Seizures and epilepsy in herpes simplex virus encephalitis: current concepts and future directions of pathogenesis and management

  title={Seizures and epilepsy in herpes simplex virus encephalitis: current concepts and future directions of pathogenesis and management},
  author={Johann Sellner and Eugen Trinka},
  journal={Journal of Neurology},
Mortality related to herpes simplex virus encephalitis (HSE) dropped dramatically with the systematic initiation of antiviral treatment in encephalitic syndromes. Further efforts need to be taken to reduce long-term morbidity in the survivors. In this regard, the high rate of postencephalitic epilepsy, which is frequently refractory to medical treatment, contributes significantly to the unfavorable clinical outcome of the disease. Seizures during the acute phase of HSE are the main risk for the… 

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

The pathophysiology, differential diagnosis, and clinical and radiological features of herpes simplex virus-1 encephalitis in adults in adults are reviewed, including a discussion of the most common complications and their treatment.

Epilepsy after cerebral infection: review of the literature and the potential for surgery.

An emphasis on the chances offered by epilepsy surgery is placed on patients with a history of meningitis or encephalitis in early childhood, as well as a history, seizure semiology, and EEG-findings compatible with the diagnosis of a mesial temporal lobe epilepsy syndrome.

Seizures and epilepsy secondary to viral infection in the central nervous system

It remains to be determined whether treatment of CNS viral infection using antiepileptic drugs (AEDs) can prevent seizures and subsequent epilepsy in patients, particularly with regard to the timing, drug choice and dosage, and duration of AEDs.

Infection or Inflammation and Critical Care Seizures

Given that many viral and inflammatory illnesses that affect the CNS have no specific treatment, the management of comorbid seizures may be one of the few targets that can effectively improve outcomes.

Comparison of immunotherapy and prognosis of seizures caused by viral encephalitis and autoimmune encephalitis

Immunotherapy may improve the seizure prognosis of patients with acute encephalitis and may be determined as early as 6 months after onset, while the seizure outcome of autoimmuneEncephalitis is further improved 12 years after onset.

Infectious Encephalitis in the Neurocritical Care Unit

Early recognition of encephalitis and appropriate treatment of the primary infection and its complications are essential to increase survival and reduce sequelae.

Molecular Mechanisms in the Genesis of Seizures and Epilepsy Associated With Viral Infection

An overview of viruses that are associated with early and late seizures in humans and potential pathophysiologic mechanisms underlying ictogenesis and epileptogenesis are described, including routes of neuroinvasion, viral control and clearance, systemic inflammation, alterations of the blood-brain barrier, neuroinflammation, and inflammation-induced molecular reorganization of synapses and neural circuits.

The Causes and Long-Term Consequences of Viral Encephalitis

How viruses can reach the brain, the impact of viral encephalitis on brain function, and the neurocognitive sequelae reported even after viral clearance are discussed are discussed.



Viral encephalitis and epilepsy

Prospective studies are required to document the risk of late unprovoked seizures and epilepsy following viral encephalitis due to different viruses as well as to determine the clinical characteristics, course, and outcome of post‐encephalitic epilepsy.

Incidence and pathogenesis of clinical relapse after herpes simplex encephalitis in adults

The lack of demonstrable HSV DNA in CSF, the lack of acute CSF signs and the lackOf signs of neural and glia cells destruction indicate that a direct viral cytotoxicity is not the major pathogenic mechanism in relapse, and the pronounced CSF proinflammatory immunological response and the relative lack of CSF anti–inflammatory cytokine IL–10 response suggest immunologically–mediated pathogenicity.

Herpes simplex encephalitis. Clinical Assessment.

Clinical data from 113 patients in whom the diagnosis was proved by viral isolation of herpes simplex encephalitis shows that diagnosis can be confirmed only by brain biopsy.

Seizures in encephalitis: Predictors and outcome

Exacerbation of herpes simplex encephalitis after successful treatment with acyclovir.

  • Y. ItoH. Kimura T. Morishima
  • Medicine, Psychology
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 2000
Exacerbation of HSE in children may be more common than previously recognized and it is suggested that the replication of HSV or another viral pathogen caused a second encephalitic illness in some cases.

Evaluation of combination therapy using aciclovir and corticosteroid in adult patients with herpes simplex virus encephalitis

Pat age, GCS at initiation of aciclovir, and corticosteroid administration were found to be significant independent predictors of outcome on multiple logistic regression analysis, and these three variables also formed the best set of predictors for the outcome of HSVE.

Risk factors for postencephalitic epilepsy in children: a hospital-based study in Taiwan.

Herpes simplex encephalitis treated with acyclovir: diagnosis and long term outcome

Although acyclovir has reduced the mortality of herpes simplex encephalitis, 30% of this group of patients either died or had a severe neurological deficit, and most of these people had persistent neurological symptoms, signs, or both.

Experiences of epilepsy surgery in intractable seizures with past history of CNS infection.

It is suggested that the surgical outcome was influenced by the type of epileptic syndromes rather than the etiology of seizures, or that the CNS infections in patients with MTLE might be milder in severity to cause selective injuries to the hippocampal neurons during their vulnerable stage.