Viral Encephalitis In Children Research Articles

The incidence and risk factors of secondary epilepsy after viral encephalitis in children: A 10-year single-center retrospective analysis.

Secondary epilepsy is a common concomitant disease of viral encephalitis (VE) in children. However, the risk factors for secondary epilepsy after VE remain debated. The aim of this study was to perform a 10-year single-center retrospective analysis to investigate the incidence and risk factors of secondary epilepsy after VE in children. A total of 8691 patients suffered from VE in our hospital between December 2011 and February 2022 were included. The patients were divided into control group (Group C) and epilepsy group (Group E) according to whether they followed secondary epilepsy. Information about treatment process was collected from medical records to determine the incidence. Univariate analysis and multivariate logistic regression analysis were performed to identify the independent risk factors. In the current study, the occurrence of secondary epilepsy after VE in pediatric patients was 10.99% (385 of 3503). The results of univariate and multivariate analysis showed that unconsciousness, convulsions, times of epilepsy >2, epileptiform discharge of Electroencephalogram (EEG), and cortical and subcortical damage of magnetic resonance imaging/computer tomography were the significant risk factors for secondary epilepsy after VE. Nearly one tenth of pediatric patients suffered from secondary epilepsy after VE. Interventions for identified risk factors should be used to prevent the occurrence of secondary epilepsy.

Effects of adjunctive Chinese patent medicine on outcome of viral encephalitis in children: A multicenter retrospective study in China

BackgroundSome patients with viral encephalitis in China seek treatment with Chinese patent medicine (CPM) to improve their symptoms, but few studies have focused on the impact of CPM on the prognosis of viral encephalitis (VE). The aim of this multicenter retrospective study was to assess the benefit of adjunctive CPM therapy on the outcome of children with VE in China. MethodsThis study retrospectively included 834 children with viral encephalitis who were hospitalized at five medical institutions from 2018 to 2021. Univariate and multivariate logistic regression was used to assess the effect of CPM on sequelae in patients with VE. 1:1 propensity score matching was used to exclude the effect of confounding factors. Forest plots were used to observe the effect of CPM on the prognosis of VE in different subgroups. ResultsThere were fewer patients with sequelae in the group of patients using CPM regardless of whether they were matched or not. The results of multivariate logistic regression analysis showed that the use of CPM was an independent protective factor for the development of sequelae in VE patients (OR = 0.063, 95 % CI: 0.011–0.350, p = 0.002). Subgroup analyses showed that CPM was a protective factor for the development of sequelae regardless of the presence or absence of coma and comorbidities. In addition, we evaluated other outcome indicators and found shorter duration of illness, fever and headache in children with EV in the CPM group. ConclusionAdjunctive CPM therapy may significantly reduce sequelae in children with VE, as well as effectively alleviate patients' clinical symptoms. However, more prospective studies and clinical trials are needed to further evaluate its efficacy and safety.

The efficacy of haemoperfusion combined with continuous venovenous haemodiafiltration in the treatment of severe viral encephalitis in children

BackgroundThis study investigated the efficacy of the integrated blood purification mode of early haemoperfusion (HP) combined with continuous venovenous haemodiafiltration (CVVHDF) in children with severe viral encephalitis, and evaluated the correlation of cerebrospinal fluid (CSF) neopterin (NPT) levels with prognosis.MethodsThe records of children with viral encephalitis who received blood purification treatment in the authors’ hospital from September 2019 to February 2022 were retrospectively analysed. According to the blood purification treatment mode, they were divided into the experimental group (HP + CVVHDF, 18 cases), control group A (CVVHDF only, 14 cases), and control group B (16 children with mild viral encephalitis who did not receive blood purification treatment). The correlation between the clinical features, severity of the disease and the extent of lesions on brain magnetic resonance imaging (MRI) and the CSF NPT levels was analysed.ResultsThe experimental group and control group A were comparable with respect to age, gender and hospital course (P > 0.05). There was no significant difference in speech and swallowing functions between the two groups after treatment (P > 0.05) and no significant difference in 7 and 14-day mortality (P > 0.05). The CSF NPT levels in the experimental group before treatment were significantly higher compared with control group B (P < 0.05). The extent of brain MRI lesions correlated positively with CSF NPT levels (P < 0.05). In the experimental group (14 cases), the serum NPT levels decreased after treatment, whereas the CSF NPT levels increased after treatment, and the differences were statistically significant (P < 0.05). Dysphagia and motor dysfunction correlated positively with CSF NPT levels (P < 0.05).ConclusionEarly HP combined with CVVHDF in the treatment of severe viral encephalitis in children may be a better approach than CVVHDF only for improving prognosis. Higher CSF NPT levels indicated the likelihood of a more severe brain injury and a greater possibility of residual neurological dysfunction.

