Social and Participatory Practices: The Case of Herpes Simplex Encephalitis. PLoS One 2016; 11:e0151145. [PMID: 26960197 PMCID: PMC4784735 DOI: 10.1371/journal.pone.0151145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/24/2016] [Indexed: 11/21/2022] Open
Abstract
Herpes simplex virus (HSV) encephalitis is a potentially devastating disease, with significant rates of mortality and co-morbidities. Although the prognosis for people with HSV encephalitis can be improved by prompt treatment with aciclovir, there are often delays involved in the diagnosis and treatment of the disease. In response, National Clinical Guidelines have been produced for the UK which make recommendations for improving the management of suspected viral encephalitis. However, little is currently known about the everyday experiences and processes involved in the diagnosis and care of HSV encephalitis. The reported study aimed to provide an account of the diagnosis and treatment of HSV encephalitis from the perspective of people who had been affected by the condition. Thirty narrative interviews were conducted with people who had been diagnosed with HSV encephalitis and their significant others. The narrative accounts reveal problems with gaining access to a diagnosis of encephalitis and shortfalls in care for the condition once in hospital. In response, individuals and their families work hard to obtain medical recognition for the problem and shape the processes of acute care. As a consequence, we argue that the diagnosis and management of HSV encephalitis needs to be considered as a participatory process, which is co-produced by health professionals, patients, and their families. The paper concludes by making recommendations for developing the current management guidelines by formalising the critical role of patients and their significant others in the identification, and treatment of, HSV encephalitis.
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Affiliation(s)
- Jessie Cooper
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Ciara Kierans
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Sylviane Defres
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, The Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, United Kingdom
| | - Ava Easton
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- The Encephalitis Society, Malton, North Yorkshire, United Kingdom
| | - Rachel Kneen
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Department of Neurology, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Tom Solomon
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
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Roed C, Sørensen HT, Rothman KJ, Skinhøj P, Obel N. Employment and disability pension after central nervous system infections in adults. Am J Epidemiol 2015; 181:789-98. [PMID: 25852076 DOI: 10.1093/aje/kwu359] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 12/05/2014] [Indexed: 11/13/2022] Open
Abstract
In this nationwide population-based cohort study using national Danish registries, in the period 1980-2008, our aim was to study employment and receipt of disability pension after central nervous system infections. All patients diagnosed between 20 and 55 years of age with meningococcal (n = 451), pneumococcal (n = 553), or viral (n = 1,433) meningitis or with herpes simplex encephalitis (n = 115), who were alive 1 year after diagnosis, were identified. Comparison cohorts were drawn from the general population, and their members were individually matched on age and sex to patients. Five years after diagnosis, the differences in probability of being employed as a former patient with pneumococcal meningitis or herpes simplex encephalitis versus being a member of the comparison cohorts were -19.9% (95% confidence interval (CI): -24.7, -15.1) and -21.1% (95% CI: -33.0, -9.3), respectively, and the corresponding differences in probability of receiving disability pension were 20.2% (95% CI: 13.7, 26.7) and 16.2% (95% CI: 6.2, 26.3). The differences in probability of being employed or receiving disability pension in former meningococcal or viral meningitis patients versus members of the comparison cohorts were small. In conclusion, pneumococcal meningitis and herpes simplex encephalitis were associated with substantially decreased employment and increased need for disability pension. These associations did not seem to apply to meningococcal meningitis or viral meningitis.
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Damsgaard J, Hjerrild S, Andersen H, Leutscher PDC. Long-term neuropsychiatric consequences of aseptic meningitis in adult patients. Infect Dis (Lond) 2015; 47:357-63. [PMID: 25738613 DOI: 10.3109/23744235.2015.1018838] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aseptic meningitis is considered a benign and self-limiting clinical condition. In contrast to viral encephalitis and bacterial meningitis, the prognosis is usually good. The existing literature is scarce on the potential long-term neuropsychiatric consequences of aseptic meningitis. Previous studies have primarily been retrospective and differences in methodologies make it difficult to draw conclusions regarding the prevalence and nature of neuropsychiatric manifestations. However, studies have reported decreased psychomotor speed and impaired executive and visuo-constructive functions following aseptic meningitis. Larger controlled prospective studies are urgently needed to elucidate the neuropsychiatric complications of aseptic meningitis.
