acyclovir and Status-Epilepticus

Herpes simplex virus (HSV) is a common cause of viral encephalitis and can result in refractory seizures. Although HSV encephalitis (HSVE) is treated primarily with acyclovir, surgery can play a role in medically intractable cases.. To systematically review cases describing surgery for the treatment of severe HSVE. We also present an illustrative case of anterior temporal lobectomy (ATL) for refractory status epilepticus in a patient with unilateral HSVE. This case demonstrates one clinical context in which surgery can be a useful adjunct.. We performed a systematic review using PubMed and Google Scholar, including case reports and series describing surgical interventions for HSVE. Clinical data were extracted from 54 publications that incorporated 67 patient cases.. Surgical decompression occurred at a wide range of times after the onset of illness, although most patients were operated on 4 or more days after HSVE symptoms began. Numerous reports indicated that decompressive craniectomy, temporal lobectomy, and hematoma removal could treat intractably elevated intracranial pressure because of HSVE with favorable long-term outcomes. We describe an additional case in which a 52-year-old woman with HSVE developed refractory right temporal lobe seizures. After ATL, the seizures resolved with significant clinical improvement.. Surgical treatment can be a useful adjunct for treatment of HSVE. There is substantial variability in the timing of surgical decompression in patients with HSVE, which can be necessary up to approximately 3 weeks after illness onset. ATL should be considered for refractory status epilepticus in HSVE with a unilateral seizure focus.

Topics: Acyclovir; Anterior Temporal Lobectomy; Encephalitis, Herpes Simplex; Female; Humans; Middle Aged; Seizures; Status Epilepticus

Acute hemorrhagic leukoencephalitis (AHL) is a rare and mostly fatal fulminant demyelinating disease. This case describes a 63-year old male in status epilepticus associated with an intracerebral hemorrhage following a one week viral prodrome with rapid decline to coma. He exhibited peripheral leukocytosis, neutrophilic pleocytosis with normal glucose and high protein in cerebrospinal fluid (CSF). Additionally, CSF was positive for herpes simplex virus (HSV) polymerase chain reaction (PCR). Medical decompression, low-dose dexamethasone, antibiotics and acyclovir were initially given. Magnetic resonance imaging (MRI) was suggestive of AHL, thus he was treated with methylprednisolone 1 g/day for 5 days. The patient improved and was discharged with significant neurologic morbidity. This is the first reported case of AHL in the Philippines presenting as a diagnostic dilemma with a protracted clinical course who responded to high dose intravenous steroids.

Topics: Acyclovir; Antiviral Agents; Diagnosis, Differential; Encephalitis, Herpes Simplex; Humans; Leukoencephalitis, Acute Hemorrhagic; Male; Methylprednisolone; Middle Aged; Neuroprotective Agents; Status Epilepticus

Viral encephalitis causes an altered level of consciousness, which may be associated with fever, seizures, focal deficits, CSF pleocytosis, and abnormal neuroimaging. Potential pathogens include HSV, VZV, enterovirus, and in some regions, arboviruses. Autoimmune (eg, anti-NMDA receptor) and paraneoplastic encephalitis are responsible for some cases where no pathogen is identified. Indications for ICU admission include coma, status epilepticus and respiratory failure. Timely initiation of anti-viral therapy is crucial while relevant molecular and serological test results are being performed. Supportive care should be directed at the prevention and treatment of cerebral edema and other physiological derangements which may contribute to secondary neurological injury.

Topics: Acyclovir; Adrenal Cortex Hormones; Anticonvulsants; Antiviral Agents; Brain Diseases; Brain Edema; Consciousness Disorders; Encephalitis; Encephalitis, Viral; Encephalomyelitis, Acute Disseminated; Glasgow Coma Scale; Guillain-Barre Syndrome; Hashimoto Disease; Humans; Intensive Care Units; Paraneoplastic Syndromes, Nervous System; Seizures; Status Epilepticus; Viremia

Topics: Acyclovir; Adrenal Cortex Hormones; Anti-Bacterial Agents; Antiviral Agents; Brain Neoplasms; Ceftriaxone; Dexamethasone; Diagnosis, Differential; Electroencephalography; Emergency Service, Hospital; Encephalitis, Herpes Simplex; Fever; Humans; Hypnotics and Sedatives; Infarction; Levetiracetam; Male; Massachusetts; Middle Aged; Phenytoin; Piracetam; Propofol; Status Epilepticus; Temporal Lobe; Tomography, X-Ray Computed; Unconsciousness; Vancomycin