Exaggerated levels of some specific TLRs, cytokines and chemokines in Japanese encephalitis infected BV2 and neuro 2A cell lines associated with worst outcome

Japanese encephalitis (JE) disease, a viral brain fever is caused by Japanese encephalitis virus (JEV). Despite the availability of effective vaccines against this deadly infection, JE is the leading cause of epidemic viral encephalitis in children in South-east Asia. There is no treatment available for the JE disease which might be due to incomplete understanding of the pathogenesis of JE virus. The JEV infections lead to permanent neurological deficits even in those who survive from the infection. Activated microglia may play a potentially detrimental role by eliciting the expression of pro-inflammatory cytokines such as interleukin (IL)-1β, IL-6, and tumor necrosis factor-α (TNF-α) influencing the surrounding brain tissue. Microglial activation, proinflammatory cytokine release and leukocytes trafficking are associated following JEV infection in central nervous system (CNS). How the pattern recognition receptors sense the viral nucleic acid and how the microglial and neuronal cells behaves following JEV infection is still unelucidated. There is scarcity of data on the expression levels of toll like receptors (TLRs), cytokines and chemokines in JEV infection in invitro model. To explore the molecular mechanisms of JEV infection of microglial cells and neuronal cells, we studied the expression profile of TLRs, cytokines and chemokines in JEV infected microglial cell line BV2 and Neuronal cell line Neuro 2A. For the present study, we developed the mouse model of encephalitis by intracerebral (IC) injection of JE virus for virus propagation, disease progression and damage study. Our results demonstrate the exaggerated release of some specific TLRs, cytokines and chemokines in invitro cell culture of microglial and Neuro 2A cell line, which are associated with bad outcome in invivo study.

Role of Magnetic Resonance Three-Dimensional Arterial Spin Labeling Perfusion in Diagnosis and Follow-Up of Viral Encephalitis in Children.

The aim ofourstudy was to investigate the role of three-dimensional arterial spin labeling (3D-ASL) perfusion in the diagnosis and follow-up of children with viral encephalitis. Twenty-five consecutive children with viral encephalitis and 25 healthy children of similar age were recruited for the study between 2017 and 2020. Conventional magnetic resonance imaging and 3D-ASL were performed for all subjects, and a color map of cerebral blood flow (CBF) was generated. The images were classified into three groups depending on the time points at which the magnetic resonance examinations were conducted, including theinitial admissionscan, inpatient review, and follow-upreview. Clinical, neuroradiologic, and follow-up features were studied.The CBF values of the lesion area in the diseased brain group and the bilateral temporal cortex in the control group were measured and the differences between the two groups were compared. Perfusion was significantly increased in the acute cerebral disease group, and CBF and normalized cerebral blood flow(nCBF) were significantly higher than in the control group (124.5 vs 70.3 mL/100 g/min, 2.85 vs 1.36). Follow-up revealed that brain tissue perfusion in the lesion area of nine children decreased gradually after treatment, as their condition improved. Brain tissue perfusion in children with viral encephalitis increases during the acute stage and decreases when the condition improves. 3D-ASL provides a reference for diagnosis and follow-up of viral encephalitis in children.

