Encephalitis is an inflammation of the brain. Most often, it is caused by a viral infection. Several different viruses can cause encephalitis. The most common are the herpes viruses, childhood viruses such as measles, and viruses transmitted by mosquito bite. There are two types of encephalitis -- primary and secondary. In primary encephalitis, a virus attacks the brain and spinal cord directly. In secondary encephalitis, the virus invades another part of your body and travels to your brain. The virus causes inflammation of the nerve cells (encephalitis) or the surrounding membranes (meningitis). Encephalitis is different from meningitis, but these two brain infections often occur together. Most cases of encephalitis are mild and don't last long. However, in some cases encephalitis can be life threatening. About 10,000 - 20,000 cases of encephalitis are reported annually in the United States.

• Ninety percent of people with encephalitis have flu-like symptoms, such as fever, sore throat, cough, and malaise.
• If meningitis accompanies encephalitis, the person may experience headache, stiff neck, intolerance to light, and vomiting.
• People with severe encephalitis usually have some change in consciousness, ranging from mild confusion to coma, often including disorientation and delusion with possible hallucinations, agitation, and personality changes.
• Up to 50% of people with encephalitis may have seizures.
• Other signs and symptoms of encephalitis depend on which area of the brain is most affected. These may include an impaired ability to use or comprehend words or coordinate voluntary muscle movements, muscle weakness or partial paralysis on one side of the body, uncontrollable tremors or involuntary movements, and an inability to regulate body temperature.
• Infants may have bulging in the fontanels (soft spots) on the skull.

Arboviruses, or viruses carried by insects, are among the most common causes of viral encephalitis. Some of the major arboviruses that are transmitted by mosquito include:

• Eastern equine encephalitis -- This infection is relatively rare, with only a few cases reported each year. However, about half the people who develop severe symptoms die or suffer permanent brain damage.
• La Crosse encephalitis -- usually affects children under 16 years of age in the upper Midwestern United States. It is rarely fatal.
• St. Louis encephalitis -- People in rural Midwestern and southern United States are primarily affected. Many people have mild symptoms, although symptoms can be severe in people over age 60. Up to 30% of infected seniors die of the condition.
• West Nile encephalitis -- Primarily affects people in Africa and the Middle East, but outbreaks have spread across the United States. Most cases are mild. Symptoms are most severe in older adults and people with weakened immune systems, and it can be fatal among those populations.
• Western equine encephalitis -- People in the western United States and Canada are most at risk. It usually causes a mild infection, except in children under 1 year of age, who can suffer permanent brain damage.

Other viruses that commonly cause viral encephalitis include:

• Herpes simplex virus type 1 (HSV-1), which is responsible for cold sores
• HSV-2, which is responsible for genital herpes
• Varicella zoster virus, which causes chicken pox and shingles
• Epstein-Barr virus, which causes mononucleosis

Childhood viruses that can cause encephalitis include:

• Measles (rubeola)
• German measles (rubella)
• Mumps

Not all cases of encephalitis are caused by viruses. Some nonviral causes of encephalitis include:

• Bacterial infection
• Fungal infection
• Parasitic infection
• Noninfectious causes, such as allergic reactions or toxins

The following factors may increase your risk of becoming infected with viral encephalitis:

• Being very young or an older adult
• Being exposed to mosquitoes or ticks
• Having a weakened immune system
• Not being immunized against measles, mumps, and rubella
• Traveling to areas where viral encephalitis is prevalent

Encephalitis is a serious condition, so you should see a doctor if you or your child starts having symptoms of encephalitis. Diagnosis and initial treatment usually take place in a hospital. After performing a physical exam, a doctor may take the following steps to diagnose the condition:

• Blood test -- detects viruses in the blood
• Spinal tap (lumbar puncture) -- detects viruses in the cerebrospinal fluid that surrounds the brain and spinal cord
• Brain imaging -- magnetic resonance imaging (MRI) and computerized tomography (CT) scan determine whether swelling is present in the brain
• Electroencephalogram (EEG) -- detects abnormal brain waves

The most effective way to prevent encephalitis is to avoid contracting viruses that lead to encephalitis:

• Protect yourself from mosquitoes. Use insect repellent and wear long pants and long sleeves. The most effective insect repellents use DEET, picaridin, or oil of lemon eucalyptus. Do not apply insect repellent to children under 2 years of age.
• Make sure your child is vaccinated against childhood diseases such as the measles, mumps, and rubella (MMR).
• Maintain a balanced diet to keep your immune system healthy.

