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

Abstract

Objective: To examine long-term outcome after tick-borne encephalitis (TBE) in children.

Study design: In this population-based cohort, 55 children with TBE with central nervous system involvement infected during 2004-2008 were evaluated 2-7 years later using the Rivermead post-concussion symptoms questionnaire (n = 42) and the Behavior Rating Inventory of Executive Functioning for parents and teachers (n = 32, n = 22, respectively). General cognitive ability was investigated in a subgroup (n = 20) using the Wechsler Intelligence Scale for Children, 4th edition.

Results: At long-term follow-up, two-thirds of the children experienced residual problems, the main complaints being cognitive problems, headache, fatigue, and irritability. More than one-third of the children were reported by parents or teachers to have problems with executive functioning on the Behavior Rating Inventory of Executive Functioning, mainly in areas involving initiating and organizing activities and working memory. Children who underwent Wechsler Intelligence Scale for Children, 4th edition testing had a significantly lower working memory index compared with reference norms.

Conclusion: A large proportion of children experience an incomplete recovery after TBE with central nervous system involvement. Cognitive problems in areas of executive function and working memory are the most prevalent. Even if mortality and severe sequelae are low in children after TBE, all children should be followed after TBE to detect cognitive deficits.

Keywords: BRIEF; Behavior Rating Inventory of Executive Function; CNS; CSF; Central nervous system; Cerebrospinal fluid; EEG; Electroencephalogram; RPQ; Rivermead post-concussion symptoms questionnaire; TBE; TBE virus; TBEv; Tick-borne encephalitis; WBC; WISC-IV; Wechsler Intelligence Scale for Children, 4th edition; White blood cells.