Etiological Analysis of Viral Encephalitis in Children in Zhejiang Province from 2018 to 2019.

Objective: To investigate the common pathogens of viral encephalitis (VE) in children, and to provide guidance for the empirical diagnosis and treatment of patients with VE. Methods: A total of 227 cerebrospinal fluid (CSF) samples were collected from pediatric patients with VE in Zhejiang province from January 2018 to December 2019. The samples were tested using multiplex and singleplex Reverse Transcription-Polymerase Chain Reaction (RT-PCR) with primers specific to enterovirus (EV), varicella-zoster virus (VZV), mumps virus (MuV), cytomegalovirus (CMV), herpes simplex virus type 1 (HSV-1)/type 2 (HSV-2), Epstein–Barr virus (EBV), and human herpesvirus 6 (HHV-6). The data of the two analyses were compared and then verified using Sanger sequencing. Results: Of the 227 CSF samples, 90 were shown to be positive for multiplex RT-PCR with a positivity rate of 39.65% and a 95% confidence interval (33.2%, 46.1%). EV was the most common cause of VE, followed by EBV, HHV-6, MuV, CMV, VZV, and HSV-1. Most included cases occurred in summer, accounting for 49.78% of all cases. For EV, EBV, and HSV-2, multiplex RT-PCR showed a positivity rate of 34.36%, which was not statistically different from that of 30.4% shown by singleplex RT-PCR. The sequences of EV, EBV, VZV, MuV, CMV, HSV-1, HHV-6, and HSV-2 were confirmed by sequencing the PCR products obtained from multiplex and singleplex PCR. Conclusions: In children, VE is more prevalent in the summer than in other seasons in Zhejiang province, and EV may be the most common causative pathogen.

Japanese encephalitis virus induces vasodilation and severe lethality in adult and aged AG129 mice lacking alpha, beta and gamma interferon receptors

Japanese encephalitis virus (JEV) is a single-stranded positive-sense RNA virus belonging to the Flaviviridae family. The JEV is the leading cause of viral encephalitis in children and the elderly which is spread by mosquitoes. JEV infection has been established in different animal models such as mouse, hamster, guinea pig, swine, rat, monkey, rabbit by using the different routes of inoculations. Here, we have shown that the alpha/beta and gamma -receptor deficient AG129 mouse induces fatal encephalitis in both young and aged old mice, when challenged with high titer JEV Indian clinical isolate by both intraperitoneal and intradermal route. The JEV infected AG129 mouse have shown neurological symptoms, JEV-induced pathological features and supported high level viral replication. Additionally, administration of JEV in AG129 mice resulted in the induction of severe peripheral vascular permeability, which is a major hall mark of Dengue infection but not shown in JEV. Taken together, our results demonstrate interferon α/β and γ receptors knock out AG129 mouse does not need adaptation of JEV clinical isolates and could be is a promising JEV challenge mouse model by mimicking the natural intradermal route of administration for rapid screening of novel antivirals and vaccines.

Effect of Glucocorticoid Combined with High-dose Gamma Globulin in the Treatment of Severe Viral Encephalitis in Children

Effect of Glucocorticoid Combined with High-dose Gamma Globulin in the Treatment of Severe Viral Encephalitis in Children

Особенности вирусных энцефалитов у детей по данным Киевской городской детской клинической инфекционной больницы с 2011 по 2016 год

