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The management of suspected encephalitis

BMJ 2012; 344 doi: (Published 06 June 2012) Cite this as: BMJ 2012;344:e3489
  1. Guy E Thwaites, clinical reader in infectious diseases
  1. 1Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Kings College London/Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
  1. guy.thwaites{at}

New UK guidance for children and adults is welcome, but a stronger evidence base is needed

Around 700 cases of encephalitis occur each year in the United Kingdom.1 Most doctors will see only one or two cases in their entire career; even those who specialise in infectious diseases or neurology diagnose and treat encephalitis infrequently, which begs the question, “Is there a need for the two recently published national guidelines on the management of suspected encephalitis in children and adults?”2 3

People who have survived encephalitis, or who have been directly responsible for its diagnosis and treatment, will probably appreciate the help these guidelines offer. However, the need for them is best illustrated by the findings of a recent two year study of 203 cases of encephalitis treated in 24 hospitals in the UK.4 The median age of patients was 30 years (range 0-87). No cause for the illness was found in 37% of cases, despite the best available imaging and microbiological diagnostic techniques. Twenty five different conditions accounted for cases with a defined cause, and although management was tailored to these …

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