P62 – 2730: Clinical spectrum of the herpes simplex encephalitis in children

Abstract

Objective This study aimed to describe the clinical spectrum of HSE in children by identifying their neurological imaging features and assessing treatment outcomes. Methods Clinical, laboratory and imaging findings in 14 patients (seven girls and seven boys) with HSE were retrospectively reviewed during the period between January 2005 and January 2010 at the Selcuk University Department of Pediatric Neurology. Diagnosis was made based on clinical signs of encephalitis, laboratory and imaging findings which included polymerase chain reaction (PCR) testing to detect HSV DNA in the cerebrospinal fluid (CSF), and/or elevated anti-HSV antibody in serum with supplemental abnormal findings on Magnetic resonance Imaging (MRI) or Computed Tomography (CT). Data were obtained from a prospective institutional review board (IRB)-approved database. Results Our study consisted of 14 patients including a patient who had a relapsing course. The mean age was 3.6 years. Seizure and fever were the most common findings at admission. CSF glucose concentration was normal in all patients and elevated protein and RBC levels were found in 4 (28%) patients. PCR for HSV was positive in 92% and cranial MRI was suggestive of HSE in all patients (100%). Prominent thalamic involvement was observed in patients less than 2 years of age however CSF findings in these patients were normal. All patients were treated with iv acyclovir. All of the patients survived with no losses during follow up, 9 patients were left with no neurological sequelae however persistent neurological sequelae was seen in 5 patients. Conclusion The findings suggested how challenging diagnosing HSE in children especially those under the age of 2 can be. Due to its diagnostic possibility in children presenting with convulsion and other encephalitic processes, treatment with acyclovir must be initiated as soon as HSE is suspected to avoid further neurological insults.