Проведен ретроспективный анализ 46 историй болезни детей, находившихся на стационарном лечении в Киев­ской городской детской клинической инфекционной больнице с 2011 по 2016 год. Была проанализирована этиология энцефалита у детей в зависимости от возраста и выявлено, что в этиологии вирусного энцефалита у детей первых 3 лет жизни преобладали цитомегаловирус и ассоциация Эпштейна — Барр вируса (EBV) с цитомегаловирусом — по 25 %. У подростков в этиологии превалировали EBV — 31 % и герпесвирус (HHV) 6-го типа — 31 %. У детей в возрасте 3–6 лет в этиологии преобладал EBV — 30 %, у детей 6–12 лет — HHV 6-го типа и EBV — по 27 %. В клинической картине энцефалита у подростков преобладал общемозговой синдром, а у детей первых 3 лет жизни — общеинфекционный. Очаговая неврологическая симптоматика отмечалась у больных всех возрастных групп. У детей старшего возраста начальными проявлениями заболевания были головная боль, недомогание, тошнота, рвота, у детей первых трех лет жизни — сонливость, раздражительность и отказ от еды. Частыми очаговыми симптомами у детей были афазия, атаксия, парезы, параличи, миоклонии.

Multiparameter magnetic resonance imaging in the diagnosis of herpes encephalitis in children

Introduction. This study is determined with the high prevalence of encephalitis in children, as well as the severe course and the possible disability. Herpes encephalitis occurs in almost half of cases of viral encephalitis in children. It is known that changes on the brain magnetic resonance imaging (MRI) in the acute stage of the disease are detected more often than on brain computed tomography (CT), but the clarification of this brain MRI changes is needed.Objectives of the study. To assess the features of brain multiparametric MRI changes in herpes encephalitis in children.Materials and methods. Two groups of children were examined, the first group included 25 children aged 6,0±4,8 years with laboratory-confirmed acute EH, the second group (control) — 23 children without signs of central nervous system damage at the comparable gender and age. Structural changes were assessed using MRI of the brain in T1-WI, T2-WI, Flair, T1-WI modes post contrast, DWI, DTI and MR spectroscopy.Results. In 40% of cases revealed panencephalitis, 36% — leukoencephalitis, 24% — polioencephalitis. Most often, the process involved the cerebral hemispheres — 72%, the brain stem — 44%, the thalamus — 40% and basal nuclei — 36%. In 52% of cases changes in DWI were found, in 20% of cases the lesions accumulated contrast agent. There was a statistically significant decrease of FA both in the focus and in the intact area in children with EH compared with the control group.Conclusion. The application of multiparametric MRI using DWI, DTI, and MR spectroscopy methods are statistically significant for the detection and assessment of focal brain lesions in children with herpes encephalitis.

Epidemiological characteristics and cerebrospinal fluid cytokine profiles of enterovirus encephalitis in children in Hangzhou, China

Enteroviruses (EVs) are common causes of viral encephalitis in children. To better understand the epidemiological and pathological characteristics of EV encephalitis, we enrolled suspected encephalitis patients younger than 15 years old in Hangzhou, China, from October 2016 to September 2019 for cerebrospinal fluid (CSF) collection and analyses. A total of 7735 CSF samples were collected, among which 330 (4.27%) were positive for the EV genome. The positivity rate was significantly higher in boys than girls (χ2 = 5.68, p = 0.02). The monthly case numbers peaked from June to August (80.30%). Among the different age groups, the 0-2 months age group showed the highest number of cases (28.48% of all cases). The 6-7 years (10.82%) and 9-10 years (9.29%) age groups showed the highest EV-positivity rates among suspected encephalitis cases. Sixty-two EV-positive and 53 control CSF samples were collected for Bio-Plex Pro human cytokine assays that simultaneously tested 48 cytokines. Principle component analyses showed significant separation between EV-positive and control samples, but insignificant separation between children and newborns. The levels of 28 cytokines and chemokines were significantly elevated in the EV-positive group including many proinflammatory and a few anti-inflammatory cytokines, as well as chemokines belonging to the CC and CXC subfamilies. Only one cytokine, stem cell growth factor-β, showed a decrease in the EV-positive group. Thus, this study revealed age, sex, and seasonal preferences for EV encephalitis incidences in children and identified many cytokines dysregulated during EV encephalitis.