Topics: Academic Medical Centers; Accidents, Home; Acyclovir; Adult; Antiviral Agents; Boston; Combined Modality Therapy; Diagnosis, Differential; Drug Overdose; Emergency Service, Hospital; Fellowships and Scholarships; Female; Humans; Medical Staff, Hospital; Neurotoxicity Syndromes; Prodrugs; Status Epilepticus; Toxicology; Treatment Outcome; Valacyclovir; Valine; Workforce; Young Adult

To analyze the electroclinical features, neuroimaging findings, treatment, and outcome of 12 patients with febrile infection-related epilepsy syndrome (FIRES).. This is a retrospective study of 12 children with FIRES with a mean time of follow-up of 6.5 years carried out at the Garrahan Hospital of Buenos Aires between 1997 and 2012.. Eight males and four females had focal status epilepticus preceded by febrile infection with a mean age at presentation of 8.5 years. In the acute period, the treatment included antiepileptic drugs (AEDs) in all cases, immunotherapy in 10 cases, and burst-suppression coma in eight. The ketogenic diet was tried in two, plasmapheresis in one, and rituximab in one. Two patients treated with IVIG and one patient given steroids had a good response, but in this phase only three patients had a prolonged good response to IVIG and a ketogenic diet. No patients died in this period. In the chronic epilepsy phase, all children had seizures arising from neocortical regions. All patients had refractory epilepsy, and most mental retardation, and behavioral disturbances. All received different AEDs and in this phase a third patient was put on a ketogenic diet. One patient was operated without good results. Only two cases had a good outcome after 2 and 10 years of follow-up.. FIRES is a well-defined severe epileptic syndrome, probably in the group of epileptic encephalopathies, characterized by focal or multifocal seizures arising from the neocortical regions with an unknown etiology. Immunoglobulin and the ketogenic diet may be considered a potentially efficacious treatment.

Topics: Acyclovir; Adolescent; Antiviral Agents; Argentina; Child; Child, Preschool; Electroencephalography; Encephalitis, Viral; Female; Follow-Up Studies; Humans; Immunoglobulins, Intravenous; Leukocytosis; Magnetic Resonance Imaging; Male; Retrospective Studies; Seizures, Febrile; Status Epilepticus; Syndrome; Treatment Outcome; Unconsciousness

New onset refractory status epilepticus (NORSE) is a relatively novel concept used to describe a cohort of previously healthy young adults mostly women presenting with denovo refractory status epilepticus which has a miserable impact on the outcome. Various infectious and non-infectious causes have been considered to be responsible for this dreaded syndrome; however, many a times the exact cause is not identified. As therapy with antiepileptic and anaesthetic drugs is not so successful, identifying and treating the exact cause could improve the outcome. Here the authors describe a woman who presented with NORSE. Investigations confirmed the diagnosis of herpes simplex encephalitis (HSE) and she responded drastically to acyclovir along with complete control of seizures. In this case, NORSE was the presenting feature of HSE and the refractoriness of her seizures was terminated only after treating the exact cause, that is, encephalitis.

Topics: Acyclovir; Adult; Antiviral Agents; Electroencephalography; Encephalitis, Herpes Simplex; Female; Humans; Magnetic Resonance Imaging; Status Epilepticus

The use of herbal and complementary medicine is common. Many herbal products are known to produce serious adverse effects. Borage oil is derived from the seeds of the borage plant (Borago officinalis) an abundant source of gamma-linolenic acid (GLA), and Borage oil has been promoted as a treatment for rheumatoid arthritis, atopic dermatitis, diabetic neuropathy, and menopause-related symptoms. We report a case of status epilepticus in a patient who consumed borage oil for one week.

Topics: Acyclovir; Adult; Anticonvulsants; Borago; Diethylcarbamazine; Drug Therapy, Combination; Female; gamma-Linolenic Acid; Humans; Lorazepam; Pentobarbital; Phenytoin; Plant Oils; Seizures; Status Epilepticus; Treatment Outcome

This report describes a 9-year-old child with status epilepticus and cat scratch disease. This patient's focal seizures and electroencephalographic changes persisted for 18 months after status epilepticus. This patient represents the third reported case of persistent focal seizures or electroencephalographic changes after status epilepticus secondary to cat scratch disease. This finding suggests that cat scratch encephalopathy may be a cause of localization-related epilepsy, and should be investigated when evaluating a patient with new-onset partial seizures.

