[Trends in the management of herpes simplex encephalitis]

Recent aspects of the diagnostic and therapeutic management of herpes simplex virus encephalitis (HSVE) are reviewed based on a clinical analysis of our adult patients. Detection of the HSV genome sequence in the cerebrospinal fluid (CSF) by the polymerase chain reaction (PCR) has been established as a gold standard diagnostic method at the acute stage of HSVE. However, several problems for the PCR in HSVE remain, as follows: the discrepancy in results based on differences of minimum detection sensitivities between the single PCR and nested PCR, and clinical pseudo-negative results which depend on the day of CSF sample collection after onset. Antiviral therapy is highly effective in reducing the mortality rate. However, only less than one-half of HSVE patients are able to return to normal. This finding indicates a need to develop a further improved therapeutic regimen. We recently reported an assessment of the efficacy of corticosteroid with aciclovir therapy for outcome in HSVE using multiple logistic regression analysis. A poor outcome was evident with older age, lower Glasgow Coma Scale scores at initiation of aciclovir, and no administration of corticosteroid. Combination therapy employing both aciclovir and corticosteroid is thus suggested to be useful for achieving a better outcome.