Encephalitis and Meningitis Health Article

Treatment

Treatment for meningitis depends on the cause and on the symptoms. Antiviral medications may be used if a virus is involved. Antibiotics are prescribed for bacterial infections. If the causative organism is unknown, antibiotic regimes can be based on the child's age. In infants

aged 30 days or younger, ampicillin is usually prescribed along with an aminoglycoside or a cephalosporin (cefotaxime) medication. In children aged 30–60 days, ampicillin and a cephalosporin (ceftriaxone or cefotaxime) can also be used. However, since S. pneumoniae occasionally occurs in this age range, vancomycin should be part of treatment instead of ampicillin. In older children, cephalosporin or ampicillin plus chloramphenicol can be used. Often, rifampicin is given (in meningococcal bacterial meningitis cases) as a preventative measure to roommates, close family members, or others who may have come in contact with an infected person.

In addition, anticonvulsant medications may be used if there are seizures. Corticosteroids may be needed to reduce brain swelling and inflammation. Dexamethasone is usually indicated for children with suspected meningitis who are older than six weeks and is recommended for treatment of infants and children with H. influenzae meningitis. Sedatives may be needed for irritability or restlessness and over-the-counter medications may be used for fever and headache.

Until a bacterial cause of CNS inflammation is excluded, the treatment should include parenteral (given by injection) antibiotics. Treatment with a third-generation cephalosporin antibiotic, such as cefotaxime sodium (Claforan) or ceftriaxone sodium (Rocephin), is usually recommended. Vancomycin (Lyphocin, Vancocin, Vancoled) should be added in geographic areas where strains of S. pneumoniae resistant to penicillin and cephalosporins have been reported.

Encephalitis can be difficult to treat because the viruses that cause the disease generally don't respond to many medications. The exceptions are herpes simplex virus and varicella-zoster virus, which respond to the antiviral drug acyclovir, and is usually administered intravenously in the hospital for at least ten days.

Treatment is available for many symptoms of encephalitis. Patients with headache should rest in a quiet, dark environment and take analgesics. Narcotic therapy may be needed for pain relief; however, medication induced changes in level of consciousness should be avoided. Anticonvulsant medication and anti-inflammatory drugs to reduce swelling and pressure within the skull are usually prescribed. Otherwise, treatment mainly consists of rest and a healthy diet including plenty of liquids.

Recovery and rehabilitation

As opposed to many untreatable neurological conditions, encephalitis and meningitis are diseases that, given the adequate treatment described above, often resolve with complete recovery. It is very important that the disease's cause is promptly identified and treated before any complication is irreversibly established. Physical and speech therapy are often helpful when neurological deficits remain, as are occupational therapists and audiologists.

Clinical trials

The National Institute of Allergy and Infectious Diseases (NIAID) and the National Institute of Neurological Disorders and Stroke (NINDS) support and conduct research on encephalitis and meningitis. Much of this research is aimed at learning more about the cause(s), prevention, and treatment of these disorders. Ongoing clinical trials as of early 2004 include:

• Valacyclovir for long-term therapy of Herpes simplex encephalitis; IVIG—West Nile encephalitis: Safety and Efficacy; Structure of the Herpes Simplex Virus Receptor; sponsored by National Institute of Allergy and Infectious Diseases
• Natural History of West Nile Virus Infection; Omr-IgG-am™ for Treating Patients with or at High Risk for West Nile Virus Disease; sponsored by Warren G. Magnuson Clinical Center
• Intrathecal Gemcitibine to Treat Neoplastic Meningitis; Intrathecal Gemcitabine in Treating Patients with Cancer and Neoplastic Meningitis; sponsored by Baylor College of Medicine

Updated information on clinical trials can be found at the National Institutes of Health clinical trials website at www.clinicaltrials.org.

Prognosis

The prognosis for encephalitis varies. Some cases are mild, short and relatively benign and patients have full recovery. Other cases are severe, and permanent impairment or death is possible. The acute phase of encephalitis may last for one to two weeks, with gradual or sudden resolution of fever and neurological symptoms. Neurological symptoms may require many months before full recovery. Prognosis for people with viral meningitis is usually good.

With early diagnosis and prompt treatment, most patients recover from meningitis. However, in some cases, the disease progresses so rapidly that death occurs during the first 48 hours, despite early treatment. Permanent neurological impairments including memory, speech, vision, hearing, muscle control, and sensation difficulties can occur in people who survive severe cases of meningitis and encephalitis.

The prognosis for appropriately treated meningitis has improved, but there is still a 5% mortality rate and significant morbidity (lasting impairment). The prognosis varies with the age of the person, clinical condition, and infecting organism.