acyclovir and Epilepsy

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.

Topics: Acyclovir; Adolescent; Antiviral Agents; Child; Child, Preschool; Drug Resistant Epilepsy; Encephalitis, Herpes Simplex; Epilepsy; Female; Humans; Male; Secondary Prevention

INTRODUCTION. Infection by the Epstein-Barr virus (EBV) -either as a primary infection, a reactivation or an active chronic infection- can give rise to several clinical forms of involvement of the central nervous system. We report a case of encephalitis due to EBV produced by viral reactivation in an immunocompetent patient which initially mimicked, from the clinical and electroencephalographic point of view, encephalitis due to type 1 herpes simplex virus (HSV-1). CASE REPORT. A 51-year-old male who had reported the presence of dorsal herpes zoster some days earlier. The patient visited the emergency department after suffering a holocranial oppressive headache and febricula for seven days; 24 hours before admission to hospital, he was suffering from drowsiness and language disorder. The neurological examination revealed stiffness in the back of the neck and dysphasia. An analysis of the cerebrospinal fluid revealed pleocytosis (422 cells/mm(3)) with 98% of mononuclear cells and normal protein and glucose concentration levels in cerebrospinal fluid. Magnetic resonance imaging of the brain and electroencephalogram readings were normal with periodic lateralised epileptiform discharges in the left temporal region. Intravenous acyclovir treatment was initiated, but renal failure meant it had to be changed to oral valaciclovir with clinical resolution and improvement of the liquoral parameters. Polymerase chain reaction in the cerebrospinal fluid was positive for EBV and negative for the other neurotropic viruses. In blood, the serology test for EBV with IgG was positive, while IgM and heterophile antibody tests were negative. CONCLUSIONS. EBV infection can give rise to acute disseminated encephalomyelitis or affect several locations in the central nervous system, especially the cerebellum. Clinical pictures mimicking HSV-1 are less frequent. When encephalitis is related to viral reactivation, precipitating factors can be detected, as in our case.. Encefalitis por el virus de Epstein-Barr: descripcion de un caso clinico y revision de la bibliografia.. Introduccion. La infeccion por el virus de Epstein-Barr (VEB) puede dar lugar –tanto como primoinfeccion, reactivacion o infeccion cronica activa– a varias formas clinicas de afectacion del sistema nervioso central. Presentamos un caso de encefalitis por VEB producido por reactivacion virica en un paciente inmunocompetente, que inicialmente simulaba, desde el punto de vista clinico y electroencefalografico, una encefalitis por virus herpes simple tipo 1 (VHS-1). Caso clinico. Varon de 51 años con antecedente de herpes zoster dorsal en los dias previos. Acudio a urgencias por un cuadro de siete dias de duracion de cefalea opresiva holocraneal y febricula; 24 horas antes de su ingreso, padecia somnolencia y alteracion del lenguaje. En la exploracion neurologica presentaba rigidez nucal y disfasia. En el liquido cefalorraquideo se evidencio pleocitosis (422 celulas/mm3) con un 98% de mononucleares, y proteinorraquia y glucorraquia normales. Resonancia magnetica cerebral normal y electroencefalograma con descargas epileptiformes lateralizadas periodicas en la region temporal izquierda. Se trato con aciclovir intravenoso; una insuficiencia renal motivo su cambio a valaciclovir oral con resolucion clinica y mejoria de los parametros licuorales. La reaccion en cadena de la polimerasa en el liquido cefalorraquideo fue positiva para VEB y negativa para el resto de virus neurotropos. En sangre, la serologia para VEB con IgG resulto positiva, y negativa con IgM y anticuerpos heterofilos. Conclusiones. La infeccion por VEB puede dar lugar a una encefalitis aguda diseminada o afectar a varias localizaciones del sistema nervioso central, principalmente el cerebelo. Menos frecuentes son los cuadros imitadores de VHS-1. Cuando la encefalitis se relaciona con reactivacion viral pueden detectarse, como en nuestro caso, factores precipitantes.

Topics: Acute Kidney Injury; Acyclovir; Antibodies, Viral; Antiviral Agents; Cerebrospinal Fluid; Drug Substitution; Electroencephalography; Encephalomyelitis, Acute Disseminated; Epilepsy; Epstein-Barr Virus Infections; Herpes Zoster; Herpesvirus 4, Human; Humans; Immunoglobulin G; Immunoglobulin M; Magnetic Resonance Imaging; Male; Middle Aged; Valacyclovir; Valine

The article gives the clinical case of herpes simplex encephalitis relapse with the resistant seizures in a child. What we describe is a clinical approach towards the differential diagnostic of the seizures in structural epilepsy, which are resistant to anticonvulsants, or late herpes simplex encephalitis relapse. Good clinical perspective may be the indication of the intratecal synthesis of the IgG-specific antibodies to the herpes simplex type 1 and 2. Conducting etiotropic treatment with the appointment of acyclovir and pathogenetic therapy with the use of Cytoflavin contributed to the rapid and stable remission of epileptic seizures and regression of neurological deficit.. В статье представлено клиническое описание рецидива герпетического энцефалита (ГЭ) у ребенка, осложненного резистентными судорогами. Представлена тактика дифференциальной диагностики судорожного синдрома как проявления структурной эпилепсии, резистентной к противоэпилептической терапии, и позднего рецидива ГЭ. Диагностически ценным может быть обнаружение интратекального синтеза специфических IgG к вирусу простого герпеса 1-го и 2-го типов, что в представленном случае позволило подтвердить реактивацию герпетической инфекции в центральной нервной системе и явилось основанием для повторного курса специфической терапии. Проведение этиотропного лечения с назначением ацикловира и патогенетической терапии с применением Цитофлавина способствовало быстрой и стойкой ремиссии эпилептических приступов и регрессу неврологического дефицита.

