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Treatment will depend on the type of encephalitis that has been diagnosed.  Some treatments may start before a definite diagnosis has been made.  These may include anti-convulsant medication for seizures and sedatives for agitation.

 

An antiviral drug, acyclovir, is given as soon as encephalitis is considered to be a possible diagnosis.  Acyclovir is a very specific antiviral drug against the herpes simplex virus (HSE).  HSE is responsible for about a third of cases of Infectious Encephalitis and treatment with acyclovir reduces the severity of the illness significantly.   Although not everyone who has a diagnosis of encephalitis will have herpes simplex encephalitis, acyclovir should still be given.  This is because there are few side effects to the drug and if the treatment is delayed, people who are ill with herpes simplex encephalitis may have a poorer outcome.  There is no specific antiviral treatment, at present, for most other viruses infecting the brain.

 

Antibiotics may also be given initially. This is because, without test results, it may be difficult to tell the difference between encephalitis and meningitis caused by bacteria.

 

Depending on the diagnostic tests, any suspicion of bacterial or fungal causes of infection may require a broader spectrum of antibiotics or antifungal agents.

 

Steroids may be given.  Steroids lessen the activity of the immune system.  Although the immune system is the body’s defence against infection, it can be overactive in encephalitis.  It can result in an excess of fluid entering the brain causing the brain to swell, this in turn increases the pressure within the skull.

Steroids are also used to treat autoimmune types of encephalitis.  A less active immune system will produce less of the antibodies that are causing the illness.  Some people may require additional immune therapy with IVIG (Intravenous immunoglobulin) or plasma exchange.

 

Other treatments for encephalitis are what doctors call ‘supportive’ treatments to help the body rest, reserving energy to fight the illness.  They include intravenous fluids, medicines to control any seizures and medicines to help with high fever, pain or agitation.

 

If the person is critically ill, or has excessive brain swelling or has constant seizures then a life support machine may be used.  This machine takes over vital functioning allowing the brain and body to rest and recover.

This information is taken from the Book “Understanding Encephalitis” by Elaine Dowell.  The book is available from Amazon Understanding Encephalitis.

 

ARTICLES AND RESEARCH PAPERS

Consensus guidelines for the investigation and management of encephalitis in adults and children in Australia and New Zealand Abstract- Encephalitis is a complex neurological syndrome caused by inflammation of the brain parenchyma. The management of encephalitis is challenging because: the differential diagnosis of encephalopathy is broad; there is often rapid disease progression; it often requires intensive supportive management; and there are many aetiologic agents for which there is no definitive treatment. Patients with possible meningoencephalitis are often encountered in the emergency care environment where clinicians must consider differential diagnoses, perform appropriate investigations and initiate empiric antimicrobials. For patients who require admission to hospital and in whom encephalitis is likely, a staged approach to investigation and management is preferred with the potential involvement of multiple medical specialties. Key considerations in the investigation and management of patients with encephalitis addressed in this guideline include: Which first-line investigations should be performed?; Which aetiologies should be considered possible based on clinical features, risk factors and radiological features?; What tests should be arranged in order to diagnose the common causes of encephalitis?; When to consider empiric antimicrobials and immune modulatory therapies?; and What is the role of brain biopsy?  http://www.ncbi.nlm.nih.gov/pubmed/25955462

The development of an intervention to promote adherence to national guidelines for suspected viral encephalitis.  BACKGROUND: Central nervous system infections can have devastating clinical outcomes if not diagnosed and treated promptly. There is a documented gap between recommended and actual practice and a limited understanding of its causes. We identified and explored the reasons for this gap, focusing on points in the patient pathway most amenable to change and the development of a tailored intervention strategy to improve diagnosis and treatment.  The development of an intervention to promote adherence to national guidelines for suspected viral encephalitis