Viral encephalitis is a serious medical condition. Although there are no specific medications to treat encephalitis, often people with symptoms are given the antiviral medication acyclovir (Zovirax), which is effective against herpes simplex and varicella-zoster viruses. Although complementary and alternative therapies have not been extensively studied for the treatment of encephalitis, some studies indicate that scalp acupuncture, combined with proper medication, may aid the healing process. Careful observation and supportive care, including rest, proper nutrition, and fluids, are a mainstay of treatment for encephalitis and allow the body to fight the infection. You should always see your doctor if you have symptoms of encephalitis; don't try to treat yourself.

Always tell your health care provider about the herbs and supplements you are using or considering using, as some supplements may interfere with conventional treatments.

Medications

Medications used to treat viral encephalitis include:

• Acyclovir (Zovirax) -- treats encephalitis caused by HSV, VZV, and EBV
• Ganciclovir (Cytovene) -- treats encephalitis caused by cytomegalovirus and HSV1
• Anticonvulsant medications -- prevent and treat seizures associated with encephalitis

Nutrition and Dietary Supplements

Although no specific vitamins or supplements have been shown to reduce symptoms of encephalitis, following these nutritional tips may help improve general health and well-being:

• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
• Avoid refined foods, such as white breads, pastas, and especially sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
• Use healthy oils in foods, such as olive oil or vegetable oil.
• Avoid caffeine, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

These supplements may also improve health:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc and selenium.
• Omega-3 fatty acids, such as fish oil, one to three times daily, to help decrease inflammation and help with immunity.
• Vitamin C, 500 - 1,000 mg one to three times daily, as an antioxidant and for immune support.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and muscular support.
• Acetyl-L-carnitine, 500 mg daily, for antioxidant and antiviral activity.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
• L-glutamine, 500 - 1,000 mg three times daily, for support of gastrointestinal health and immunity.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day.

No herbs have been shown to help treat encephalitis. These herbs may help support general health:

• Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, anti-inflammatory, and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, for inflammation and antiviral activity.
• Garlic (Allium sativum), standardized extract, 400 mg two to three times daily, for immune activity.
• Astragalus (Astragalus membranaceus) standardized extract, 250 - 500 mg four times daily for immune support and antiviral activity.
• Elderberry (Sambucus nigra), one to two teaspoonfuls of standardized liquid extract two to four times daily, for immune support and antiviral activity.

Acupuncture

A study of a small number of people with complications from encephalitis suggests that acupuncture delivered to the scalp may lessen severe complications and reduce symptoms. Some practitioners believe that scalp acupuncture is effective for people with encephalitis because all meridians converge at the head, and the method can stimulate and regulate qi (energy) throughout the entire body. More research is needed.

Pregnancy

The most common cause of encephalitis in newborns is vaginal delivery by a mother who is infected with herpes simplex virus 2 (HSV-2). This infection in newborns is often severe and fatal. For this reason, pregnant women with a history of HSV-2 infection may be advised to have a cesarean section, even if there is no sign of an active infection.

Prognosis and Complications

Full recovery from encephalitis can take weeks or months. People recovering from serious cases may have complications ranging from fatigue and difficulty concentrating to tremors and personality changes. The most severe problems associated with encephalitis result from the destruction of nerve cells in the brain. How severe the complications are depends on the person's immune system (whether it is healthy or weak) and what infection caused the encephalitis. For example, many of those infected with Eastern equine encephalitis and St. Louis encephalitis have permanent brain damage (such as problems with memory, speech, vision, hearing, muscle control, and sensation) and a low survival rate. Those infected with Epstein-Barr or varicella zoster rarely experience any serious complications.

Most cases of encephalitis are mild and people make a full recovery.

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