Neuropediatrics 2012; 43 - PS16_04
DOI: 10.1055/s-0032-1307122

Pediatric herpes simplex virus encephalitis: a critical multicentric analysis

L Schleede 1, K Weigt-Usinger 2, M Smitka 3, S Stephan 4, S Baumgartner 5, T Opladen 6, O Kaiser 7, T Lücke 2, K Rostásy 5, A van Baalen 8, G Jorch 4, U Schara 7, H Skopnik 9, M Häusler 1
  • 1Kinder- und Jugendmedizin, UK/RWTH Aachen, Aachen, Germany
  • 2Neuropädiatrie, Univ. Kinderklinik Bochum, Bochum, Germany
  • 3Univ. Kinderklinik. Uniklinik Carl Gustav Carus, Dresden, Germany
  • 4Pädiatrie, Otto von Guericke Universität Magdeburg, Magdeburg, Germany
  • 5Pediatric Neurology, Medical University Innsbruck, Innsbruck, Austria
  • 6Zentr. für Kinder- und Jugendmedizin, Uniklinik Heidelberg, Heidelberg, Germany
  • 7Neuropädiatrie, Uniklinik Essen, Essen, Germany
  • 8Neuropädiatrie, Uniklinik Kiel, Kiel, Germany
  • 9Kinderklinik, Klinikum Worms, Worms, Germany

Aims: The prognosis of paediatric herpes simplex virus encephalitis (HSVE) remains unsatisfying despite effective treatment options. Consequently, new approaches are necessary to improve outcome.

Methods: Combined retro- and prospective study on 22 patients from 9 hospitals (16 boys and 6 girls; age: 10 months to 16 years).

Results: First clinical symptoms found prior to admission were fever (59%), headaches (41%) and seizures (18%). In patients with seizures as first symptom (n=4) the median time until diagnosis was 1.5 days (range: 1 to 2 days) compared to 6 days in the remaining patients (n=18; range: 2 to 19 days). Patients with seizures as initial symptom were diagnosed earlier (p<0.01 Wilcoxon rank sum test), had no recurrences (0/4 versus 5/18), were discharged earlier (median 17 versus 23 days), only one showed mild residua. In further 6 patients seizures occurring later in the disease course also led to admission. Compared to patients without seizures, these children were not diagnosed faster or discharged earlier. 7 of the 18 Patients without seizures as first symptom showed fever combined with impaired vigilance at admission. Here, the diagnosis was established after a mean of 2 days (0–6 days) after admission.

5 patients experienced relapses between 7 to 37 days after diagnose, developing impaired vigilance (60%), hemiparesis (40%), movement disorder (40%) and psychiatric symptoms (40%). A reappearance of HSV-DNA in CSF was not found in any of the 3 patients studied. All 5 relapses were further treated with acyclovir, 4 also with steroids, resulting in considerable improvement in 3 patients. All 5 were discharged with residua.

Conclusion: Early diagnosis and therapy improves prognosis of HSVE as seen from seizure patients, but initial symptoms are often nonspecific. Although fever combined with impaired vigilance is not unusual in children, HSVE should be considered in all these patients. About 1/4 of HSVE patients experience relapses of assumed post-infectious etiology (PCR negative) which may lead to additional treatment options (steroids + acyclovir).

Herpes simplex virus encephalitis - symptoms - recurrences - aciclovir - steroids