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Affiliation(s)
- Jesper Damsgaard
- From the Department of Infectious Diseases, Aarhus University Hospital , Aarhus , Denmark
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23
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Identifying neural correlates of memory and language disturbances in herpes simplex encephalitis: a voxel-based morphometry (VBM) study. J Neurol 2014; 262:563-9. [DOI: 10.1007/s00415-014-7604-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/23/2014] [Accepted: 12/01/2014] [Indexed: 11/26/2022]
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Vahter L, Kannel K, Sorro U, Jaakmees H, Talvik T, Gross-Paju K. Cognitive dysfunction during anti-NMDA-receptor encephalitis is present in early phase of the disease. Oxf Med Case Reports 2014; 2014:74-6. [PMID: 25988034 PMCID: PMC4399511 DOI: 10.1093/omcr/omu028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/31/2014] [Accepted: 06/02/2014] [Indexed: 12/30/2022] Open
Abstract
Anti-NMDA-receptor encephalitis is an autoimmune disorder with a well-defined set of clinical features including psychiatric changes (anxiety, agitation, bizarre behaviour, delusional or paranoid thoughts), epileptic seizures and cognitive disturbance followed by movement disorders including orofacial dyskinesias, alterations in the level of consciousness and dysautonomia. Although the cognitive changes are not always very clear at presentation, they can persist after recovery from the acute and often prolonged illness. However, there are few studies describing neuropsychiatric changes in depth, both in the early course of the disease and in long-term follow-up.
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Affiliation(s)
- L. Vahter
- Department of Neurology, West-Tallinn Central Hospital, Tallinn, Estonia
- Institute of Psychology, University of Tallinn, Tallinn, Estonia
- Correspondence address. Neurology Department, West-Tallinn Central Hospital, Paldiski rd 68, Tallinn 10617, Estonia. Tel: +372-6507-397; Fax: +372-6507-395; E-mail:
| | - K. Kannel
- Department of Neurology, West-Tallinn Central Hospital, Tallinn, Estonia
| | - U. Sorro
- Department of Neurology, West-Tallinn Central Hospital, Tallinn, Estonia
| | - H. Jaakmees
- Department of Neurology, West-Tallinn Central Hospital, Tallinn, Estonia
| | - T. Talvik
- Department of Paediatrics, University of Tartu, Tartu, Estonia
- Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - K. Gross-Paju
- Department of Neurology, West-Tallinn Central Hospital, Tallinn, Estonia
- Institute of Clinical Medicine, Tallinn Technical University, Tallinn, Estonia
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Butler CR, Miller TD, Kaur MS, Baker IW, Boothroyd GD, Illman NA, Rosenthal CR, Vincent A, Buckley CJ. Persistent anterograde amnesia following limbic encephalitis associated with antibodies to the voltage-gated potassium channel complex. J Neurol Neurosurg Psychiatry 2014; 85:387-91. [PMID: 24403282 DOI: 10.1136/jnnp-2013-306724] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Limbic encephalitis (LE) associated with antibodies to the voltage-gated potassium channel complex (VGKC) is a potentially reversible cause of cognitive impairment. Despite the prominence of cognitive dysfunction in this syndrome, little is known about patients' neuropsychological profile at presentation or their long-term cognitive outcome. METHODS We used a comprehensive neuropsychological test battery to evaluate cognitive function longitudinally in 19 patients with VGKC-LE. RESULTS Before immunotherapy, the group had significant impairment of memory, processing speed and executive function, whereas language and perceptual organisation were intact. At follow-up, cognitive impairment was restricted to the memory domain, with processing speed and executive function having returned to the normal range. Residual memory function was predicted by the antibody titre at presentation. CONCLUSIONS The results show that, despite broad cognitive dysfunction in the acute phase, patients with VGKC-LE often make a substantial recovery with immunotherapy but may be left with permanent anterograde amnesia.
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Affiliation(s)
- Christopher R Butler
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, , Oxford, UK
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Epidemiology of infectious encephalitis, differences between a prospective study and hospital discharge data. Epidemiol Infect 2012; 141:2256-68. [PMID: 23168268 DOI: 10.1017/s0950268812002518] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The French epidemiology of infectious encephalitis has been described in a 2007 prospective study. We compared these results with available data (demographic features, causative agents, case-fatality ratio) obtained through the French national hospital discharge 2007 database (PMSI), in order to evaluate it as a surveillance tool for encephalitis. Causative agents were identified in 52% of cases in the study, and 38% in PMSI (P < 0·001). The incidence of encephalitis in France in 2007 was estimated as 2·6 cases/100 000 inhabitants. HSV and VZV were the most frequent aetiological agents in both databases with similar rates. Listeria monocytogenes and Mycobacterium tuberculosis were less frequent in PMSI than in the study (Listeria: 2% vs. 5%, P = 0·001; Mycobacterium: 2% vs. 8%, P < 0·001). The case-fatality ratios were similar, except for Listeria (46% in the study vs. 16%). Nevertheless, despite the absence of case definitions and a possible misclassification weakening PMSI data, we suggest that PMSI may be used as a basic surveillance tool at a limited cost.
