Encephalitis refers to inflammation of the brain typically caused by infections ,autoimmune reactions or other triggers. It can vary in severity ,ranging from mild symptoms to life threatening conditions requiring intensive care.

In Ayurveda this condition can be correlated to sannipathika jwara, that manifests in a compressed or shortened duration but is often severe or acute. This term can be interpreted as describing a fever that progresses rapidly with intense symptoms, potentially caused by a sudden aggravation of doshas (primarily pitta and vata)or external factors such as infections.

The doshas involved here are:

• Pitta: Typically elevated ,causing heat, thirst and inflammation.
• Vata: Causes shivering, restlessness and fluctuating body temperature.

SYMPTOMS OF SANNIPATHIKA JWARA ARE:

A)General symptoms:

• High fever with fluctuating intensity.
• Body pain and heaviness.
• Weakness and fatigue.
• Headache with heaviness or throbbing sensation.
• Severe discomfort due to multi dosha involvement.
• Confusion or delirium.

B) Vata symptoms:

• Shivering and chills.
• Dryness of the body and mouth.
• Restlessness and nervousness.

C)Pitta Symptoms:

• Burning sensation of the body.
• Excessive thirst.
• Nausea and vomiting.
• Bitter and sour taste in mouth.
• Yellowish discoloration of skin, urine or eyes.

D)Kapha symptoms:

• Lethargy and heaviness in the body.
• Loss of appetite.
• Sluggish digestion.

Mental Symptoms:

• Delirium(Bhrama): Confusion and disorientation due to vata and pitta imbalances.
• Restlessness(Chittodvega): Anxiety, unease or agitation caused by aggravated vata.
• Irritability and anger(krodha): Frequent mood swings or aggression linked to pitta dominance.
• Lethargy(Tandra): Sluggishness, excessive  sleepiness or drowsiness influenced by kapha imbalance.
• Depression(Manodaurbalya): A feeling of sadness, hopelessness or mental fatigue due to overall  doshic disturbance.
• Hallucinations(Moha): Sensory distortions, confusion or inability to recognize familiar people or surroundings, commonly associated with severe imbalance.
• Poor concentration(Avyavasthitha chittha): Difficulty focusing or processing thoughts due to vata disruptions.
• Insomnia(Anidra): Lack of sleep linked to heightened vata and pitta.
• Clouded Thinking(Medha Bhramsha): Cognitive dullness or a lack of clarity due to kapha’s heaviness combined with vata’s instability.

TYPES OF ENCEPHALITIS:

Encephalitis is classified into  various types based on the underlying cause. Here’s an overview of the main types.

*INFECTIOUS TYPES:

I)Infectious Encephalitis:

Caused by direct infection of the brain by pathogens.

A)Viral Encephalitis(most common):

• Herpes simplex virus(HSV):The leading cause of sporadic encephalitis in adults, often affects the temporal lobe ,can be life threatening if untreated.
• Varicella Zoster Virus(VZV) Encephalitis: Associated with chickenpox or shingles.
• Arboviral Encephalitis: Spread by mosquitoes  or tricks ,such as West Nile virus, Japanese encephalitis virus, dengue or zika virus.
• Rabies Encephalitis: Develops after a bite from an infected animal.
• Enteroviruses: Including coxsackie virus, echovirus and poliovirus.
• HIV associated Encephalitis: Due to advanced or untreated HIV/AIDS.
• Childhood viruses: Measles, mumps, rubella.

B)Bacterial infections:

• Rare, but can occur as secondary complications.
• Tuberculosis.
• Listeria monocytogenes.
• Secondary bacterial spread from meningitis.

C)Fungal Encephalitis:

• Cryptococcus(common in immunocompromised individuals).
• Histoplasmosis.

D) Parasitic infections:

• Toxoplasmosis.
• Amebic Encephalitis.

*NON INFECTIOUS TYPES:

A)Autoimmune Encephalitis:

Caused by the immune system attacking brain tissues.

I)Anti-NMDA Receptor Encephalitis:

• Often associated with ovarian teratomas or other tumors.
• Symptoms: psychosis, seizures and memory deficits.

II)Limbic Encephalitis:

• Targets the limbic system.(emotions, memory).
• May occur with cancers(paraneoplastic syndromes).

