Herpes Simplex Encephalitis Treated With Vidarabine (Adenine Arabinoside)

Taber, Larry H.; Greenberg, Stephen B.; Perez, Francisco I.; Couch, Robert B.

doi:10.1001/archneur.1977.00500220042006

Cited by 24 publications

(6 citation statements)

References 9 publications

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“…)ine has been shown to be an effective Weight loss was significant at daily doses of 200 gainst HSV encephalitis in hamsters (17), mg/kg for 4 days. The latter dose also effects a 18,19), and humans (2,20,21). A pilot moderate reduction in number of Jerne hemoy Ch'ien et al (2) In vitro antiviral activity of ACV was not determined.…”

Section: Tionmentioning

confidence: 99%

Therapy of Experimental Herpes Simplex Encephalitis with Aciclovir in Mice

Park

Pavan-Langston

McLean

et al. 1979

Antimicrob Agents Chemother

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This report is concerned with the capacities of aciclovir to protect mice challenged intracerebrally with multiple lethal doses of type 1 herpes simplex virus and to control multiplication of this virus in the brain. With treatment initiated 12 h after inoculation and continued for 4 consecutive days, aciclovir administered subcutaneously in daily doses ranging from 40 to 100 mg/kg led to 21-day survival rates of from 33 to 73% and reduced virus titers by 1 to 1,h x 4 logs on postchallenge day 8. The therapeutic accomplishments of the 100-mg/kg doses of aciclovir were comparable to those of 1,000-mg/kg doses of vidarabine (9-,B-Darabinofuranosyladenine); however, as measured by impact on body weight, aciclovir was better tolerated than vidarabine at these similarly effective doses.Aciclovir [ACV; 9-(2-hydroxyethoxymethyl)-guanine, or acycloguanosine] has been introduced recently as a potent and selective antiviral agent against herpes simplex virus type 1 (HSV-1) and 7,9,13,16). In vitro this compound also inhibits the multiplication ofvaricella zoster virus, cytomegalovirus, and B virus but has no effect on vaccinia virus, adenovirus type 5, and a range of ribonucleic acid viruses (16). ACV penetrates infected cells to a greater degree than uninfected cells (6). Once introduced into cells, it is converted to a monophosphate form by an HSV-specific thymidine kinase and eventually to a triphosphate form. ACV triphosphate then acts by inhibition of viral DNA polymerase. An additional selective advantage is that ACV triphosphate has a 30-foldgreater affinity for viral deoxyribonucleic acid polymerase than for cellular deoxyribonucleic acid polymerase in vitro (6,7). In the present study we evaluated the therapeutic efficacy of ACV for the herpes encephalitis by observing the capacities of ACV to protect mice inoculated intracerebrally with HSV-1 and to control the multiplication of this virus in the brain. More Forty-five mice inoculated with saline were divided into three equal subgroups which were treated as follows: (i) phosphate-buffered saline, 0.2 ml/day; (ii) ACV, 100 mg/kg per day; or (iii) ara-A, 1,000 mg/kg per day. Treatments were initiated 12 h after the inoculation of HSV-1 or saline and consisted of subcutaneous injections of two divided doses per day for 4 days. The mice were weighed on days 0, 2, 4, 8, 10, 14, and 16 after the inoculation to monitor weight change. The

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Section: Tionmentioning

confidence: 99%

Therapy of Experimental Herpes Simplex Encephalitis with Aciclovir in Mice

Park

Pavan-Langston

McLean

et al. 1979

Antimicrob Agents Chemother

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“…Decompressive craniectomy with or without concurrent temporal lobectomy was frequently reported in HSVE cases (72% [46/64]) in the setting of clinical deterioration and radiological evidence of elevated ICP. 8,16-19,21,22,24,25,28,30,33,38,40-43,46-54,56-59,61,62,64-67 However, temporal or frontal lobectomy without craniectomy was also sometimes reported (28% [18/64]) for surgical decompression in HSVE cases. 20,23,24,26,27,29,32-36,39,44,48,53,63 Although elevated ICP in HSVE often results from diffuse cerebral edema, numerous patients (19% [12/64]) developed frank hemorrhage that required surgical evacuation because of significant mass effect and neurological deterioration.…”

Section: Resultsmentioning

confidence: 99%

“…20,23,24,26,27,29,[32][33][34][35][36]39,44,48,53,63 Although elevated ICP in HSVE often results from diffuse cerebral edema, numerous patients (19% [12/64]) developed frank hemorrhage that required surgical evacuation because of significant mass effect and neurological deterioration. 30,33,[35][36][37]42,45,48,49,56,59,66 Craniotomy with or without concurrent decompressive surgery also provided tissue for confirmation of the HSV diagnosis in 27 primarily older cases in this review, 8,[16][17][18][19][20][21][22][23][24]26,27,29,33,42,44,53,56,63,66 although tiss...…”

Section: Literature Reviewmentioning

confidence: 99%

“…However, in-hospital mortality (20% [12/61]) and moderate to severe long-term functional disability (23% [14/61]) were also prevalent. [17][18][19][20][22][23][24][25][26][45][46][47]49,51,56,62,[64][65][66] Seizures associated with HSVE were present in a sizable proportion (50% [30/60]) of cases before surgical intervention (Table ). The majority of patients (66% [20/30]) had isolated seizures, which ultimately did not recur in several patients after either temporal lobectomy alone 27 or lobectomy with concurrent decompressive craniectomy.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Decompressive craniectomy with or without concurrent temporal lobectomy was frequently reported in HSVE cases (72% [46/64]) in the setting of clinical deterioration and radiological evidence of elevated ICP. 8,[16][17][18][19]21,22,24,25,28,30,33,38,[40][41][42][43][46][47][48][49][50][51][52][53][54][56][57][58][59]61,62,[64][65][66][67] However, temporal or frontal lobectomy without craniectomy was also sometimes reported (28% [18/64]) for surgical decompression in HSVE cases. 20,23,24,26,27,29,[32][33][34][35][36]…”

Section: Literature Reviewmentioning

confidence: 99%

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Surgical Management in Herpes Simplex Encephalitis: Illustrative Case Report and Systematic Review of the Literature

et al. 2023

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BACKGROUND: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.OBJECTIVE: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.METHODS: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.RESULTS: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.CONCLUSION: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.

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