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IP Indian Journal of Neurosciences


Long term cognitive outcome in herpes simplex encephalitis


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Author Details: Firosh Khan, Fazal Ghafoor, Abdulkhader Shehna

Volume : 4

Issue : 1

Online ISSN : 2581-916X

Print ISSN : 2581-8236

Article First Page : 6

Article End Page : 14


Abstract

Aims: Herpes Simplex Encephalitis (HSE) is a leading cause of acquired cognitive disability. We aimed to describe cognitive sequelae of HSE in relation to clinical variables during hospitalization.
Methods: Consecutive cases of encephalitis with a discharge diagnosis of HSE from January 2010 to December2016 were reviewed to collect the clinical details. Glasgow-Outcome-Score (GOS), Barthel-Index (BI), Seizure-Score (Engel-Score, ES) at the time of discharge, first follow-up and final follow-up were noted. A detailed neuropsychological evaluation was done at last follow-up in survivors and these scores were compared to clinical variables during hospitalization. c2 test, Fisher’s exact test and ANOVA were used for analysis.
Results: There were 30 patients (11males) at a median age of 31.5years. Cerebro-spinal-fluid was abnormal in 82.8%, electroencephalogram in 96.7% and Magnetic Resonance Imaging (MRI) in 80% patients. All were treated with acyclovir and 80% had intensive-care-unit stay. Mortality was 26.7% and it correlated with glasgow coma score <8, status epilepticus and Periodic Lateralized Epileptiform Discharges (PLEDs) in electroencephalogram. At the first follow-up of 8.4±5.2 weeks and final follow-up of 36.6±26.5 months, survivors had a good functional recovery with GOS4-5 and BI90-100. At final follow-up, median ES was one. ES was not correlated with seizures, status-epilepticus, electroencephalogram or MRI features. At final follow-up, 5/18(27.8%) had significant neuropsychological verified cognitive abnormalities and those with longest follow-up had least abnormalities. Neuropsychological profile didn’t correlate with any clinical variables other than the association of poor attention score and orbito-frontal signal changes in MRI.
Conclusions: Acyclovir treated HSE has a mortality of 26.7%, but survivors have good functional/seizure outcome. Significant cognitive problems occur in a third, but not related to any clinical variables.


Keywords: Encephalitis, Herpes, Outcome, Cognitive outcome, Neuropsychology.

Doi :-https://doi.org/10.18231/.2018.0003