PAPER

Evaluation of combination therapy using aciclovir and corticosteroid in adult patients with herpes simplex virus encephalitis

S Kamei¹, T Sekizawa², H Shiota¹, T Mizutani¹, Y Itoyama³, T Takasu¹, T Morishima⁴ and K Hirayanagi⁵

¹ Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
² Department of Health Science, Yamagata Prefectural University of Health Science,Yamagata-shi, Japan
³ Department of Neurology, Tohoku University School of Medicine, Seiryo-cho, Aoba-ku, Sendai-shi, Japan
⁴ Department of Health Science, Nagoya University School of Medicine, Higashi-ku, Nagoya-shi, Japan
⁵ Department of Hygiene and Public Health, Nihon University of Physical Education, Tokyo, Japan

Correspondence to:
Correspondence to:
Dr S Kamei
Division of Neurology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan; skamei{at}med.nihon-u.ac.jp

Objective: Herpes simplex virus encephalitis (HSVE) is associated with significant morbidity and mortality, even with appropriate antiviral therapy. In the present investigation, the first to assess efficacy of corticosteroid treatment with aciclovir therapy in HSVE, multiple logistic regression analysis was performed of predictors of outcome in adult patients with HSVE.

Methods: A non-randomised retrospective study of 45 patients with HSVE treated with aciclovir was conducted. The patients were divided into poor and good groups based on outcome at three months after completion of aciclovir treatment. The variables evaluated were: clinical variables (sex, age, days after onset at initiation of aciclovir, Glasgow Coma Scale (GCS) at initiation of aciclovir, initial and maximum values for the cell numbers and protein concentration in the cerebrospinal fluid, and corticosteroid administration); neuroradiological variables (detection of lesions by initial cranial computed tomography and by initial magnetic resonance imaging); and one neurophysiological variable (detection of periodic lateralised epileptiform discharges on the initial electroencephalogram). Single variable logistic regression analysis was performed followed by multiple logistic regression analysis. The best set of predictors for the outcome of HSVE was estimated by stepwise logistic regression analysis.

Results: A poor outcome was evident with older age, lower GCS score at initiation of aciclovir, and no administration of corticosteroid. Patient age, GCS at initiation of aciclovir, and corticosteroid administration were found to be significant independent predictors of outcome on multiple logistic regression analysis, and these three variables also formed the best set of predictors (R² = 0.594, p<0.0001).

Conclusion: Combination therapy using both aciclovir and corticosteroid represents one of the predictors of outcome in HSVE.

Abbreviations: CT, computed tomography; GCS, Glasgow Coma Scale; HSVE, herpes simplex virus encephalitis; MRI, magnetic resonance imaging

Keywords: outcome; corticosteroid; predictor; herpes simplex virus encephalitis; multiple logistic regression analysis

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