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Engman ML, Lindström K, Sallamba M, Hertz C, Sundberg B, Hansson MEA, Lindquist L, Orvell C, Lidefelt KJ, Sundin M. One-year follow-up of tick-borne central nervous system infections in childhood. Pediatr Infect Dis J 2012; 31:570-4. [PMID: 22333696 DOI: 10.1097/inf.0b013e31824f23c0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Neurologic sequelae, including cognitive deficits, after childhood tick-borne encephalitis (TBE) and neuroborreliosis (NB) are not well-characterized. These infections are among the most common affecting the central nervous system in children and can be difficult to diagnose due to vague symptomatology. The aim of this study was to investigate long-term (>1 year) consequences of pediatric TBE and NB as well as the value of markers for brain damage and genetic susceptibility. METHODS From a previous prospective study, children diagnosed with TBE (n = 8) and NB (n = 12) as well as pediatric controls (n = 15) were followed up by clinical examination, semistructured interview and screening for cognitive dysfunction by the Five-to-Fifteen Questionnaire. The follow-up also included detection of serum autoantibodies against the neural proteins; glial fibrillary acidic protein and myelin basic protein, as well as genotyping of a 32 basepair deletion in the chemokine receptor type 5 gene. RESULTS Children diagnosed with TBE displayed significantly more long-term subjective complaints (ie, fatigue, headache and irritability) compared with the NB and control groups. Significantly higher frequency of disabilities was also detected by the Five-to-Fifteen Questionnaire in the TBE group. Both TBE and NB cause consequences (eg, prolonged convalescence, worries and financial loss) for the families. Markers for genetic susceptibility and brain damage had no prognostic values in this cohort. CONCLUSIONS Pediatric TBE results in long-lasting residual symptoms and neurologic deficits affecting daily life. Vigilance for TBE-related morbidity among pediatricians and long-term clinical follow-up with assessment of cognitive dysfunctions and appropriate interventions seems reasonable for these children.
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Affiliation(s)
- Mona-Lisa Engman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet at Karolinska University Hospital Huddinge, Sweden
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Damsgaard J, Marinovskij E, Leutscher PDC. Discrepant findings between proton magnetic resonance spectroscopy and magnetic resonance imaging in an immunocompetent patient with herpes simplex virus type 1 encephalitis. ACTA ACUST UNITED AC 2011; 44:315-9. [PMID: 22122735 DOI: 10.3109/00365548.2011.633551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The authors report discrepant findings between proton magnetic resonance spectroscopy and conventional magnetic resonance imaging in a 67-y-old woman with herpes simplex virus type 1 encephalitis. The sparse amount of literature on proton magnetic resonance spectroscopy in patients with herpes simplex type 1 encephalitis is discussed.
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Affiliation(s)
- Jesper Damsgaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Aarhus N, Denmark
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Schmidt A, Bühler R, Mühlemann K, Hess CW, Täuber MG. Long-term outcome of acute encephalitis of unknown aetiology in adults. Clin Microbiol Infect 2011; 17:621-6. [PMID: 20518796 DOI: 10.1111/j.1469-0691.2010.03276.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Encephalitis is caused by a variety of conditions, including infections of the brain by a wide range of pathogens. A substantial number of cases of encephalitis defy all attempts at identifying a specific cause. Little is known about the long-term prognosis in patients with encephalitis of unknown aetiology, which complicates their management during the acute illness. To learn more about the prognosis of patients with encephalitis of unknown aetiology, patients in whom no aetiology could be identified were examined in a large, single-centre encephalitis cohort. In addition to analysing the clinical data of the acute illness, surviving patients were assessed by telephone interview a minimum of 2 years after the acute illness by applying a standardized test battery. Of the patients with encephalitis who qualified for inclusion (n = 203), 39 patients (19.2%) had encephalitis of unknown aetiology. The case fatality in these patients was 12.8%. Among the survivors, 53% suffered from various neurological sequelae, most often attention and sensory deficits. Among the features at presentation that were associated with adverse outcome were older age, increased C-reactive protein, coma and a high percentage of polymorphonuclear cells in the cerebrospinal fluid. In conclusion, the outcome in an unselected cohort of patients with encephalitis of unknown aetiology was marked by substantial case fatality and by long-term neurological deficits in approximately one-half of the surviving patients. Certain features on admission predicted an unfavourable outcome.
