What is involved in tertiary prevention of encephalitis?

Tertiary Prevention in Encephalitis

Tertiary prevention of encephalitis focuses on comprehensive rehabilitation and long-term follow-up to minimize disability, prevent complications, and improve quality of life in patients who have survived the acute phase of the disease.

Comprehensive Rehabilitation Approach

Neurological and Cognitive Rehabilitation

• All patients with encephalitis should have access to assessment for rehabilitation regardless of age 1
• A multidisciplinary rehabilitation team should include:
  • Neuropsychology and neuropsychiatry specialists
  • Speech and language therapists
  • Neuro-physiotherapists
  • Occupational therapists 1

Psychiatric Support

• Targeted intervention for common sequelae including:
  • Anxiety disorders (46% increased risk compared to general population)
  • Depressive disorders
  • Psychotic disorders (348% increased risk)
  • Bipolar disorder (634% increased risk) 2
• Early psychiatric assessment and treatment is critical as psychiatric sequelae are among the most common complications after encephalitis

Seizure Management

• Long-term anticonvulsant therapy for post-encephalitic epilepsy (risk is 31.9 times higher than general population) 2
• Regular neurological follow-up with EEG monitoring
• Medication adjustment based on seizure control and side effects

Structured Follow-up Care

Discharge Planning

• Patients should not be discharged without either a definite or suspected diagnosis
• Discharge meeting must include arrangements for outpatient follow-up and plans for ongoing therapy and rehabilitation
• At least one follow-up appointment should be scheduled before discharge 1

Long-term Monitoring

• Regular follow-up appointments to assess:
  • Neurological function
  • Cognitive status
  • Psychiatric well-being
  • Medication effectiveness and side effects
• Monitoring for late-onset complications, particularly in the first year when risk is highest 2

Special Considerations for Immunocompromised Patients

• Immunocompromised patients with HSV encephalitis require:
  • Extended antiviral treatment (at least 21 days)
  • CSF PCR reassessment before stopping therapy
  • Consideration of long-term oral treatment until CD4 count >200 106/L 1

Patient and Family Support

Education and Resources

• Provide information on encephalitis and its management
• Connect patients with support organizations like the Encephalitis Society
• Family education on managing cognitive and behavioral changes 1

Psychosocial Support

• Family counseling to address caregiver burden
• Support groups for patients and families
• Vocational rehabilitation for return to work when possible

Common Pitfalls in Tertiary Prevention

Inadequate Follow-up

• 33% of encephalitis patients are discharged without outpatient follow-up despite 96% reporting ongoing complications 1
• Failure to recognize that sequelae may not be immediately apparent at discharge

Insufficient Specialist Care

• Limited access to specialized brain injury rehabilitation services
• Only 39% of encephalitis patients are cared for on neurological wards during acute care 1

Delayed Recognition of Complications

• Highest risk for complications is in the first year after encephalitis, particularly for epilepsy (139.6 times higher risk in first year) 2
• Failure to monitor for cognitive decline and dementia development

Implementation of Tertiary Prevention

Early Intervention

• Begin rehabilitation assessment as soon as the patient is medically stable
• Transfer to a neurological unit when diagnosis is not rapidly established or patient fails to improve with therapy 1

Coordinated Care

• Establish a care coordinator to manage the multidisciplinary approach
• Regular team meetings to adjust rehabilitation strategies based on progress

Long-term Planning

• Develop individualized rehabilitation plans with measurable goals
• Adjust plans as recovery progresses or new challenges emerge

By implementing comprehensive tertiary prevention strategies, healthcare providers can significantly improve outcomes and quality of life for encephalitis survivors, reducing the long-term burden of disease and supporting reintegration into society.