OBJECTIVE
To assess the prognostic value of neuro-specific protein concentrations during the acute phase of Varicella zoster virus (VZV) encephalitis in predicting the severity and duration of neurological deficits in pediatric patients.
MATERIAL AND METHODS
This single-center study, approved by the local ethics committee, included both prospective and retrospective components and was conducted from 2018 to 2025. Thirty-five children aged 5 months to 18 years with laboratory-confirmed VZV encephalitis were enrolled. Clinical, neurological, and laboratory evaluations were performed during the acute stage (days 5—7 after onset) and throughout a 2-year follow-up at 3-month intervals. Neurological deficits were assessed using the International Classification of Functioning, Disability and Health (ICF). Based on acute-phase ICF scores, patients were categorized into two groups: severe disease (22—38 points) and extremely severe disease (40—64 points). Neuron-specific enolase (NSE) and S100B protein levels were measured in cerebrospinal fluid and blood.
RESULTS
In the acute phase, 51% of patients exhibited extremely severe disease. At 3—6 months follow-up, 45% of children in the severe disease group showed a reduction in ICF scores to 16—29 points (p<0.05). A comparable trend was noted in the extremely severe group, with 48% of patients achieving scores of 30—44 points (p<0.05). By 6—12 months, most patients in both groups demonstrated substantial regression of neurological deficits. During the acute phase, cerebrospinal fluid concentrations of NSE and S100B in the severe disease group were approximately twice those in the extremely severe group. At 3—6 months, significant differences remained only for S100B levels (p<0.03). By 9—12 months, no significant differences in NSE or S100B concentrations were detected between the groups (p>0.05).
CONCLUSION
Elevated NSE levels in VZV encephalitis indicate neuronal injury from both direct viral cytopathic effects and secondary inflammatory processes. Assessing neuro-specific protein concentrations during the acute phase may serve as a valuable tool for early prediction of the duration and severity of neurological deficits in pediatric patients. Due to the high incidence of neurological sequelae, emphasis should be placed on timely etiopathogenetic therapy and early, individualized, comprehensive medical rehabilitation, including the use of Cytoflavin, to improve long-term outcomes.