III)Hashimoto’s Encephalopathy:

• Linked  to thyroid dysfunction and anti thyroid antibodies.

B)Post Infectious (Para-infectious)Encephalitis:

I)Acute Disseminated Encephalomyelitis(ADEM):

• Often follows viral infections or vaccinations.
• Causes widespread inflammation in the brain and spinal cord.

II)Rasmussen’s Encephalitis:

• A rare chronic inflammatory condition affecting one hemisphere of the brain.
• Causes severe seizures and neurological decline.

C)Toxic or Metabolic Encephalitis:

Inflammation caused by exposure to toxins or metabolic imbalances.

• Toxic causes: Lead poisoning, alcohol abuse.
• Metabolic causes: Severe liver failure (hepatic encephalopathy)or Kidney failure(uremic encephalopathy).

D).Paraneoplastic Encephalitis:

• A rare type caused by the body’s immune response to a tumor (eg ;lung cancer, ovarian teratomas).

E).Idiopathic Encephalitis

• When no clear cause is identified.

CLINICAL SYMPTOMS OF ENCEPHALITIS:

The clinical symptoms can vary in severity and presentation depending on the cause ,the part of the brain affected and patient’s overall health.Common symptoms include:

A)Initial Symptoms:

• Fever: High grade fever is common.
• Headache: Often severe and persistent.
• Fatigue or malaise: General feeling of tiredness or weakness.
• Muscle aches: Often accompanying the initial viral illness.

B)Neurological Symptoms:

• Altered mental status: Confusion, disorientation or difficulty thinking clearly.
• Seizures: Can range from mild(focal)to severe (generalized).
• Photophobia: Sensitivity to light.
• Neck stiffness: May resemble meningitis symptoms.
• Behavioral changes: Agitation, irritability or lethargy.
• Speech difficulties: Slurred speech, difficulty in forming sentences.
• Hallucinations: Both visual and auditory in severe cases.

Motor and Sensory symptoms:

• Weakness or paralysis: Often affecting one side of the body(hemiparesis).
• Coordination problems: Ataxia or unsteady movements.
• Sensory disturbances: Tingling or numbness.

Severe symptoms(Medical Emergency):

• Loss of consciousness: Ranging from stupor to coma.
• Severe seizures.
• Continuous or repetitive seizures(status epilepticus).
• Breathing difficulties: Respiratory depression due to brain stem involvement.
• Increased intracranial pressure: Can cause papilledema, vomiting or severe headache.

Pediatric Symptoms(Specific to children):

• Bulging fontanelle(in infants).
• Poor feeding or irritability.
• Crying or refusal to be comforted.

DIAGNOSIS OF ENCEPHALITIS:

Diagnosing encephalitis involves identifying the underlying causes and assessing the extent of brain involvement. The process typically includes clinical evaluation, laboratory tests, and imaging studies.

1. Clinical Evaluation:

History and symptoms evaluation:

• Recent infection, exposure to ticks/ mosquitoes,  or contact with infected individuals.
• Symptoms like fever, headache, altered mental status, seizures, photophobia, or neck stiffness.

Neurological Examination:

• Assessment of mental status, reflexes, coordination, motor and sensory functions, and signs of increased intracranial pressure.

2. Laboratory tests:

A)Blood tests:

Complete Blood Count(CBC):

• To detect the signs of infection and inflammation.
• Serology: To identify specific viral, bacterial, or functions. Eg: Herpes simplex virus, arbovirus.
• Autoimmune markers: For autoimmune encephalitis(eg: anti-NMDA receptor antibodies).

B)Lumbar puncture(CSF Analysis):

• Elevated white blood cells(lymphocytic pleocytosis).
• Increased protein levels.
• Normal or slightly reduced glucose.
• Polymerase chain reaction(PCR): To detect specific viral DNA or RNA. Eg: HSV, CMV, enteroviruses.
• CSF culture: To identify bacterial or fungal pathogens.

C)Imaging Studies:

I)Magnetic Resonance Imaging(MRI):

• Preferred imaging modality for encephalitis.
• Identifies inflammation, edema, or lesions in the brain(commonly in the temporal lobes of HSV encephalitis).

