Steroid Use In The Treatment Of Children With Herpes Simplex Virus Encephalitis

Objective:The role of steroids in the treatment of herpes simplex virus encephalitis(HSVE) in children is controversial. This study evaluates if steroids are uesful in the treatmen of children with HSVE.Methods:15 children aged from 5 months to 11 years old(12 females, 3 males) with HSVE received glucocorticoid treatment. All children were admitted within 5 days of symptoms onset. The most common presenting complaints were fever(14 cases) and seizures(14cases), of which generalized tonic seizures were seen in five cases, unilateral limb tonic seizures in four cases, and drooling or mouth twitching in five cases. Other symptoms including altered level of consciousness(seven cases) and vomiting(six cases). Three cases presented with abnormalities in muscle strength and tone, one case had a history of varicella, and one case had perioral herpes. All of the patients were diagnosed with clinical symptoms and intrathecal HSV-specific antibodies. In addition to the antiviral therapies, intravenous methylprednisolone(1-2 mg/kg/d) was given in nine cases,intravenous dexamethasone(0.3-0.5 mg/kg/d) was given in three cases, and intravenous methylprednisolone(20 mg/kg/d) was given in three cases. In each case, the dose of intravenous methylprednisolone was reduced every 2-3 days, switched to oral prednisone,and tapered to zero within a week.Result:The average length of stay was 30.8±14.664 days. Patient’s temperatures normalised within 3-5 days after steroid use. Repeating MRI brain scans showed interval improvement of intracranial lesions 10-15 days after the initial scans in 9 cases. The lesions were most commonly located in the frontal lobe, followed by the parietal lobes,temporal lobes or the thalamus. Among the 15 children, encephalomalacia was seen in three cases. All patients were followed up for more than six months. Four cases(26.66%)recovered completely without any neurological deficits, while 11 children(73.33%) had different degrees of CNS sequelae: 10 children(66.66%) had motor deficits, 10 children(66.66%) developed epilepsy, and six(40.00%) of which were intellectual impairment.Compared to the mortality rate of 15-20% from HSVE reported in the literature, no deaths were observed in this study. All patients didn’t show secondary infections and disease relapse during hospitalization period.Conclusion:HSVE in children is a serious intracranial infectious disease, with poor prognosis for most patients. Our data shows that use of glucocorticoid did not result in disease relapse and there were no apparent complications due to steroid treatment. Multicentre data with a larger sample size and prospective studies are needed to better elucidate the benefit of glucocorticoid administration in this patient population.