● 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 supportive measures: to control elevated ICP from edema, includes: elevate HOB, mannitol, hyperventilation (dexamethasone unproven efficacy)
Anticonvulsants are used for seizure prophylaxis.
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.
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)
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 1).