Japanese encephalitis in children from an endemic district of West Bengal, India: A hospital based observational study

Background: Japanese encephalitis (JE) is an important cause of viral encephalitis in children in South East Asian countries including India. Aims and Objective: We have done this study in an JE endemic district of India to know the demographic profile, clinical presentation, seasonal variation, outcome and about the vaccination status of the JE cases. Materials and Methods: This observational, cross sectional study was done for a period of one year in the Pediatric department of Burdwan Medical College, West Bengal in children up to the age of 12 year, presented with acute encephalitis syndrome (AES). Demographic data, clinical presentation and JE vaccination status were recorded and confirmed JE cases were detected by either serum or CSF JE IgM antibody. Outcome of the JE cases were noted as discharge, death or leave against medical advice (LAMA). Results: We have found confirmed JE in 18 children out of total 125 AES cases (14.4%). 61.1% of them were within 6 to 12 year age, mostly from low socioeconomic status and 100% case occurred during monsoon and post monsoon period. History, was of JE vaccination were present in only 11.1% case of JE. Most common presenting symptoms were high fever (100%), convulsion (94.4%) and altered sensorium (72.2%). 77.8% JE case were discharged and 11.1% expired. Conclusion: We must consider JE whenever a child from any endemic district comes with AES and we should try to bring every child under the JE vaccination coverage in the endemic regions globally to reduce the burden of this preventable encephalitis.

Application Effect of Rehabilitation Nursing in Nursing of Severe Viral Encephalitis in Children

Application Effect of Rehabilitation Nursing in Nursing of Severe Viral Encephalitis in Children

Analysis of the Effect of Incentive Nursing Intervention in Children with Severe Viral Encephalitis and Myocarditis during Rehabilitation Based on Diffusion Weighted MRI.

Background Severe viral encephalitis in children causes a viral infection that damages their central nervous system. This situation arises the mental abnormalities, sudden rise in body temperature, disturbance of consciousness, and so forth in children, which can be life-threatening. Objective This work aimed at exploring the effect of diffusion weighted MRI on children with severe viral encephalitis and myocarditis. Methods This work presents a diffusion weighted MRI scanning method that involves scanning through a serial imaging device, axial scanning, and sagittal and coronal scanning. 60 children with severe viral encephalitis and myocarditis who admitted to Brain Hospital of Hunan Province from April 2017 to May 2020 were deemed as research subjects. All the children underwent CT and MRI examination, blood routine examination, and cerebrospinal fluid examination after admission. This work uses the random number table method to classify the subjects into control group and observation group, each consisting of 30 cases. Children in the control group were provided with the routine nursing intervention, whereas children in the observation group were subjected to incentive nursing intervention. The baseline data, ECG monitoring indicators, body abnormalities, and clinical symptom relief time of the two groups of children were compared and the results of diffusion weighted MRI scans were analyzed and the ADC values were counted. Results The two groups of children were compared on the basis of baseline data, and the variation was not statistically substantial (P > 0.05). The cases of children in the control group had higher heart rate and respiration, and physical dysfunction, language dysfunction, unconsciousness, and nervous dysfunction were more than those in the observation group. However, the cases of blood oxygen saturation were less than those of the observation group. After nursing intervention done for the control group, remission time of clinical symptoms such as convulsion, physical dysfunction, unconsciousness, and nerve dysfunction was longer relative to the observation group (all P < 0.05 are considered). Conclusion The diffusion weighted MRI had diagnostic significance for severe viral encephalitis and myocarditis. For children with severe viral encephalitis and myocarditis, clinical incentive nursing intervention was particularly imperative. It can not only help children to relieve symptoms and control the deterioration of the disease in a short time but also help improve the quality of life of the children and the confidence of family members to cope with the disease.

