====== Herpes simplex encephalitis treatment ======

● optimal treatment: early administration of IV [[acyclovir]] is the drug of choice.

Treatment should be instituted rapidly without waiting for biopsy, before the onset of coma.

===== General treatment measures =====

General supportive measures: to control elevated [[ICP]] from [[edema]], includes: elevate HOB, [[mannitol]], [[hyperventilation]] ([[dexamethasone]] unproven efficacy)

Anticonvulsants are used for seizure prophylaxis.

===== Antiviral medications =====

==== Acyclovir ====

The drug of choice for HSE.

Drug info: Acyclovir (Zovirax®)

℞ Adult: 30 mg/kg/day, in divided q 8 hr doses in minimum volume of 100 ml IV fluid over 1 hr (cau- tion: this fluid load may be hazardous, especially since cerebral edema is already usually problematic) for 14–21 days (some relapses have been reported after only 10 days of treatment).

℞ Children>6 mos age: 500mg/m2 IV q 8 hrs×10 days. ℞ Neonatal: 10 mg/kg IV q 8 hrs for 10 days.

==== Drug info: Vidarabine (Vira-A®) ====


Six month mortality following treatment with acyclovir was influenced by:
● age (6% under age 30, 36% over age 30)
● Glasgow coma score (GCS) at time of treatment initiation (25% for GCS ≤ 10, 0% for GCS > 10)
● duration of disease before therapy (0% for initiating therapy within 4 days of onset of symptoms,
35% if after 4 days)


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Findings suggest that [[CTRP4]] is highly expressed in [[herpes simplex encephalitis]] and is closely related to the progression of HSE. Thus, CTRP4 may serve as a potential severity index for HSE and targeting CTRP4 might be a promising therapeutic strategy against HSE
((Xu W, Zhou H, Li X, Wang L, Guo X, Yin L, Chang H, Wei Y, Li Q, Deng J, Zhou
X, Yang H, Zhang X, Yi F, Ma W. C1Q/TNF-related protein 4 expression correlates
with herpes simplex encephalitis progression. Ann Transl Med. 2019 Jun;7(11):235.
doi: 10.21037/atm.2019.05.01. PubMed PMID: 31317005; PubMed Central PMCID:
PMC6603354.
)).