Encephalitis is an inflammation of brain membrane and parenchyma. It has a lower incidence than a traumatic brain injury or a stroke. Despite its low incidence, however, having variable clinical manifestations from a traumatic brain injury and a stroke and adverse outcomes in discharge, encephalitis imposes much medical burden on patients and public health systems. Nevertheless, clinical features of the functional deficits and effectiveness of rehabilitative intervention have not been extensively studied.
We reviewed the charts of the encephalitis patient who admitted for the past ten years in the rehabilitation center retrospectively and investigated basic demographic characteristics and the indicators of functional deficits. Variables of age, sex, and duration of hospital stay were collected as basic demographic characteristics in addition to disease characteristics such as seizure history, which is a common feature in encephalitis. Shoulder and hip flexor MMT test results in MRC grade (Shoulder MMT and hip MMT), Fugl-Mayer assessments in upper and lower extremities(FMA-U and FMA-L), Berg-balance score(BBS), Functional ambulation category(FAC), Korean-mini mental state examination(K-MMSE) and Korean-Modified Barthel index score(K-MBI) were collected as the indicators for functional deficits and, which were routinely evaluated in the rehabilitation center. Assessments of both admission and discharge were compared to evaluate the effect of rehabilitative intervention during hospitalization.
Data of 20 encephalitis patients were collected. The etiology of encephalitis can be categorized into three; viral (n=10), autoimmune (n=8), and unknown (n=2) etiology. The average duration of hospital stay was 92.5 days, and all patients had quadriplegia (n=20). More than half of the encephalitis patients reported past seizure experiences and had taken anticonvulsants (n=14). The mean values of physical and functional assessment at the admission are indicated in table 1. Physical assessments such as shoulder and hip MMT result and FMA score, showed no interval change between admission and discharge, but variables considered to represent the functional deficits, such as BBS, FAC, and MBI, showed a significant interval change between the admission and discharge. Assessments of two major encephalitis groups at admission, viral and autoimmune, showed no difference between two groups. We compared the change in function from admission to discharge after rehabilitative intervention for viral and autoimmune encephalitis. Improvements were significant in FAC, K-MMSE and K-MBI for viral etiology and only in K-MBI for autoimmune etiology.
Rehabilitative intervention of encephalitis patients can promote significant functional gains rather than improvements in individual strengthening. Viral encephalitis group showed more functional gains than autoimmune encephalitis group, which can be attributed to the wax and wane characteristics of autoimmune disease.
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