Encephalitis: Viral - Treatment

Treatment

With the exception of herpes simplex and varicella-zoster encephalitis, the viral forms of encephalitis are not treatable. The primary objective is to diagnose the patient as soon as possible so they receive the right medicines to treat the symptoms. It is very important to lower fever and ease the pressure caused by swelling of the brain.

Patients with very severe encephalitis are at risk for body-wide (systemic) complications including shock, low oxygen, low blood pressure, and low sodium levels. Any potentially life-threatening complication should be addressed immediately with the appropriate treatments.

Treating Probable Causes of Encephalitis

Since it is difficult to determine the cause of encephalitis and rapid treatment is essential, it is common to give the patient medication for the symptoms that respond to therapy without waiting to determine the cause of the illness.

• Some experts advise immediately administering intravenous acyclovir, the standard treatment for herpes simplex encephalitis, to all patients whose symptoms indicate encephalitis.
• Corticosteroids, which reduce inflammation, may also be administered immediately.
• Antibiotics, which attack bacteria but not viruses, are used in case the cause of the symptoms is bacterial meningitis.

Additional Treatments

All encephalitis treatments are aimed at reducing symptoms.

• Seizures may be prevented by using fosphenytoin (Cerebyx).
• Seizures may be treated with intravenous lorazepam (Ativan).
• Sedatives may be prescribed for irritability or restlessness.
• Simple pain relievers may be used for fever and headache.
• In patients who are otherwise stable, the only other treatment measures are to keep the head elevated and monitor the patient's status.

Treatments for Herpes Virus Encephalitis

Intravenous acyclovir is the treatment of choice for encephalitis caused by herpes simplex virus or varicella-zoster virus. Treatment must be initiated within 2 days of symptoms for the best outcome. In nearly all cases, the virus clears within 2 weeks of treatment. If it does not, medications are continued for another 2 weeks. In rare cases, surgical measures may be needed to relieve the buildup of pressure in the brain.

Acyclovir is usually administered in the hospital. However, some patients may be safely treated with intravenous medications at home after the first few days with close monitoring by a health professional.