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An overview of Herpes Simplex Encephalitis

H, I'm professor Tom Solomon. I'm
professor of neurology at the University of Liverpool and the Walton neurocenter
in Liverpool and I'm president of the Encephalitis Society.
Encephalitis is inflammation and swelling of the brain and it's quite
often caused by a virus and the most common viral cause of encephalitis
around the world – the most common sporadic cause is herpes simplex virus. Herpes simplex virus is a very common
virus.

About 70% of people have been infected by it and in most people it
just lives in a nerve at the back of the nose and then occasionally comes down
and causes cold sores and people are familiar with that but in an unfortunate
small number of people instead of coming down and causing a cold sore around the
mouth the virus goes the other way up into the brain and causes, if you like, a
cold sore on the brain and that's what inflammation and swelling in the brain
is.

That's what herpes encephalitis is. When patients are first ill with herpes
encephalitis, they may just have a flu-like illness it may be a fever,
headaches, they may be achy. It may seem like any other flu and patients may want
to take to their bed but they clue that this is something more serious than that
is that patients may become confused or muddled or they may even behave
strangely. Now sometimes this means that patients are thought to have psychiatric
illness and enter the psychiatric services. But that confusion and strange
behavior often then progresses so that they actually become drowsy, they may
have convulsions. Children especially are more likely to have convulsions and they
may slip into coma, and all these things together make it quite clear that this
is a patient who has a serious brain problem a brain infection and needs to
get medical attention as soon as possible. The way we diagnose any form of
encephalitis is usually with a lumbar puncture and brain scan. The lumbar
puncture is when we pop a needle in between the bones of the vertebra to get
some of the spinal fluid, cerebrospinal fluid.

This is the fluid that washes the
brain and in that fluid we can tell if there's inflammation, if there are
inflammatory cells there that shouldn't be there, and then ultimately we can do
tests for the actual cause of that inflammation such as a PCR test a
polymerase chain reaction test for herpes simplex virus, then we usually
also do a brain scan and this is another way of seeing if there is
inflammation and swelling in the brain.

We treat Herpes Simplex Virus Encepalitis with an anti-virus drug called acyclovir and we've been using
this for about 30 or 40 years, and what we've shown over the last few years in
our research in conjunction with the Encephalitis Society is that patients were
often being treated late with this drug because doctors and nurses were failing
to recognize the disease. But over the last ten years or so we've improved that
and now patients get on treatment much quicker and they have better outcomes.
But still, even when patients do get this aciclovir treatment quickly, still the
outcomes are sometimes not as good as we'd like them to be and one of the big
questions which we are answering at the moment with a big research study across
the UK is whether giving the anti-inflammatory drug dexamethasone
will actually improve the outcome even further
by reducing the brain swelling Some patients with herpes simplex virus
encephalitis do very well.

They get on the treatment very quickly and the
treatment seems to stop the swelling and stop the virus replicating and they
might feel very unwell for a few days, typically they're treated for two to
three weeks with drugs, but eventually they get back home, get back to work if
they're working, get back to a normal life. But sadly that's not the case for
all patients and many patients are left particularly with memory problems –
short-term memory problems because that's the part of the brain that's
affected by Herpes Encephalitis, and then sadly some patients do die of this
condition although thankfully with the research that we've been doing at the
University of Liverpool and through the Encephalitis Society and with the help
of many others over the last 10 to 15 years those numbers have dropped.

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