Prognostic Value of Initial Standard EEG and MRI in Patients with Herpes Simplex Encephalitis
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Background and Purpose Herpes simplex encephalitis (HSE) is the most common type of sporadic encephalitis worldwide, and it remains fatal even when optimal antiviral therapy is applied. Tere is only a weak consensus on the clinical outcomes and prognostic factors in patients with HSE. Tis study examined whether the radiological and electrophysiological fndings have a prognostic value in patients with HSE. Methods We retrospectively analyzed patients who were diagnosed with HSE by applying the polymerase chain reaction to cerebrospinal fuid and who received intravenous acyclovir at our hospital from 2000 to 2014. We evaluated the clinical outcomes at 6 months afer onset and their correlations with initial and clinical findings, including the volume of lesions on MRI, the severity of EEG fndings, and the presence of epileptic seizures at the initial presentation. Results Twenty-nine patients were enrolled (18 men and 11 women). Univariate analysis revealed that the presence of severe EEG abnormality and epileptic seizures at the initial presentation were signifcant correlated with a poor clinical outcome at 6 months (p=0.005 and p=0.009, respectively). In multivariate analysis, the presence of severe EEG abnormality was the only independent predictor of a poor outcome at 6 months (p=0.006). Conclusions In cases of HSE, the initial EEG severity and seizure presentation may be useful predictive factors for the outcome at 6 months afer acyclovir treatment.
Abstract
Background and Purpose Herpes simplex encephalitis (HSE) is the most common type of sporadic encephalitis worldwide, and it remains fatal even when optimal antiviral therapy is applied. Tere is only a weak consensus on the clinical outcomes and prognostic factors in patients with HSE. Tis study examined whether the radiological and electrophysiological fndings have a prognostic value in patients with HSE. Methods We retrospectively analyzed patients who were diagnosed with HSE by applying the polymerase chain reaction to cerebrospinal fuid and who received intravenous acyclovir at our hospital from 2000 to 2014. We evaluated the clinical outcomes at 6 months afer onset and their correlations with initial and clinical findings, including the volume of lesions on MRI, the severity of EEG fndings, and the presence of epileptic seizures at the initial presentation. Results Twenty-nine patients were enrolled (18 men and 11 women). Univariate analysis revealed that the presence of severe EEG abnormality and epileptic seizures at the initial presentation were signifcant correlated with a poor clinical outcome at 6 months (p=0.005 and p=0.009, respectively). In multivariate analysis, the presence of severe EEG abnormality was the only independent predictor of a poor outcome at 6 months (p=0.006). Conclusions In cases of HSE, the initial EEG severity and seizure presentation may be useful predictive factors for the outcome at 6 months afer acyclovir treatment.
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