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J Neurol Neurosurg Psychiatry 2005;76:1544-1549 doi:10.1136/jnnp.2004.049676
  • Paper

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

  1. S Kamei1,
  2. T Sekizawa2,
  3. H Shiota1,
  4. T Mizutani1,
  5. Y Itoyama3,
  6. T Takasu1,
  7. T Morishima4,
  8. K Hirayanagi5
  1. 1Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
  2. 2Department of Health Science, Yamagata Prefectural University of Health Science,Yamagata-shi, Japan
  3. 3Department of Neurology, Tohoku University School of Medicine, Seiryo-cho, Aoba-ku, Sendai-shi, Japan
  4. 4Department of Health Science, Nagoya University School of Medicine, Higashi-ku, Nagoya-shi, Japan
  5. 5Department of Hygiene and Public Health, Nihon University of Physical Education, Tokyo, Japan
  1. 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; skameimed.nihon-u.ac.jp
  • Received 14 July 2004
  • Accepted 7 May 2005
  • Revised 30 April 2005

Abstract

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.

Footnotes

  • This study was supported by a grant from the Ministry of Education, Culture, Sports, Science, and Technology for the promotion of the industry–university collaboration at Nihon University, Japan, and a grant for scientific research from the Alumni Association of Nihon University School of Medicine.

  • Competing interests: none declared

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