Encéphalite herpétique

[Simon Charbonneau]

Je ne trouve que quelques articles vraiment “pile” sur le sujet, et c’est effectivement un peu daté (années 1990), incluant les deux ci-dessous. C’est p-e un cas de livre…

 

http://jnnp.bmj.com/content/57/11/1334.full.pdf

 

&

 

Neuropsychiatry Neuropsychol Behav Neurol. 1997 Jul;10(3):180-9.

The long-term neuropsychological outcome of herpes simplex encephalitis in a series of unselected survivors.

Utley TF1, Ogden JA, Gibb A, McGrath N, Anderson NE.

Author information

Abstract

This study sought to produce a cognitive profile of herpes simplex encephalitis (HSE) survivors from a large group of definitively diagnosed, acyclovir-treated participants. Results from 22 adults who underwent a battery of neuropsychological tests indicated anterograde memory dysfunction to be the most severe and common deficit (although the variation was great), with less severe and less frequent impairments in the areas of retrograde memory, executive functions, and language functioning. Overall, neuropsychological outcome was unimpaired in six participants, mildly impaired in thirteen, moderately impaired in one, severely impaired in two. Older participants and those with a lower level of consciousness before the start of treatment produced poorer scores on certain aspects of cognitive outcome (p < 0.05). A significantly better cognitive outcome was found in participants for whom there was a short delay (fewer than 5 days) between symptom onset and acyclovir treatment compared with those participants for whom there was a longer delay. The two children in the study had disparate results on most tests, the exception being those assessing memory functioning on which both children had scores at population norms. On a naming task designed to explore category-specific knowledge deficits, the adults as a group made more errors on pictures of living things than nonliving things (matched pair-wise for word frequency and visual familiarity), although this difference disappeared on a smaller subset of pictures also matched for visual complexity.

[Simon Charbonneau]

Sinon il a Medscape: http://emedicine.medscape.com/article/1165183-overview#a6

 

PROGNOSIS

 

Untreated HSE is progressive and often fatal in 7-14 days. A landmark study by Whitley et al in 1977 revealed a 70% mortality in untreated patients and severe neurologic deficits in most of the survivors.^[24]

Mortality in patients treated with acyclovir was 19% in the trials that established its superiority to vidarabine. Subsequent trials reported lower mortalities (6-11%), perhaps because they included patients who were diagnosed by polymerase chain reaction (PCR) rather than brain biopsy and who thus may have been identified earlier with milder disease.^{[1, 3]}

The mortality of neonatal HSE is substantial, even with treatment; 6% in patients with isolated HSE and 31% in those with disseminated infection.

Sequelae among survivors are significant and depend on the patient’s age and neurologic status at the time of diagnosis. Patients who are comatose at diagnosis have a poor prognosis regardless of their age. In noncomatose patients, the prognosis is age related, with better outcomes occurring in patients younger than 30 years.

Significant morbidity exists among those treated. Neurologic outcomes in survivors treated with acyclovir are as follows:

• No deficits or mild deficits – 38%
• Moderate deficits – 9%
• Severe deficits – 53%

Anterograde memory often is impaired even with successful treatment of HSE. Retrograde memory, executive function, and language ability also may be impaired. A study by Utley et al showed that patients who had a shorter delay (< 5 d) between presentation and treatment had better cognitive outcomes.^[25]

Elbers and colleagues followed properly treated children for 12 years after the HSE. They found seizures in 44% of the children and developmental delay in 25% of the children. They concluded that HSE continues to be associated with poor long-term neurologic outcomes despite appropriate therapy.^[26]

Shelley and colleagues reported a case of intracerebral hematoma occurring in a patient successfully treated with a full course of acyclovir after apparent eradication of the virus. The hematoma occurred in the region of the encephalitis.^[27]

Marschitz and colleagues reported a case of chorea after HSE.^[28]

Relapses after HSE have been reported to occur in 5-26% of patients, with most relapses occurring within the first 3 months after completion of treatment. Relapses are more frequent in children than adults. It is unclear whether such relapses represent recurrence of viral infection or an immune-mediated inflammatory process. Some of the relapses reported in earlier studies may have been due to inadequate duration of treatment rather than true recurrences of HSE.

A long-term follow-up study of patients with HSE suggested that the pathogenic mechanisms present during relapses differ from those present during the initial infection.^[29] Serial measurements of inflammatory markers as well as HSV viral load in the CSF of relapsing patients demonstrated increased inflammatory markers without detectable HSV during relapses. These findings suggest that immune-mediated events, rather than direct viral-mediated neuronal toxicity, may predominate in relapses.

[Vincent Moreau]

J’ai déjà vu un patient qui avait survécu à une encéphalite herpétique. Il était resté avec des séquelles assez sévères. Il n’y a effectivement pas beaucoup de littérature sur le sujet. Pour un point du vue plus personnel, tu peux jeter un coup d’oeil au livre In the shadow of memory par Floyd Skloot. C’est un écrivain et poète américain qui décrit son expérience avec les séquelles de cette encéphalite (avec l’aide de sa conjointe pour que le tout soit cohérent) et qui a eu comme neuropsychologue nulle autre que Muriel Lezak. C’est très intéressant pour avoir un aperçu de comment se déroule l’adaptation à un trouble neurologique du point de vue du patient.

[Valérie Drolet]

Merci les gars!!

Julie Brosseau

Membre

14 janvier 2016 à 12 h 49 min

J’avais eu une patiente en stage avec une encéphalite herpétique. Elle conservait des séquelles sur le plan des fonctions exécutives. Elle ne pouvait plus travailler (technicienne si ma mémoire est bonne), mais elle se débroullait quand même bien au quotidien. Elle venait à ses rendez-vous en voiture. Je l’avais évaluée 2 fois et il n’y avait eu aucune amélioration entre les 2 évaluations. 

[Julie Brosseau]

J’avais eu une patiente en stage avec une encéphalite herpétique. Elle conservait des séquelles sur le plan des fonctions exécutives. Elle ne pouvait plus travailler (technicienne si ma mémoire est bonne), mais elle se débroullait quand même bien au quotidien. Elle venait à ses rendez-vous en voiture. Je l’avais évaluée 2 fois et il n’y avait eu aucune amélioration entre les 2 évaluations.