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Affiliation(s)
- A Schmidt
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
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30
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Herpes simplex encephalitis and management of acyclovir in encephalitis patients in France. Epidemiol Infect 2011; 140:372-81. [DOI: 10.1017/s0950268811000483] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
SUMMARYThis study reports on the clinical profiles of herpes simplex encephalitis (HSE) case-patients and the management of acyclovir prescriptions. We designed a study on the causes of encephalitis in France in 2007. Case-patients fulfilling the inclusion criteria were enrolled in all the hospitals that volunteered to participate. Fifty-five of 253 enrolled case-patients were diagnosed with HSE. Three (5%) HSE patients died and 48 (89%) were discharged with persistent neurological symptoms. All HSE patients were prescribed acyclovir, 10 of whom had a 2-week course; 42 a 3-week course; two received incomplete courses; and one received two courses of 21 days each due to relapse. The acyclovir dosage was reported for 45 adult HSE patients, 25 (53%) of whom received 10 mg/kg t.i.d. and 22 (47%) received 15 mg/kg t.i.d. The mortality rate was low despite 49% of patients being admitted to intensive-care units. A high dose of acyclovir was not associated with a better outcome in HSE patients. Most patients had persisting symptoms on discharge suggesting neuropsychological rehabilitation is an important issue for survivors.
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Grydeland H, Walhovd KB, Westlye LT, Due-Tønnessen P, Ormaasen V, Sundseth Ø, Fjell AM. Amnesia following herpes simplex encephalitis: diffusion-tensor imaging uncovers reduced integrity of normal-appearing white matter. Radiology 2010; 257:774-81. [PMID: 20935078 DOI: 10.1148/radiol.10100179] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To explore white matter (WM) and gray matter tissue integrity in the apparently unaffected hemisphere of patients with herpes simplex encephalitis (HSE) who have gross unilateral medial temporal lobe (MTL) lesions and both verbal and visuospatial memory deficits. MATERIALS AND METHODS This study had institutional ethics committee approval and included written informed consent. Magnetic resonance (MR) imaging was performed in five patients who had recovered from HSE (one woman, four men; median age, 32 years; interquartile range, 28.5-37 years) and 51 age-matched controls (30 women, 21 men; median age, 32 years; interquartile range, 28-37 years). As markers of microstructural WM integrity, fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity, and radial diffusivity (RD) derived from diffusion-tensor (DT) imaging were used. An automated regional brain segmentation approach yielded estimates of subcortical volumes, including hippocampus, and cortical thickness. Group differences were evaluated by using permutation tests. RESULTS Examination of standard MR images found unilateral lesions in all patients. The patients with HSE showed reduced FA and increased MD and RD in several WM tracts contralateral to lesions (P < .05, corrected for multiple comparisons). Affected tracts included connections between the MTLs and other parts of the brain. No significant group differences were observed in subcortical volume or cortical thickness. CONCLUSION These results suggest that patients with HSE have reduced microstructural integrity of normal-appearing WM contralateral to grossly visible lesions. These subtle lesions, detectable at DT imaging, probably contribute to the memory impairment manifested by these patients. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100179/-/DC1.
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Affiliation(s)
- Håkon Grydeland
- Center for the Study of Human Cognition, Department of Psychology, University of Oslo, PO Box 1094, Blindern, 0317 Oslo, Norway.
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Yochim BP, Kane KD, Horning S, Pepin R. Malingering or expected deficits? A case of herpes simplex encephalitis. Neurocase 2010; 16:451-60. [PMID: 20401805 DOI: 10.1080/13554791003623334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study describes a patient with herpes simplex encephalitis. Brain MRI showed the expected finding of medial temporal damage. Neuropsychological assessment results were consistent with the location of damage, with profound memory impairment and mildly impaired naming, but normal visuospatial and executive skills. The patient also showed a typical testing pattern of insufficient effort and possible malingering, which was concerning as she was seeking disability compensation. In spite of this, we chose to place greatest weight on the finding of deficits consistent with the type, location, and severity of brain damage, considering this to be true cognitive impairment.
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Affiliation(s)
- Brian P Yochim
- University of Colorado at Colorado Springs, Colorado Springs, CO 80918, USA.
