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Choreoathetosis as an initial sign of relapsing of herpes simplex encephalitis
1Department of Pediatrics, Chang Gung Medical College, Taiwan, Republic of China.
Insights
Choreoathetosis, a movement disorder, may signal relapse in children with herpes simplex encephalitis. This symptom indicates a poor prognosis and requires further study into its underlying causes.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neuroscience
Background:
- Herpes simplex encephalitis (HSE) is a severe neurological condition in children.
- Relapse can occur, presenting unique clinical challenges.
- Understanding prognostic indicators is crucial for patient management.
Purpose of the Study:
- To investigate the clinical presentation and prognostic significance of choreoathetosis in pediatric herpes simplex encephalitis.
- To explore the potential link between choreoathetosis and HSE relapse.
- To examine neuroimaging findings in relation to movement disorders.
Main Methods:
- Longitudinal monitoring of twelve children with type 1 herpes simplex encephalitis over seven years.
- Administration of intravenous acyclovir in varying dosages and durations.
- Clinical observation for signs of relapse and movement disorders, including choreoathetosis.
- Computed tomography (CT) scans to assess brain structure.
Main Results:
- Choreoathetosis emerged as an initial sign of relapse in three out of three relapsed patients.
- One non-relapsed patient also developed choreoathetosis during recovery.
- Involuntary movements remitted within 3 months to 2 years in affected patients.
- One patient with choreoathetosis died, and the three survivors experienced severe developmental delays.
- CT scans revealed damage to cerebral mantles, suggesting disrupted neural connections as a source of movement disorders.
Conclusions:
- Choreoathetosis may serve as an early indicator of relapse in pediatric herpes simplex encephalitis.
- The presence of choreoathetosis is associated with a poor prognosis.
- Further research is needed to elucidate the neuropathogenesis of choreoathetosis in HSE.
Abstract:
Twelve children with type 1 herpes simplex encephalitis (3 with relapse, 9 without) have been monitored during the past 7 years. Ten of the children received intravenous infusion of acyclovir (30 mg/kg/day) for 10 days, 1 child who experienced relapse received 15 mg/kg/day, and another relapsed child received no antiviral agents until relapse. Relapse occurred 20-36 days after initial onset. All relapsed patients underwent another 10 days of acyclovir treatment (30 mg/kg/day). Choreoathetosis appeared as the initial sign of relapse followed by rapidly progressive unresponsiveness in all 3 relapsed patients: in 1 nonrelapsed patient choreoathetosis occurred during the recovery period. In these 4 patients involuntary movement was remitted within 3 months to 2 years. One patient with choreoathetosis died of measles pneumonia 4 months after onset of herpes simplex encephalitis and the surviving 3 were severely retarded. Although neuroimaging sparing of basal ganglia does not indicate structural and functional abnormalities, the disturbance of the neural connection among the basal ganglia and the cerebral cortex, which manifested severe damage over frontal, temporal, and parietal mantles on CT, may be the source of movement disorders in these patients. We conclude that choreoathetosis may be the first sign of relapse of herpes simplex encephalitis in children and may be an indicator of poor prognosis. The neuropathogenesis of choreoathetosis requires further investigation.