II)Computed Tomography(CT Scan):

• Used to rule out other causes ( eg: tumors, abscesses, or stroke).

D)Electroencephalogram(EEG):

• Detects abnormal brain activity patterns, such as seizures or slow wave activity associated with encephalitis.

E)Specific tests for infectious causes:

• Viral culture: For certain viruses in blood or CSF.
• PCR Tests: For rapid identification of viral pathogens.
• Antibody Testing: For viruses like West Nile virus, Japanese encephalitis, or Zika virus.

F)Brain biopsy(very rare):

• Performed only when the cause remains uncertain و the patient doesn’t respond to standard treatments.

DIFFERENTIAL DIAGNOSIS:

Encephalitis symptoms can overlap with conditions such as:

• Meningitis.
• Brain abscesses.
• Stroke.
• Autoimmune or demyelinating disorders.

AYURVEDIC THERAPIES AND ITS EFFECTS IN ENCEPHALITIS:

Our hospital integrates  Ayurveda, physiotherapy and acupuncture to provide a holistic and patient centered approach to health and wellness.

EXTERNAL TREATMENT GIVEN IN AYURVEDA

1.PODI KIZHI(CHOORNA PINDA SWEDA):

Podi means “powder” and Kizhi means “bolus”. Hence, Podikizhi involves using boluses made of medicated herbal powders. The herbal boluses are warmed  and are massaged over the affected areas. The therapists use tapping, circular و linear strokes to ensure uniform heat distribution.

The boluses are reheated frequently during the process. The treatment lasts about 30-60 minutes depending on the condition. For preparing podi kizhi in our hospital, normally Kolakulathadi choornam is used.

Benefits of Podi kizhi in Encephalitis:

• It reduces neuromuscular stiffness, weakness, and physical discomfort, and improves muscle tone and flexibility.
• It stimulates the blood flow.
• It helps in eliminating toxins.
• It balances Vata and Kapha doshas.
• It alleviates neuropathic pain.
• It restores vitality and energy.
• It can also promote relaxation and stress reduction.

2.UDWARTHANAM:

Udwarthanam is a classic Ayurvedic procedure. The herbal powder is applied evenly over the body. The massage is performed using upward strokes(against the direction of hair growth). The strokes are rhythmic, firm, and invigorating, stimulating the lymphatic and circulatory systems. The procedure usually lasts for about 30-45 minutes. We use either Kolakulathadi choornam or kolakulathadi mixed with triphala for the same.

Benefits of أودوارتانام in Encephalitis:

• It improves circulation and detoxification.
• It reduces muscle weakness and stiffness.
• It balances kapha dosha.
• It promotes mental clarity and relaxation.

Udwarthanam is contraindicated during the acute or inflammatory phase of encephalitis. It’s suitable in the rehabilitation phase.

3.NADI SWEDA:

Nadi sweda is the localized sudation therapy in Ayurveda. It involves the application of the herbal steam to specific parts of the body through a hose, tube, or nozzle. The treatment focuses on relieving pain, stiffness, and inflammation, especially in conditions affecting joints and muscles. Normally we use Dashamoola kashaya to produce steam here.

Benefits of Nadi sweda in encephalitis:

• It improves circulation to affected areas, reducing muscle stiffness, spasticity, and pain.
• The localized warm steam soothes the nervous system, helping to relieve stress, anxiety, and mental fatigue which are secondary to the illness.
• By inducing mild sweating it may eliminate toxins from the body aligning with Ayurvedic principles of cleansing.
• It can also reduce localized swelling and inflammation that might have occurred due to post-encephalitis weakness.
• The warmth and herbal effects relax the muscles and calm the nervous system.

4.NASYAM:

Nasyam (Nasya) is one of the five purificatory therapies (panchakarma)in Ayurveda. It involves administration of the medicated oils or powders through the nostrils to treat various health conditions. Nasyam is particularly effective in disorders related to the head, neck, and shoulders.

Types of Nasyam:

• Marsha nasya: Here administration of medicated oil, or powder is usually done in higher doses. The procedure is designed to lubricate, nourish, and maintain the health of nasal passages and related structures. Normally Ksheerabala (101) is used for this.
• Pratimarsha nasya: It’s a daily form of nasya therapy, which is also the mildest form of nasya in Ayurveda. Anu Taila is generally used for the Pratimarsha nasyam.