Topics: Acyclovir; Anti-Bacterial Agents; Anticonvulsants; Antiviral Agents; Cat-Scratch Disease; Ceftriaxone; Child; Drug Therapy, Combination; Electroencephalography; Epilepsy, Tonic-Clonic; Humans; Lorazepam; Male; Phenytoin; Status Epilepticus; Vancomycin

Nonconvulsive status epilepticus is a specific form of status epilepticus characterized by alteration in mental status and persistent seizure activity on EEG, with or without motor phenomena. Recognition of the consequences of nonconvulsive status epilepticus has attracted greater attention to this condition. We present a 24-year-old woman with epilepsy who developed nonconvulsive status epilepticus during pregnancy. Despite treatment with antiepileptic drugs, the seizures persisted and confusion deepened. Further workup to explain the etiology revealed the diagnosis as herpes encephalitis. She recovered completely by the third day of parenteral acyclovir administration. Herpes simplex encephalitis causing nonconvulsive status epilepticus in a pregnant, epileptic woman is an unfortunate and unusual condition, which was simultaneously complicated by the presence of multiple etiological factors.

Topics: Acyclovir; Adult; Antiviral Agents; Electroencephalography; Encephalitis, Herpes Simplex; Epilepsies, Partial; Female; Humans; Pregnancy; Pregnancy Complications; Pregnancy Complications, Infectious; Status Epilepticus

Topics: Acyclovir; Aged; Aged, 80 and over; Anticonvulsants; Antiviral Agents; Female; Herpes Zoster; Humans; Kidney Failure, Chronic; Status Epilepticus; Treatment Outcome; Valacyclovir; Valine

Topics: Acyclovir; Adult; Brain; Child, Preschool; Encephalitis, Herpes Simplex; Epilepsy, Frontal Lobe; Female; Humans; Infant; Status Epilepticus

A case of aseptic meningoencephalitis with recurrent abnormal behavior, status epilepticus and aphthous stomatitis was described. A 39-year-old man, who had a history of low grade fever and abnormal behavior over 2 years without mucocutaneo-ocular symptoms, was admitted to Shinshu University Hospital because of status epilepticus. On admission, neurological examination revealed comatose state with neck stiffness, anisocoria (right greater than left), conjugate deviation to right and bilateral pyramidal tract signs. His cerebrospinal fluid examination revealed a total protein content of 206 mg/dl with 22 lymphocytes and 134 polymorphonuclear leukocytes/mm3. EEG recorded on the 3rd hospital day showed periodic sharp waves and polyspikes, occurring every 1 seconds, predominantly arise from the right hemisphere, which corresponds to periodic lateralized epileptiform discharges (PLEDs). Herpes simplex encephalitis was suspected and acyclovir was administered. Neck stiffness and cerebrospinal fluid findings were improved and PLEDs disappeared. But aphthous stomatitis appeared and meningoencephalitis was relapsed. Laboratory examination revealed erythrocyte sedimentation rate 40 mm/hr, positive C-reactive protein, elevated CH50 and sialic acid, enhanced migration of neutrophils and HLA-B 51. Neuro-Behçet's syndrome was strongly suspected with laboratory data but the clinical course was atypical. His clinical signs were markedly improved after administration of prednisolone. The present case suggests that neuro-Behçet's syndrome with only a part of major symptoms could be diagnosed as viral encephalitis and acyclovir may be effective for the treatment of neuro-Behçet's syndrome.

Topics: Acyclovir; Adult; Diagnosis, Differential; Electroencephalography; Humans; Male; Meningitis; Meningitis, Aseptic; Recurrence; Status Epilepticus; Stomatitis, Aphthous

Four patients with typical manifestations of herpes simplex encephalitis were treated with Aciclovir. Infection with herpes simplex virus was confirmed in three of the four cases. Complete cure was achieved in each of the patients despite severe initial disease patterns. In view of these results in the treatment of a disease that had so far been partly lethal or produced severely defective states, the specific use of Aciclovir is emphasised.

Topics: Acyclovir; Adult; Cell Transformation, Viral; Cerebrospinal Fluid; Electroencephalography; Encephalitis; Epilepsy, Tonic-Clonic; Female; Herpes Simplex; Humans; Male; Middle Aged; Status Epilepticus