Post-Encephalitic Parkinsonism

Post-Encephalitic Parkinsonism refers to parkinsonian symptoms (slowness, stiffness, gait and balance problems) that develop after encephalitis or severe brain infection/inflammation. Some people also experience tremor, speech/swallow changes and cognitive or behavioural effects.

At The Royal Buckinghamshire Hospital, we provide consultant-led inpatient neurorehabilitation for adults living with movement and cognitive difficulties after encephalitis. Our programmes aim to improve walking, safety, communication, confidence and day-to-day independence.

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What Causes Post-Encephalitic Parkinsonism?

After encephalitis (viral, autoimmune or post-infectious), inflammation can damage brain networks that control movement (basal ganglia and frontal-subcortical circuits). Consequences may appear weeks to months later and can coexist with fatigue, cognitive slowing, mood change or functional symptoms.

Common antecedents include:

• Viral encephalitis (e.g. herpes simplex, influenza, post-COVID)
• Autoimmune encephalitis (e.g. anti-NMDA receptor)
• Post-infectious neuroinflammation

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Symptoms

• Bradykinesia (slowness), rigidity and reduced facial expression
• Gait disturbance: shuffling steps, freezing, difficulty turning, falls
• Tremor (variable; may be less prominent than in idiopathic Parkinson’s)
• Speech and swallowing changes (quiet voice, dysarthria, dysphagia)
• Cognitive effects: slowed thinking, attention/executive difficulties, apathy
• Fatigue, sleep disturbance and reduced exercise tolerance
• Mood or behavioural change (anxiety, low mood, irritability)

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Diagnosis

A specialist (neurology or infectious diseases team) will assess your history and examination. Investigations may include:

• MRI brain to review post-inflammatory changes
• Blood tests/CSF from the acute phase (if available) and autoimmune panels
• DaTscan in selected cases to characterise dopaminergic involvement
• Neuropsychological assessment to profile cognition and guide therapy

Response to levodopa or other dopaminergic medicines is variable; management often focuses on rehabilitation and targeted symptom control.

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Treatment Overview (Medical)

• Optimisation of dopaminergic therapy where beneficial
• Management of spasticity, dystonia or myoclonus if present
• Treatment of mood, sleep and autonomic issues
• Ongoing review by your specialist team

We do not provide acute infectious disease treatment onsite; our role is post-acute neurological rehabilitation once medically stable.

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Rehabilitation At The Royal Buckinghamshire Hospital

Our inpatient neurorehabilitation addresses movement, cognition, communication and fatigue together.

Your Programme May Include

Neurophysiotherapy

• Gait cueing (auditory/visual), step-length and turning practice
• Freezing-of-gait strategies, balance and falls prevention
• Strength, posture and endurance training

Occupational Therapy

• Energy conservation and pacing for post-viral fatigue
• Task practice for dressing, transfers and community mobility
• Home/environmental adaptations and equipment provision

Speech & Language Therapy

• Voice volume, articulation and communication techniques
• Swallowing assessment with safe-eating strategies where indicated

Neuropsychology

• Attention/executive strategies, memory support and routine building
• Mood and adjustment therapy; carer education and resilience

Education & Discharge Planning

• Personalised home exercise plan, freezing/falls plans
• Community therapy handover and follow-up recommendations

Explore Our Rehabilitation Centre

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When To Consider Inpatient Rehab

• Recurrent falls, freezing or unsafe transfers
• Significant fatigue or cognitive slowing limiting daily life
• Persistent speech/swallow or communication difficulties
• Need for co-ordinated, multidisciplinary input and carer training
• Limited progress with outpatient therapy alone

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Living Well After Encephalitis

• Keep a structured daily routine with regular rests
• Use cueing strategies (metronome beats, counting, floor markers) for walking
• Optimise sleep, hydration and nutrition; review swallow safety
• Check footwear and home hazards; consider rails and seating
• Involve family/carers in therapy to embed strategies at home