[Early adenine arabinoside therapy in herpes simplex encephalitis (HSE)]

Five patients with HSE were treated with adenine arabinoside and one additional patient with cytosine arabinoside. The diagnosis of HSE was confirmed in retrospect by the rising CF titers and the Enzyme-Linked Immunosorbent Assay (ELISA) levels in CSF (Table 2). Brain biopsy was not performed. The treatment was started promptly when HSE was strongly suspected by symptoms and signs, EEG, CT and CSF findings before the specific laboratory data were available. The clinical and laboratory data on the 6 patients were shown in Table 1. All the 5 patients of HSE treated with adenine arabinoside survived: 3 returned to normal daily life, including one having no neurological deficits, and the other 2 had mild to moderate memory disturbances. Improvement of CT abnormalities indicated a good prognosis. Age or sex did not have influence on the prognosis. The patient treated with cytosine arabinoside died of complications after being in a state of apallic syndrome for 1 year and 8 months. On the basis of the analysis of our patients, one of the crucial factors in the treatment of HSE seems to be the earliest possible use of adenine arabinoside: in our patients on the 2nd up to 9th day of onset, although there was no correlation between the day the medication was started and the morbidity. The other important factor includes the management of acute stage of HSE: the treatment of cerebral edema and generalized convulsions. The major side effects of adenine arabinoside included diarrhea (one case), elevation of GOT, GPT or LDH (one case) which all improved after the treatment. Adenine arabinoside could be an effective drug for HSE reducing the mortality and morbidity with few side effects.