MOVEMENT-DISORDERS IN JAPANESE ENCEPHALITIS

Movement disorders in Japanese encephalitis (JE), although reported, h ave not been analyzed systematically. In this study, we report an anal ysis of movement disorders in 14 out of 17 JE patients, correlated wit h the radiological findings. All patients had at least a four fold ris e of IgG antibodies against JE in a haemagglutination inhibition test. The patients' ages ranged between 2 and 54 years and 4 of them were w omen. Extrapyramidal signs, such as hypokinesia, hypophonia and maskin g of the face, were present in all patients by the first month as the patients came out of the coma - except for 1 patient. Eight patients h ad axial and 3 tongue dyskinesia; rigidity was present in 6 and tremor in 2 patients. At 3 months, these symptoms improved considerably in 6 patients. Cranial CT scan revealed thalamic involvement in 10, which was bilateral in 9 patients. Two patients had brain stem and one had c erebellar involvement. Cranial MRI was carried out in 9 patients and r evealed additional findings in lentiform nucleus, midbrain and pens in 3 each and cerebellum in 4 patients. Bilateral thalamic involvement o n MRI was seen in all the patients, including two patients whose CT sc ans were normal. SPECT studies using Tc-99m-ECD revealed bilateral tha lamic hypoperfusion in all (n = 7) and frontal hypoperfusion in 3 pati ents. In JE, movement disorders are common and may be due to thalamic involvement in isolation or in combination with basal ganglia or midbr ain or both.