Procalcitonin measurement using antibody-conjugated fluorescent microspheres distinguishes atypical bacterial meningitis from viral encephalitis in children

Examination of cerebrospinal fluid in atypical bacterial meningitis (ABM) is similar to that of viral encephalitis (VE), so ABM can easily be misdiagnosed as VE, which can delay diagnosis and treatment. We developed a simple, rapid hand-held lateral flow immunoassay detection system based on fluorescent microspheres (FMS) for procalcitonin (PCT) detection, which provides an indicator to differentiate between ABM and VE. With this novel method, the antigen-antibody reaction systems involve different species, making the test strips more stable than those utilizing one species. The strips exhibited a wide dynamic range (0.04–50 ng/mL) and good sensitivity (0.03 ng/mL). The function of PCT in the identification of ABM and VE in children was further studied. A significant difference in PCT levels was observed between the ABM and VE groups (P = 0.00) and between the ABM and the normal control groups (P = 0.00). PCT levels were not significantly different between the VE and normal control groups (P = 0.30). The area under the receiver operating characteristic curve of PCT for the diagnosis of ABM was 0.95. These findings collectively indicate the usefulness of the PCT detection method based on FMS for clinically differentiating between ABM and VE.

Clinical and laboratory characteristics of viral encephalitis in children in Menoufia governorate, Egypt

ObjectiveThis study was designed to highlight clinicoepidemiological profile investigation findings of acute viral encephalitis in children.BackgroundOwing to the high morbidity and mortality associated with viral encephalitis, it is important to establish a diagnosis and initiate therapy as soon as possible.Patients and methodsThis study was conducted on 50 cases that met the diagnostic criteria of encephalitis. Most of these patients were admitted at either General Department or Pediatric ICUs of Menoufia University Hospital and Shebin El-Kom Fever Hospital. All were subjected to complete history and examination, cerebrospinal fluid examination, electroencephalogram, computed tomography brain, and MRI brain.ResultsOf the 50 patients included in the study, there were 30 (60%) male 20 (40%) female patients, with mean ± SD age of 5.56 ± 4.90 (0.42–15.0) years. A total of 35 (70%) patients were from the rural area, 25 (50%) patients had low socioeconomic status, and 20% had positive consanguinity. Delayed development was observed only in 14% of patients. Pus cells ranged from 5 to 500 cell in 74% of patients, with mean lymphocyte percentage of 53.33 ± 35.98. Protein was elevated more than or equal to 50 in 82% of patients, and 20% of the patients showed background slowing and focal sharp wave in temporal lobe by electroencephalogram. Brain edema was detected in 15% patients. MRI abnormalities were detected in 24 patients.ConclusionClinical data, laboratory results, and neuroimaging findings support the diagnosis of encephalitis.

Cortisol and laboratory indicators of systemic inflammation in case of bacterial purulent meningitis and viral encephalitis in children

Pediatric bacterial purulent meningitis (BPM) and viral encephalitis (VE) are significant medical and social problems due to their course severity, high frequency of death cases, and formation of neurologic deficiency at the disease outcome. Activation of hormonal regulation and severity syndrome of systemic inflammatory response are important factors to evaluate the character of BPM and VE course.Objective.To study the level of cortisol and laboratory indicators of systemic inflammation in children with various variants of BPM and VE course depending on the period of the disease (acute period, reconvalescence) to specify their role in the pathogenesis of acute neuroinfections.Object and methods.There were investigated hematological indicators, the level of cortisol, C-reactive protein in blood serum of 60 children, 39 of them had BPM and 21 ones VE. The comparison group included 14 children aged from 1 to 14 years old who were undergoing rehabilitation care due to neurologic problems at the Federal State-Financed Institution Pediatric Research and Clinical Center for Infectious Diseasesunder the Federal Medical Biological Agency.Results.The patients were divided into some subgroups according to the severity of their condition at the moment of hospitalization, i.e. urgent condition or critical condition requiring organ replacement therapy. The maximum increase of cortisol level and laboratory markers of systemic inflammation during the acute period was revealed in case of BPM in comparison with VE with a subsequent normalization to the stage of reconvalescence. Thelevel of cortisol during the acute period of BPM was reliably higher in the subgroup with urgent conditions, whereas in case of VE in the subgroup with critical conditions. There were no significant differences in the laboratory indicators of systemic inflammation response among the subgroups. There was established a correlation interrelation of cortisol level and the content of granulocytes and blood lymphocytes.Conclusion.There were identified characteristic features of cortisol content in children with bacterial and viral neuroinfections depending on the course of the disease.

