Encephalitis - Treatment

Treatment of encephalitis includes pathogenetic, etiotropic, symptomatic therapy, as well as restorative measures.

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Pathogenetic treatment of encephalitis

The main directions of pathogenetic therapy are:

• dehydration and control of edema and swelling of the brain (10-20% mannitol solution 1-1.5 g/kg intravenously, furosemide 20-40 mg intravenously or intramuscularly, 30% glycerol 1-1.5 g/kg orally, acetazolamide);
• desensitization (clemastine, chloropyramine, mebhydrolin, diphenhydramine);
• hormonal therapy (prednisolone at a dose of up to 10 mg/kg per day using the pulse therapy method for 3-5 days, dexamethasone - 16 mg/day, 4 mg every 6 hours intravenously or intramuscularly), which has an anti-inflammatory, desensitizing, dehydrating effect, and also protects the adrenal cortex from functional exhaustion;
• improvement of microcirculation (intravenous drip administration of isotonic dextran solution [mol. mass 30,000-40,000]);
• antihypoxants (ethylmethylhydroxypyridine succinate, etc.);
• maintenance of homeostasis and water-electrolyte balance (parenteral and enteral nutrition, potassium chloride, dextrose, dextran [average molecular weight 50,000-70,000], dextran [mol. weight 30,000-40,000], sodium bicarbonate);
• angioprotectors: hexobendin + etamivan + etofylline, vinpocetine, pentoxifylline, etc.;
• elimination of cardiovascular disorders (camphor, sulfocamphoric acid + procaine, cardiac glycosides, polarizing mixture, vasopressor drugs, glucocorticoids);
• normalization of breathing (maintaining airway patency, oxygen therapy, hyperbaric oxygenation, in case of bulbar disorders - intubation or tracheostomy, artificial ventilation);
• restoration of brain metabolism (vitamins, polypeptides of the cerebral cortex of cattle, gamma-aminobutyric acid, piracetam, etc.);
• anti-inflammatory therapy (salicylates, ibuprofen, etc.).

This form is now called Schilder's diffuse sclerosis.

Etiotropic treatment of encephalitis

There are no specific methods for treating viral encephalitis yet. Antiviral drugs are used - nucleases that inhibit the reproduction of the virus.

Interferon alpha-2 is prescribed as antiviral therapy, in severe cases in combination with ribavirin (10 mg/kg per day for 14 days). In RNA and DNA viral encephalitis, tilorone is effective. Glucocorticoids (methylprednisolone) are used by the pulse therapy method intravenously up to 10 mg/kg for 3 days. Alternatively, in case of severe cerebral edema, dexamethasone can be used for the first 3 days (0.5-1 mg/kg per day in 3-4 doses intravenously). In case of impaired consciousness and seizures - mannitol, anticonvulsants. Transfer to mechanical ventilation is mandatory, in case of convulsive status, barbiturates, sodium oxybate, diazepam are prescribed. In severe cases, intravenous immunoglobulin transfusions can be used. Intensive supportive care is necessary, as most patients make a complete or near complete recovery.

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Symptomatic treatment of encephalitis

Symptomatic therapy includes the following components.

• Anticonvulsant therapy. To stop status epilepticus, diazepam is used in a dose of 5-10 mg intravenously in a dextrose solution, 1-2% hexobarbital solution intravenously, 1% sodium thiopental solution intravenously, inhalation anesthesia, phenobarbital, primidone.
• Antipyretic therapy. To reduce the temperature, use lytic mixtures, 2 ml of 50% sodium metamizole solution, droperidol, local hypothermia, ibuprofen.
• Therapy of delirious syndrome. Use lytic mixtures, chlorpromazine, droperidol. It is advisable to prescribe magnesium sulfate, acetazolamide. To normalize consciousness, use biostimulants, metabolic drugs (choline alfoscerate), to normalize the psyche - tranquilizers, antidepressants.
• Normalization of sleep. Benzodiazepines (nitrazepam) and other sleeping pills are used.

Restorative treatment of encephalitis

Restorative treatment includes several components.

• Treatment of Parkinsonism. Anticholinergics, levodopa preparations (levodopa + benserazide), muscle relaxants (tolperisone, tizanidine), and preparations affecting brain metabolism are used. Stereotactic surgeries are indicated when rigidity increases and drug therapy is ineffective.
• Treatment of hyperkinesis. Prescribe metabolic drugs, alpha-adrenergic blockers, neuroleptics (haloperidol, chlorpromazine), tranquilizers. Stereotactic operations are indicated for severe hyperkinesis that do not respond to drug therapy.
• Treatment of Kozhevnikovsky epilepsy. Drugs that improve brain metabolism, anticonvulsants (valproic acid, carbamazepine), tranquilizers (chlordiazepoxide, meprobamate, tetramethyltetraazobicyclooctanedione), neuroleptics (chlorpromazine) are used. In progressive forms, surgical treatment is possible.
• Treatment of paresis. Prescribed drugs that improve metabolism in the brain and muscle tissue (trifosadenin, polypeptides of the cerebral cortex of cattle, glutamic acid, vitamins of group B, vitamin E), energy correctors (carnitine and its analogues, idebenone), drugs that improve neuromuscular conductivity (bendazole, galantamine, neostigmine methylsulfate, ambenonium chloride, ipidacrine). Exercise therapy, massage and physiotherapy are of great importance in the restoration of motor functions.
• Treatment of neuroendocrine disorders. Metabolic drugs, desensitizing agents, tranquilizers, neuroleptics are used.