Topics: Acyclovir; Child; Encephalitis, Herpes Simplex; Epilepsy; Herpes Simplex; Humans; Immunoglobulin G; Recurrence; Seizures

Drug-induced hypersensitivity syndrome (DIHS)/drug rash with eosinophilia and systemic symptoms (DRESS) is a severe multiorgan reaction with reactivation of herpesviruses. Various features are often seen during the course of the disease. Many aspects of this syndrome suggest close similarities between DIHS/DRESS and graft-versus-host disease. We describe a patient with phenobarbital-induced hypersensitivity syndrome who revealed syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with limbic encephalitis during the course of the disease. In view of previous reports that SIADH and limbic encephalitis are caused by reactivation of latent herpesviruses after transplantation, both conditions may be secondarily caused by reactivation of latent herpesviruses, which is typically observed in DIHS/DRESS. These neurological symptoms should be added to a growing list of important complications of DIHS/DRESS because of the high mortality rate associated with them.

Topics: Acyclovir; Aged; Anticonvulsants; Antiviral Agents; Coma; Drug Hypersensitivity; Encephalitis; Epilepsy; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Phenobarbital; Syndrome; Treatment Outcome

Glaxo Wellcome becomes aware of prenatal exposures to its medications as early as the clinical trial phase of development. An international process for monitoring prenatal exposure to all Glaxo Wellcome medicines has been developed. For specific products there are prospective pregnancy registries.. The registries are observational, case-registration, and follow-up studies designed to detect evidence of teratogenicity associated with specific medications. After prenatal exposure to the registry medication, pregnancies are registered prospectively, through voluntary reports by health care providers. An advisory committee of independent scientists for each registry reviews data and advises in dissemination of information. Risk of birth defects, as defined by the Centers for Disease Control and Prevention, is compared with published risks both in women in the general population and in women with the underlying condition being treated, if available.. The following data show results from the prospective first-trimester exposures registered since establishment of each registry. The published risk of birth defects in the general population range is 3% to 5%, and the risk in women with epilepsy is 6% to 9%. The proportions of outcomes with birth defects are as follows: in the Acyclovir (antiviral medication) Pregnancy Registry (1984-1998) (19/581), 3.3% (95% confidence interval, 2.0%-5.2%); in the Lamotrigine (monotherapy and polytherapy antiepileptic medication) Pregnancy Registry (1992-September 1998) (8/123), 6.5% (95% confidence interval, 3.1%-12.8%); in the Sumatriptan (migraine medication) Pregnancy Registry (1996-October 1998) (7/183), 3.8% (95% confidence interval, 1.7%-8.0%). The Valacyclovir, Bupropion, and Naratriptan registries have insufficient data for analysis.. None of the registries has provided a risk estimate exceeding that expected in the disorder treated, and no pattern of defects has been observed. Whereas information from the larger registries is reassuring regarding risk, these studies cannot rule out possible small excess risks from use of these drugs in pregnancy. Data obtained through these registries are shared with the medical community as a supplement to animal toxicology studies to assist in weighing potential risks and benefits of treatment for individual patients. The success of the registries depends on the continued willingness of the obstetrics and gynecology community to notify the registries of prenatal exposures.

Topics: Abnormalities, Drug-Induced; Acyclovir; Anticonvulsants; Antiviral Agents; Drug Industry; Epilepsy; Female; Humans; Lamotrigine; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy Trimester, First; Prospective Studies; Registries; Risk Factors; Sumatriptan; Triazines; Vasoconstrictor Agents

Herpes simplex encephalitis (HSE) rarely occurs in children, is not easily diagnosed, and has a poor prognosis.. We report a pediatric case with a relapse on the 29th day despite conventional acyclovir therapy. As the relapse mechanism is not clearly understood, antiviral and immunosuppressive therapy was administered.. This case underlines the importance of clinical examination and the necessity of accurate testing prior stopping antiviral treatment. A better understanding of the relapse mechanism is required in order to propose more efficient treatment.

Topics: Acyclovir; Anti-Anxiety Agents; Anti-Inflammatory Agents; Anticonvulsants; Antiviral Agents; Benzodiazepines; Brain; Child, Preschool; Clobazam; Drug Therapy, Combination; Encephalitis, Herpes Simplex; Epilepsy; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Methylprednisolone Hemisuccinate; Recurrence; Time Factors; Tomography, X-Ray Computed; Valproic Acid; Vigabatrin