Abstract
We followed clinical and EEG examinations of two patients with herpes simplex encephalitis (HSE) in acute condition along with monitoring their early and late outcomes. Patients: M. B., 23-year-old female, who completed home treatment as a severe organic psycho-syndrome, reliant on nursing care, and L. J., now 16-year-old female patient, whose HSE in the 3 rd year of her life went into auto-aggressive Rasmussen encephalitislike condition with epileptic status in the form of Epilepsia parcialis continua (EPC).The EEG signal was statistically processed using «power spectral analysis» with color maps 3D BM showing the performance of individual frequency bands topographically and the measurement of connectivity in longitudinal and transversal direction by means of the mean coherencies — indexes of connectivity.On the 9th year of L. J. life when she overcame varicella with a significant eruption of the skin and high temperature the highly active EEG patterns were attenuated both graphically and clinically with a significant reduction in focal epilepsy. The latter was affected by a total thiopentotal anesthesia and bolus corticotherapy, as well as amantadine sulphate.This patient exhibited central right lower limb mono-paresis in a selfstanding walk and 4–5 short myoclonic abduction cramps in arm joints associated with vocalized «hee-haw», deep inspiring and expiring in full consciousness. MRI proved hyperintense area parasagitally on the left side of the centromotor region and EEG with epileptogenic grapho-elements in adjacent scar. We compared the last sample of the EEG signal to the EEG patterns of her homozygous sister and found them identical with no pathological graphoelements.These patients survival was the result of continuing anti-viral treatment, intensive medical and nursing care aimed to protect neural cells in the brain, the effect of which was longitudinally monitored by classic and statistical EEG signal analysis.The late outcome of these patients was diametrically different. L. J. graduated from the 9-year primary school with good results. M. B. was progressively mobilized, despite the clinical signs of severe alterations of psychic sphere as a result of postencephalitic encephalopathy with insufficient response to neuroleptics and sedatives. After parents’ agreement received she was transferred to the regional hospital.
Highlights
Herpes simplex virus of Type 1 labialis causes meningo-encephalitis, which is usually located in the fronto-temporal area and is commonly haemorrhagic with poor prognosis and comparatively high lethality [1]
In the EEG analysis we used the Neuron Spectrum AM program, where we evaluated the EEG signal visually, and using power spectral analysis
Сlinical data confirm the herpes simplex virus-1 (HSV-1) induced symptomatic — Rasmussen-like encephalitis (RLE) that was consisted with the continuation of clinical signs of epilepsia partialis continua, except that the left lower limb (LLL) was affected, i. e. one-haemisphere disorder was not fulfilled, which was typical for the type 2 RLE
Summary
Herpes simplex virus of Type 1 labialis causes meningo-encephalitis, which is usually located in the fronto-temporal area and is commonly haemorrhagic with poor prognosis and comparatively high lethality [1]. Several viruses including herpes simplex virus-1 (HSV-1) served as etiological factors inducing non-specific grapho-elements in the EEG signals acquired from the area of centro-motor cortex of the contra-lateral hemisphere [1]. Acyclovir is admitted as a basic medication in i.v. infusion at 10 mg/kg for 1 hour in adults. Without this treatment, viral load leads to a rapid lethal outcome in approximately 70% of cases. HSE is fatal in the 1/3 of cases, with severe neurological defects, and more than 50% patients survive. The survivors recover with mild neurological defects, only a small sample of survivors (2.5%) retain normal brain functions [4]
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