What is the role of steroids in the treatment of herpes simplex encephalitis (HSE)?

Updated: Jul 17, 2018
  • Author: Wayne E Anderson, DO, FAHS, FAAN; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

The role of steroids in the treatment of HSE remains uncertain. To the extent that cellular damage in HSE is the result of immune-mediated inflammatory processes triggered by the viral infection, the anti-inflammatory effects of steroids may be beneficial. However, there is also concern that steroids might suppress immune responses of the host that are necessary to limit viral replication.

Animal studies have demonstrated a beneficial effect of steroids on outcome, without evidence of increased viral replication or dissemination. [46, 47] Steroids have been used to reduce cerebral edema in patients with severe HSE.

One nonrandomized, retrospective human study compared the outcomes of patients with HSE who received steroids in addition to acyclovir with the outcomes of those who received acyclovir alone. [48] The steroid group had improved outcomes at 3 months. Although these results suggest a possible role for steroids in HSE, definitive recommendations must await the results of larger prospective studies.

The German trial of Acyclovir and Corticosteroids in Herpes-simplex-virus-Encephalitis (GACHE), a multicenter, randomized, placebo-controlled trial, is currently enrolling patients with HSE in a study designed to assess the outcomes of treatment with acyclovir against the outcomes of treatment with acyclovir plus dexamethasone. [49]


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