title: Tick-borne encephalitis carries a high risk of incomplete recovery in children.
abstract: OBJECTIVE
  To examine long-term outcome after tick-borne encephalitis (TBE) in children.
  
  
  METHODS
  In this population-based cohort, 55 children with TBE with central nervous system involvement infected during 2004-2008 were evaluated 2-7 years later using the Rivermead post-concussion symptoms questionnaire (n = 42) and the Behavior Rating Inventory of Executive Functioning for parents and teachers (n = 32, n = 22, respectively). General cognitive ability was investigated in a subgroup (n = 20) using the Wechsler Intelligence Scale for Children, 4th edition.
  
  
  RESULTS
  At long-term follow-up, two-thirds of the children experienced residual problems, the main complaints being cognitive problems, headache, fatigue, and irritability. More than one-third of the children were reported by parents or teachers to have problems with executive functioning on the Behavior Rating Inventory of Executive Functioning, mainly in areas involving initiating and organizing activities and working memory. Children who underwent Wechsler Intelligence Scale for Children, 4th edition testing had a significantly lower working memory index compared with reference norms.
  
  
  CONCLUSIONS
  A large proportion of children experience an incomplete recovery after TBE with central nervous system involvement. Cognitive problems in areas of executive function and working memory are the most prevalent. Even if mortality and severe sequelae are low in children after TBE, all children should be followed after TBE to detect cognitive deficits.
authors: Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. asa.fowler@ki.se
authors: Åsa
authors: Å
authors: Fowler
authors: Lea
authors: L
authors: Forsman
authors: Margareta
authors: M
authors: Eriksson
authors: Ronny
authors: R
authors: Wickström
mesh_terms: D000293:Adolescent; D002493:Central Nervous System Diseases / Q000821:virology; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000821:virology; D004675:Encephalitis, Tick-Borne / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors; D055815:Young Adult
keywords: BRIEF; Behavior Rating Inventory of Executive Function; CNS; CSF; Central nervous system; Cerebrospinal fluid; EEG; Electroencephalogram; RPQ; Rivermead post-concussion symptoms questionnaire; TBE; TBE virus; TBEv; Tick-borne encephalitis; WBC; WISC-IV; Wechsler Intelligence Scale for Children, 4th edition; White blood cells