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COMMENTARY |
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Year : 2014 | Volume
: 7
| Issue : 6 | Page : 768-769 |
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Post Japanese encephalitis orolingual tremor
Viroj Wiwanitkit
Faculty of Medicine, University of Nis, Serbia; Hainan Medical University, China; Joseph Ayo Babalola University, Nigeria
Date of Web Publication | 18-Nov-2014 |
Correspondence Address: Viroj Wiwanitkit Wiwanitkit House, Bangkhae, Bangkok 10160, Thailand
Source of Support: None, Conflict of Interest: None | Check |
How to cite this article: Wiwanitkit V. Post Japanese encephalitis orolingual tremor. Med J DY Patil Univ 2014;7:768-9 |
Encephalitis is an important neurological disorder. It is considered a serious neurological disorder that can be highly morbid and mortal. This problem can be seen world-wide and it is still the present concern in clinical neurology. There are various causes of encephalitis and the infection is a considered an important group of medical disorder that can result in encephalitis. Many infections can be the causes of encephalitis. Many pathological viruses can induce encephalitis. A well-known one is Japanese encephalitis virus.
Japanese encephalitis virus is an important pathogen that can induce neurological disorder. Although most of infected cases are not symptomatic, some can present clinical neurological signs and symptoms. The encephalitis is a hallmark clinical feature of Japanese encephalitis. [1],[2] Epidemiologically, this encephalitis is reported world-wide. It is considered as an important mosquito borne viral infection. This arbovirus infection has a specific incubation period between 1 and 2 weeks. Around 4 from 1,000 infected cases can finally develop neurological presentation. [1],[2] The clinical features of cases with neurological presentation include fever, headache, fatigue and other non-specific symptoms. The possible neurological presentations include decreased sensory, convulsions, headache, brainstem signs with pyramidal and extrapyramidal problems. The fever is usually high. Some cases can have severe neurological presentations. The acute encephalitis features can be seen. The patient will develop neck rigidity accompanied with other neurological problems including convulsion and paresis. [1],[2] Some patients can be in comatose and the fatality can be expected. As a viral induced disorder, the specific treatment of Japanese encephalitis is not available and the management is usually symptomatic treatment. Some patients can recover whereas many cases can have the morbidity and mortality.
An article entitled "case report of patient with orolingual tremors as post Japanese encephalitis sequelae" in Medical Journal of Dr. D.Y. Patil University is a very interesting case report. [3] In fact, the neurological sequelae of Japanese encephalitis can be expected. Rayamajhi et al. noted that risk of neurological sequelae, especially hemiparesis was significantly more common in Japanese encephalitis comparing to other encephalitic disorders. [4] The neurological sequelae are usually observed at 6 weeks follow-up and around one-fifth of the cases can have this problem. [4],[5] The patients might have disability. According to a recent study from Cambodia, 11% of disability are severe, 39% moderate and 45% are mild sequelae. [6] Another report from Cambodia showed 25%, 7% and 18% had severe, moderate and mild sequelae, respectively. [7]
Some uncommon sequelae of Japanese encephalitis are also observable. The good example is acute transverse myelitis, which is believed to be an immune-mediated process. [8] Focusing on orolingual tremor, it is an uncommon sequelae of Japanese encephalitis. In fact, the motor disorder and tremor due to Parkinsonism More Details can be observed in many patients with Japanese encephalitis, [9] however, the isolated orolingual tremor, a combination of tremors of the jaw, tongue, pharynx, and face, is rarely presented. The exact pathogenesis of isolated orolingual tremor as post Japanese encephalitis sequelae is still a myth. It is believed to be related to immune-mediated brain disorder. Since orolingual tremor is a specific kind of head tremor that is presently not completely well-understood in clinical neurology, the specific management of the case is usually difficult and not successful. [10]
References | | |
1. | Yun SI, Lee YM. Japanese encephalitis: The virus and vaccines. Hum Vaccin Immunother 2014;10:263-79. [ PUBMED] |
2. | Miyake M. The pathology of Japanese encephalitis. A review. Bull World Health Organ 1964;30:153-60. [ PUBMED] |
3. | Deshpande A, Khardenavis S, Shetty A. Case report of patient with orolingual tremors as a post Japanese encephalitis sequelae. Med J Dr. D.Y. Patil Univ 2014;7:766-8. |
4. | Rayamajhi A, Singh R, Prasad R, Khanal B, Singhi S. Study of Japanese encephalitis and other viral encephalitis in Nepali children. Pediatr Int 2007;49:978-84. |
5. | Kakoti G, Dutta P, Ram Das B, Borah J, Mahanta J. Clinical profile and outcome of Japanese encephalitis in children admitted with acute encephalitis syndrome. Biomed Res Int 2013;2013:152656. |
6. | Hills SL, Van Cuong N, Touch S, Mai HH, Soeung SC, Lien TT, et al. Disability from Japanese encephalitis in Cambodia and Viet Nam. J Trop Pediatr 2011;57:241-4. |
7. | Maha MS, Moniaga VA, Hills SL, Widjaya A, Sasmito A, Hariati R, et al. Outcome and extent of disability following Japanese encephalitis in Indonesian children. Int J Infect Dis 2009;13:e389-93. |
8. | Verma R, Praharaj HN, Patil TB, Giri P. Acute transverse myelitis following Japanese encephalitis viral infection: An uncommon complication of a common disease. BMJ Case Rep 2012;2012:pii: bcr2012007094. |
9. | Misra UK, Kalita J. Prognosis of Japanese encephalitis patients with dystonia compared to those with Parkinsonian features only. Postgrad Med J 2002;78:238-41. |
10. | Silverdale MA, Schneider SA, Bhatia KP, Lang AE. The spectrum of orolingual tremor - A proposed classification system. Mov Disord 2008;23:159-67. |
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