From the Guidelines
Post viral encephalitis should be treated with antiviral medications, particularly aciclovir (10 mg/kg three times daily intravenously) for up to 14 days, especially if it can be started within a few days of symptom onset, as recommended by the Association of British Neurologists and British Infection Association national guidelines 1.
Treatment Approach
The primary goal in managing post viral encephalitis is to reduce morbidity, mortality, and improve quality of life.
- Antiviral treatment is crucial, with aciclovir being the preferred choice for many viral causes, including varicella-zoster virus (VZV) and herpes simplex virus (HSV) 1.
- The dose of aciclovir should be adjusted for patients with impaired renal function, and most clinicians use the 10 mg/kg dose 1.
- A course of steroids (for example, 60-80 mg of prednisolone daily for 3 to 5 days) is also often given, because of the inflammatory nature of the lesion 1.
Specific Considerations
- In immunocompromised patients with VZV encephalitis, a prolonged course of intravenous aciclovir may be needed 1.
- For enterovirus infections, pleconaril has shown promise in reducing symptoms, but its availability and use are limited, and it is not widely recommended for encephalitis 1.
- Intravenous immunoglobulin may be useful in patients with severe enterovirus 71 infection or chronic enterovirus meningitis, though evidence is based on limited trials 1.
Supportive Care
- Supportive care is essential and includes seizure management with anticonvulsants, management of increased intracranial pressure, and respiratory support if needed.
- Early treatment significantly improves outcomes, making prompt recognition and intervention crucial in managing post viral encephalitis.
From the Research
Definition and Diagnosis of Post Viral Encephalitis
- Post viral encephalitis is a medical emergency that requires immediate diagnosis and treatment 2.
- The diagnosis of post viral encephalitis should be based on medical history, examination, and analysis of cerebrospinal fluid for protein and glucose contents, cellular analysis, and identification of the pathogen by polymerase chain reaction (PCR) amplification and serology 2.
- Neuroimaging, preferably by magnetic resonance imaging, is an essential aspect of evaluation 2.
Treatment and Management of Post Viral Encephalitis
- Supportive therapy is an important basis of management for post viral encephalitis 2.
- Specific, evidence-based, anti-viral therapy, such as acyclovir, is available for herpes simplex virus encephalitis 2, 3.
- Corticosteroids as an adjunct treatment for acute viral encephalitis are not generally considered to be effective and their use is controversial 2, 3.
- Surgical decompression is indicated for impending uncal herniation or increased intracranial pressure refractory to medical management 2.
Complications and Long-Term Outcomes of Post Viral Encephalitis
- Post viral encephalitis can lead to long-term morbidity, including seizures and epilepsy 4, 5.
- Autoimmune encephalitis can be triggered by herpes simplex virus encephalitis and should be considered in patients who are not responding to treatment 3, 6.
- The emergence of post-HSE autoimmune encephalitis reveals a new immunological paradigm in autoantibody-mediated disease 6.
- Future studies should focus on better management of sequelae, and better treatment regimens, including those targeting the immune response 3.
Risk Factors and Prognosis of Post Viral Encephalitis
- The prognosis of post viral encephalitis is dependent on the specific pathogen and the immunological state of the host 2.
- Mortality related to herpes simplex virus encephalitis dropped dramatically with the systematic initiation of antiviral treatment in encephalitic syndromes 4.
- The high rate of postencephalitic epilepsy contributes significantly to the unfavorable clinical outcome of the disease 4.