Objective: Movement disorders in Japanese encephalitis is known, but under reported. In this study we tried to analyse the spectrum of movement disorders in patients with Japanese encephalitis correlated with radiological findings in a tertiary care hospital in North eastern region of India.

Background: Japanese encephalitis has been emerging as a major health problem in South east Asia and several out breaks have been reported in South east Asia. It has been reported first in India in the southern state of Tamil Nadu in 1955.The disease is appearing in sporadic or in epidemic outbreaks since 1976 in various parts of North Eastern region of India, particularly in the state of Assam.Geographic location,Climatic condition,abundance of potential vectors,adequate reservoir,amplifying hosts,socio-cultural behavior of the people,agricultural practices etc are contributing for a congenial atmosphere for the spread of Japanese encephalitis virus in the region.

Methods: We reviewed prospectively 34 patients admitted in the hospital during the monsoon season(June through September) in two consecutive years(2014-15). Diagnosis of Japanese encephalitis was based on clinical, serological(Cerebrospinal fluid or serum) and radiological criteria. Samples(Cerebrospinal fluid/Serum) were tested for Japanese encephalitis virus specific IgM antibody using ELISA technique. Magnetic resonance imaging(MRI) of the brain (Using 1.5 Tesla) were done in all the patients. Among which 14(41.1%) patients had presented with various forms of movement disorders.

Results: Patients age ranged between 7-85 years.Male: Female ratio=9:5. 9(64.2%) Patients who were in coma had facial masking while coming out of coma.Tremor in 10(71.4%) ,Generalised dystonia in 1(7.1%) ,Rigidity in 7(50%), bradykinesia in 8(57.1%), choreiform movements in 2(14.2%). In MRI brain studies,bilateral thalamic involvement were present in all the patients.Basal ganglial lesions were found in all the patients presenting with movement disorders.3(21.4%) patients had midbrain and pontine involvement and 2(14.2%) patients had cerebellar involvements.

Conclusions: Movement disorders are not manifested as a presenting symptom initially, but are not uncommon manifestations and typically related to the anatomical site of involvement.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/movement-disorders-in-patients-with-japanese-encephalitis-experience-in-a-tertiary-care-hospital-in-north-eastern-region-of-india/