In reply We appreciate the comments by Dr Wang on our article. In Taiwan, the incidence of JE has been significantly reduced following vaccination programs. In 1997, the incidence of patients in Taiwan with confirmed JE was 0.03 per 100 000 people.1,2 Recently 3 more cases of JE have been reported in southern Taiwan.2 The seroconversion rate was 85% after more than 2 doses of vaccine, emphasizing that at least 15% of the population in this region are at risk for developing JE.1 With the declining incidence of JE in Japan, Korea, and Taiwan, ANEC is increasingly being reported. Some of these reports have not carefully excluded the possibility of JE.3 Therefore, it is important to consider and cautiously exclude JE in patients who initially appear to have ANEC. Thalamotegmental involvement besides arboviral infections has also been reported with mitochondrial disorders, Wilson disease, and venous sinus thrombosis, which may have characteristic clinical findings but rarely pose diagnostic difficulties when associated with fever. During the post-monsoon period in Southeast Asia, the occurrence of thalamotegmental lesions in a patient with encephalitic syndrome suggested JE,4 but these may have been due to several other viruses as well. In the United States, similar findings have been reported in eastern equine encephalitis5 and more recently with West Nile encephalitis. In Japan, Taiwan, and Korea, on the other hand, ANEC is emerging as an important cause of thalamotegmental lesions. The absence of basal ganglia and cerebral cortical involvement in ANEC has been reported. However, these findings are based on small series and need further confirmation in larger studies before they can be considered diagnostic. The pathologic features of ANEC are not distinctive, and similar results have been reported in autopsy studies of American soldiers who died of JE in Korea.6 Creating eponyms or naming syndromes at an early stage may hamper our efforts to understand the etiology of the disease. We hope that ANEC will not play such a role. Correspondence: Dr Misra, Neurology, Sanjay Gandhi PGIMS, Lucknow 226014, India (firstname.lastname@example.org). References 1. Wu YCHuang YSChien LJ et al The epidemiology of Japanese encephalitis on Taiwan during 1966-1997. Am J Trop Med Hyg.1999;61:78-84.PubMedGoogle Scholar 2. Tseng HFTan HFChang CKHuang WLHo WC Seroepidemiology study of Japanese encephalitis neutralizing antibodies in southern Taiwan: a comparative study between urban city and country townships. Am J Infect Control.2003;31:435-440.PubMedGoogle Scholar 3. Yagishita ANakano IUshioda TOtsuki NHaseawa A Acute encephalopathy with bilateral thalamotegmental involvement in infants and children: imaging and pathology findings. Am J Neuroradiol.1995;16:439-447.PubMedGoogle Scholar 4. Kalita JMisra UK Comparison of CT scan and MRI findings in the diagnosis of Japanese encephalitis. J Neurol Sci.2000;174:3-8.PubMedGoogle Scholar 5. Deresiewicz RLThaler SJShu LZamani AA Clinical and neuroradiographic manifestations of eastern equine encephalitis. N Engl J Med.1997;336:1867-1874.PubMedGoogle Scholar 6. Zimmerman HM Pathology of Japanese encephalitis. Am J Pathol.1946;22:965-991.Google Scholar
Archives of Neurology – American Medical Association
Published: Jul 1, 2004
Keywords: magnetic resonance imaging,child,japanese encephalitis,encephalopathy
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