Benefits of Nasya

• Improvement in neurological function.
• It enhances blood circulation and promotes detoxification.
• It alleviates symptoms such as headaches, dizziness, nasal congestion, etc.
• It enhances sensory and motor functions, which might be affected in encephalitis.
• It aids in calming the nervous system.
• It supports rehabilitation.

5.SHIRODHARA:

Shirodhara is a traditional ayurvedic therapy involving the continuous pouring of liquid, typically herbal oil, buttermilk, or medicated milk over the forehead in a rhythmic, and consistent flow. The commonly preferred oil for shirodhara is ksheerabala taila, wherein in the liquid is heated to a specific temperature and maintained throughout the therapy.

Benefits of shirodhara in Encephalitis:

• Neurological stabilization: Encephalitis often causes system dysfunction such as seizures, tremors, and restlessness. Shirodhara helps calm the hyperactivity in the nervous system, potentially reducing such symptoms. It also aids in balancing vata and pitta dosha.
• Improves sleep quality: Encephalitis can lead to insomnia or disturbed sleep due to neurological stress. Shirodhara induces a deep state of relaxation and promotes sound sleep, helping in overall recovery.
• Enhanced cognitive function and memory: It enhances circulation and nervous system relaxation promotes brain repair and formation of new neural pathways(neuroplasticity). It also aids in improving cognitive function and memory.
• Mood stabilization: Mood swings, irritability, and depression are common post-encephalitis symptoms. Shirodhara’s steady rhythmic flow stimulates serotonin and dopamine production, uplifting mood and improving overall mental health.
• Improves circulation to the brain: Enhanced blood flow to the brain ensures better oxygenation and nutrient delivery.

6.THALAPOTHICHIL:

Thalapothichil also known as Shirolepa, is a traditional ayurvedic treatment primarily focused on mental relaxation and treating conditions related to the head and mind. In this case, the patient is first given a thalam with a medicinal oil (ksheerabala), and then the entire scalp is covered with medicinal plant paste, which is usually wrapped with banana leaves.

The medicinal herb paste is made with 

• Amala (Indian gooseberry, Phyllanthus emblica).
• Mustha(Nut Grass, Cyperus rotundus).
• Usheera (Ramacham, Vetiveria zizanioides,).
• Kachuram(Kachuram, Curcuma zedoaria).
• Rasnadi choornam.
• Curd.

Benefits of Thalapothichil:

• It reduces pitta imbalance: The herbs like amala, mustha, usheera pacify pitta.
• Neuroprotective action: These herbs promote regeneration and improve brain function.
• Reduces headache and pressure: The cooling effects of medicines will provide relief from these symptoms.
• Improves mental clarity and calmness of the mind and alleviates symptoms like mental confusion, irritability, and agitation.
• The therapy improves circulation to the head, which can help in reducing neurological symptoms like tremors or convulsions associated with encephalitis.
• The therapy induces deep relaxation and promotes sound sleep, which is critical for recovery.
• Strengthens immunity: Certain herbs in the medical paste, such as amalaki,musta  have immune-boosting properties that can support body’s natural defense mechanisms during the recovery phase of encephalitis.

7.ROOKSHA VASTHI:

Rooksha Vasthi is a type of therapeutic enema that is predominantly dry and non-unctuous in nature. It’s a subtype of Shodhana Vasthi(purificatory enema) and is primarily used to balance aggravated Kapha and medas (fat tissue)in the body.

The patient is positioned in the left lateral position(vama parshva)with the leg extended and the right leg bent. The anal area is minimally lubricated with a dry or less oily preparation. The medicinal decoction or dry powder suspension is filled in فاستي apparatus. It is gently introduced into the rectum through anal canal slowly. The patient is instructed to retain the substance for a specified time. The retention is shorter than in sneha Vasthi(oil based enema)due to dry nature of the formulation. Usually, it ranges from 3-7 days as a part of the treatment plan.