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Schretlen DJ, Vannorsdall TD, Winicki JM, Mushtaq Y, Hikida T, Sawa A, Yolken RH, Dickerson FB, Cascella NG. Neuroanatomic and cognitive abnormalities related to herpes simplex virus type 1 in schizophrenia. Schizophr Res 2010; 118:224-31. [PMID: 20153952 DOI: 10.1016/j.schres.2010.01.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Revised: 01/14/2010] [Accepted: 01/19/2010] [Indexed: 01/19/2023]
Abstract
Herpes simplex virus 1 (HSV-1) tends to replicate in the temporal cortex and can damage the limbic system. The presence of serum antibodies to HSV-1 is associated with cognitive impairment in adults with schizophrenia, suggesting that cerebral gray matter abnormalities might distinguish patient subgroups defined by HSV-1 exposure. We assessed 43 adult outpatients with schizophrenia. The assessment included clinical interviews, neurocognitive testing, anatomic brain magnetic resonance imaging and measures of serum IgG antibodies specific to herpes simplex viruses 1 and 2. We then compared 25 patients who tested positive for antibodies to HSV-1 with 15 who were seronegative for both HSV-1 and HSV-2. The seropositive patients performed significantly worse than the seronegative patients on four neuropsychological measures of psychomotor speed, executive functioning, and explicit verbal memory. Voxel-based morphometric analyses revealed that the same patients showed reduced gray matter volume in the anterior cingulate and areas of the cerebellum. Finally, performance on the test of psychomotor speed and executive functioning that showed the largest between- group effect size correlated with reduced gray matter volume in some of the same brain regions (cingulate and cerebellum) that distinguished the two HSV-1 subgroups. In these outpatients with schizophrenia, HSV-1 seropositivity and performance on a cognitive test that is highly sensitive to it co-localize to closely overlapping brain regions.
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Affiliation(s)
- David J Schretlen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
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Tattevin P. Méningoencéphalites infectieuses de l’adulte non immunodéprimé. Rev Med Interne 2009; 30:125-34. [DOI: 10.1016/j.revmed.2008.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 05/09/2008] [Accepted: 05/14/2008] [Indexed: 10/21/2022]
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Dewar BK, Gracey F. "Am not was": cognitive-behavioural therapy for adjustment and identity change following herpes simplex encephalitis. Neuropsychol Rehabil 2007; 17:602-20. [PMID: 17676537 DOI: 10.1080/09602010601051610] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The cognitive sequelae of encephalitis are well documented, and it is increasingly recognised that disorders of mood and anxiety can accompany these sequelae. Loss of identity is emerging as a key theme in psychotherapeutic interventions in adjustment following acquired brain injury (ABI). Cognitive-behavioural therapy can be applied to construct a new model of the self in the context of behavioural, cognitive and social sequelae of the ABI, with consideration of pre-illness identity. Behavioural experiments, in particular, may be an effective means of redefining the meaning of current situations to create a positive sense of self. In the current paper we describe the therapeutic intervention to address anxiety and changes in identity in a woman recovering from herpes simplex viral encephalitis. The intervention highlights the need to take into account the interplay between cognitive changes, such as memory and executive function, with emotion in adjustment following herpes simplex viral encephalitis.
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Emslie H, Wilson BA, Quirk K, Evans JJ, Watson P. Using a paging system in the rehabilitation of encephalitic patients. Neuropsychol Rehabil 2007; 17:567-81. [PMID: 17676535 DOI: 10.1080/09602010701381933] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Memory and executive problems following encephalitis are common yet there are few published papers on the successful rehabilitation of such patients. We recently demonstrated (Wilson, Emslie, Quirk, & Evans, 2001; Wilson, Emslie, Quirk, Evans, & Watson, 2005) that a paging system could reduce the everyday memory and planning problems for people with non-progressive brain injury. Among the 143 patients who participated in the 2001 study were four people who had survived encephalitis. Their results are reported here. During a 2-week baseline, the successful task achievement of our four clients ranged from 2-81%. They then received a pager for 7 weeks and task achievement was documented in weeks 6 and 7. All were significantly more successful with the pager than they had been at baseline with success rates ranging from 45-96%. Five weeks after returning their pagers they were monitored once more. One of the encephalitic patients failed to achieve any of his target tasks, returning to baseline level, the other three dropped back a little but were still significantly more successful than at baseline. It is concluded that the paging system can reduce everyday memory and planning problems of patients with encephalitis.
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Affiliation(s)
- H Emslie
- MRC Cognition and Brain Sciences Unit, Cambridge, UK.
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