Epidemiological characterizations of Japanese encephalitis and its associated risk factors in Quang Ngai province, Vietnam, 2009–2017

Background: Japanese encephalitis (JE) is one of the leading etiologies causing viral encephalitis in children in Asian and Pacific regions. The goal of this study is to determine the epidemiology characterizations of JE and Its associated risk factors in Quang Ngai province during 2009–2017. Methods and materials: A descriptive cross-sectional study combining with a prospective study of 411 cases diagnosed with viral encephalitis suspected of Japanese encephalitis (JE) and JE identified, which aim to determine epidemiology characterizations of JE and Its associated risk factors in Quang Ngai province, 2009–2017. Results: The results showed that the average incidence was 0.57/100.000 population, mortality on the incidence was 1.79%, the age group who was the most infected was under a 15-year-old group. The cases of JE lived mainly in mountainous areas with a rate of 71.4% and the plain and urban areas accounting for 28.6%. The distribution of the disease was seasonal, these cases were determined mainly during the summer months, with the peak of the epidemic in June. Among JE cases, 66% have not had a JE vaccine. The group vaccinated with three fully JE vaccines accounted for 14.3%. There is an association between the rate of fully three doses of Japanese encephalitis vaccinated and the incidence/100.000 population in Quang Ngai province. When the rate of injection of three doses of JE vaccine increases by 1%, the rate of JE determined will decrease 0.074/100.000 population with (95% CI: 2,32–12,95; p < 0,05). Conclusion: In order to reduce the incidence of Japanese encephalitis in Quang Ngai province, the national expanded immunization program organizes additional vaccination campaign for high-risk areas, groups of children who have not had enough shots for the JE vaccine and the target group of ethnic minorities in mountainous areas of Quang Ngai province.

The Role of Intravenous Immunoglobulins in Treatment of Viral Encephalitis in Children

The Role of Intravenous Immunoglobulins in Treatment of Viral Encephalitis in Children

Management and results of epilepsy surgery associated with acyclovir prophylaxis in four pediatric patients with drug-resistant epilepsy due to herpetic encephalitis and review of the literature.

Herpes simplex virus encephalitis (HSE) is the most common cause of sporadic viral encephalitis in children and is responsible for epilepsy in approximately half of patients. In addition to medical treatment, epilepsy surgery may be offered to drug-resistant patients but carries a high risk of relapse of herpetic encephalitis. We are reporting our series of patients operated on between 2000 and 2019 with the systematic administration of acyclovir (ACV). Four pediatric patients aged 4.5-12.8 years with drug-resistant epilepsy post-HSE underwent a tailored focal resection following invasive recordings (three patients) and a complete callosotomy (one patient). The total number of the surgical procedures for the four patients was eight, and a systematic administration of ACV as a prophylactic treatment of herpetic encephalitis relapse was done at each step. No patients had a relapse and the ACV was well-tolerated in all the cases. Following surgery two patients are seizure free, the patient who underwent callosotomy is Engel 3 and the fourth patient, in whom a large epileptic zone has contraindicated a second surgery, is Engel 4. Our series demonstrated the dramatic efficacy of systematic ACV prophylaxis during all cranial surgeries. Moreover, our results on epilepsy, together with those of the literature, encourage more consideration regarding epilepsy surgery in this specific etiology. All types of surgical procedures (curative or palliative) can be offered to the patients, but in the case of focal surgery, due to the poor anatomical limits, invasive recordings are highly recommended.