Benefits of Rooksha vasthi in encephalitis:

• Aids in elimination of toxins: Metabolic toxins can exacerbate inflammation in encephalitis and rooksha vasthi helps to eliminate it.
• Anti-inflammatory effects: The herbs used in rooksha vasthi like triphala, guduchi have anti-inflammatory properties and help in the reduction of inflammation.
• It supports nervous system function: This supports the healing process of neurological tissues.
• It aids in the restoration of agni: Encephalitis can weaken digestive and cellular metabolism, and contribute to sluggish healing. Rooksha Vasthi aids in rekindling Agni, improving nutrient absorption and overall recovery.

8.SHIRO PICHU:

Shiro Pichu is a therapeutic procedure in Ayurveda that involves placing a medicated oil-soaked cotton pad(Pichu) on the head, particularly over the crown or affected area. For this, we use Ksheerabala or Chandanadi taila. The pad is left in place for about 20-45 minutes, ensuring the oil is warm throughout.

Benefits of Shiro Pichu:

• Neurological support: It nourishes and strengthens the nervous tissues, helping in the recovery of brain functions after encephalitis.
• It provides relief from symptoms like headaches.
• It reduces inflammation: Since the oil used has an anti-inflammatory properties and cooling effect, it helps alleviate brain inflammation and reduce associated discomfort.
• It controls seizures by stabilizing Vata.
• It rejuvenates the nervous system and supports recovery from post-encephalitis fatigue or cognitive impairments.
• It helps to restore mental clarity, by nourishing brain tissues and balancing disturbed doshas.

9.THALAM:

In Ayurveda, thalam refers to, applying a medicinal paste on the middle of the head. By activating and acting upon nerve endings, the therapeutic paste helps to alleviate and treat ailments.

Among its advantages are:

• Aids in sleep problems.
• Increases sensory channels and improves senses.
• Controlling high blood pressure.
• Lowering the incidence of ENT-related disorders and headaches, including migraines.

For Thlalam, Rasnadi with Ksheerabala is typically used in our hospital.

PHYSIOTHERAPY AND ITS ADVANTAGES IN ENCEPHALITIS:

Physiotherapy plays a crucial role in the rehabilitation of patients recovering from encephalitis by addressing these impairments and improving overall quality of life.

Physiotherapy techniques for encephalitis:

1.Neuromuscular Re-education techniques:

• Neuromuscular re-education involves training the nervous system to improve motor control and coordination.

Techniques:

• Proprioceptive Neuromuscular Facilitation(PNF): Enhances motor responses through guided movements and muscle activation patterns.
• Task-specific training: Involves practicing daily activities to rebuild neural pathways.

Advantages:

• Improves motor coordination and voluntary control.
• Reduces abnormal muscle tone(spasticity).
• Enhances functional independence in activities of daily living(ADLs).

2.Range of Motion (ROM) exercises:

• ROM exercises are aimed at preserving or restoring joint flexibility and mobility.

Techniques:

• Passive ROM: The therapist moves the patient’s joint passively.
• Active Assisted ROM: Patient initiates movement with assistance.
• Active ROM: Patient performs full joint movements independently.

Advantages:

• Prevents joint contractures and stiffness due to prolonged immobility.
• Maintains circulation and reduces the risk of deep vein thrombosis(DVT).

3.Strengthening Exercises:

• These exercises rebuild muscle strength weakened by encephalitis-related immobility.

Techniques:

• Resistance training using bands, weights or machines.
• Isometric exercises for early rehabilitation in severe cases.

Advantages:

• Enhances muscle strength and endurance.
• Improves posture and movement efficiency.

4.Balance and coordination training:

• Encephalitis often affects the cerebellum and vestibular systems, impairing balance and coordination.

Techniques:

• Static and dynamic balance exercises(eg: standing on one leg, walking on uneven surfaces).
• Vestibular rehabilitation(head and eye movement exercises).

Advantages:

• Reduces the risk of falls.
• Improves proprioception and postural stability.

5.Gait training

• Impairments in walking are common after encephalitis, requiring targeted rehabilitation.

Techniques:

• Parallel bar training for initial support.
• Use of assistive devices(Eg: walkers or canes)as needed.
• Treadmill training with body weight support for advanced recovery.

Advantages:

• It helps in restoring normal walking patterns.
• It improves lower limb strength and coordination.

6.Spasticity Management:

• Spasticity (increased muscle tone)can hinder movement. Physiotherapists use a variety of techniques to manage this condition.

Techniques:

• Stretching exercises to elongate muscle and reduce tightness.
• Cryotherapy or heat therapy to relax muscles.
• Functional Electrical Stimulation(FES) to improve muscle activation.

Advantages:

• Reduces discomfort caused by spasticity.
• Enhances functional mobility and range of motion.

7.Cognitive and perceptual Rehabilitation:

• Cognitive impairments, such as memory loss and attention deficits are common in encephalitis.

Techniques:

• Dual-task training(combining motor and cognitive tasks).
• Visual and spatial training exercises.

Advantages:

• Enhances cognitive-motor integration.
• Improves attention and executive functioning.

8.Cardiopulmonary Rehabilitation:

• In severe cases, encephalitis can lead to respiratory and cardiovascular complications.

Techniques:

• Breathing exercises; Eg:(diaphragmatic breathing, inspiratory muscle training).
• Aerobic exercises; Eg: walking, and cycling tailored to the patient’s capacity.

Advantages:

• It improves lung capacity and oxygenation.
• It enhances overall cardiac health.

9.Assistive Technology and Ergonomic training:

• Physiotherapists introduce tools and devices to aid recovery and independence.

Techniques:

• Use of orthoses, splints, or adaptive devices.
• Ergonomic training for safe movement and posture.

Advantages:

• It promotes independence in daily tasks.
• It prevents secondary complications like deformities.

10.Utilisation of TENS and Ultrasound:

Techniques and advantages:

• TENS works by stimulating the sensory nerves, which may reduce pain perception by modulating the nervous system. Hence it provides pain relief and improves neuromuscular function.
• Ultrasound therapy: The sound waves deliver deep heat to tissues, promoting relaxation and improving circulation. Thus reducing musculoskeletal pain, stiffness, or spasticity which are secondary complications to encephalitis.

ACUPUNCTURE AND ITS BENEFITS IN ENCEPHALITIS

Acupuncture is an ancient Chinese medical practice, that can play a supportive role in managing encephalitis particularly in alleviating symptoms and aiding recovery.

Techniques of Acupuncture:

1.Needling

Targeted points:

• GV20(Baihui): Enhances circulation to the brain and promotes neurological repair.
• GB20(Fengchi): Relieves headaches, dizziness, and neurological symptoms.
• ST36(Zusanil): Strengthens the immune system and boosts energy levels.
• L14(Hegu) and LR3(Taichong): Used together to balance the nervous system and reduce inflammation.

2.Electroacupuncture: Mild electrical stimulation applied to needles may enhance therapeutic effects, especially for neurological recovery.

Benefits of Acupuncture in Encephalitis:

• Pain relief: Reduces headaches and discomfort without relying heavily on medication.
• Reduced dependence on medication: Alleviates symptoms, minimizing side effects from drugs.
• Enhanced recovery: May speed up recovery by improving circulation, reducing inflammation, and promoting neural repair.
• Support for mental health: Improves mood and reduces stress, which is critical during recovery.

THE GENERAL DIET GUIDELINES SUGGESTED IN OUR HOSPITAL ARE:

• Do not engage in strenuous activity.
• Consume two and a half to three liters of water.

The following foods are recommended: 

• Steamed foods such as chapati, put, idiyappam, and appam (not fermented).
• Boiled vegetables.
• Hot Kanji.

Foods that are discouraged include:

• Such as fermented appam, idli, and dosa.
• Sweet potatoes, tapioca, and potatoes are examples of tubers.
• Meat, fish, and eggs that are not vegetarian (may be consumed in curry form, if necessary).
• Cold food, pickles, fruits, dry fruits, nuts, milk, milk products, processed, fatty, and fried foods.

 

DISCLAIMER: The information provided in this article is intended solely for educational  purposes. Treatment decisions should be made exclusively by a well-qualified Ayurvedic physician. Self-medication is strongly discouraged.

 

Maurya Ayurveda Hospital, opposite to Sabine Hospital, Pezhakkapilly P.O,Muvattupuzha,Ernakulam;PIN:686673,Contact no:9947183000

Email: [email protected]

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