Encephalitis: treatment

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

[1], [2], [3], [4], [5], [6], [7], [8]

Pathogenetic treatment of encephalitis

The main directions of pathogenetic therapy are:

• dehydration and control of cerebral edema and swelling (10-20% mannitol solution at 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, mebhydroline, diphenhydramine);
• hormonal therapy (prednisolone at a dose of up to 10 mg / kg per day by the pulse-therapy method for 3-5 days, dexamethasone 16 mg / day for 4 mg after 6 hours intravenously or intramuscularly), which has anti-inflammatory, desensitizing, dehydrating action, and Protecting the adrenal cortex from functional exhaustion;
• improvement of microcirculation (intravenous drip introduction of isotonic solution of dextran [molecular weight 30 000-40 000]);
• antihypoxants (ethylmethylhydroxypyridine succinate, etc.);
• maintenance of homeostasis and water-electrolyte balance (parenteral and enteral nutrition, potassium chloride, dextrose, dextran [compare molecular weight 50,000-70,000], dextran [molecular weight 30,000-40,000], sodium hydrogen carbonate);
• angioprotectors: hexobenzidine + etamivan + etofillin, vinpocetine, pentoxifylline, etc .;
• elimination of cardiovascular disorders (camphor, sulphocamphoric acid + procaine, cardiac glycosides, polarizing mixture, vasopressor preparations, glucocorticoids);
• normalization of respiration (maintenance of airway patency, oxygen therapy, hyperbaric oxygenation, with bulbar disorders - intubation or tracheostomy, ventilation);
• restoration of brain metabolism (vitamins, cortex cerebral cortex polypeptides, gamma-aminobutyric acid, pyracetam, etc.);
• anti-inflammatory therapy (salicylates, ibuprofen, etc.).

At present, this form is called Schilder's diffuse sclerosis.

Etiotropic treatment of encephalitis

Specific methods of treatment of viral encephalitis do not exist yet. Apply antiviral drugs - nuclease, delaying the reproduction of the virus.

As an antiviral therapy, interferon alfa-2 is prescribed, in severe cases in combination with ribavirin (10 mg / kg per day for 14 days). With RNA and DNA viral encephalitis, the use of tylorone is effective. Glucocorticoids (methylprednisolone) are used by the method of pulse therapy intravenously to 10 mg / kg for 3 days. Alternatively, with severe edema of the brain, the first 3 days can be used dexamethasone (0.5-1 mg / kg per day for 3-4 intravenous injections). With violations of consciousness and convulsions - mannitol, anticonvulsants. Mandatory translation to artificial ventilation, with convulsive status appoint barbiturates, sodium oxybate, diazepam. In severe cases, transfusions of intravenous immunoglobulins can be used. An intensive maintenance therapy is needed, as in the majority of patients there is a complete or almost complete recovery.

[9], [10], [11]

Symptomatic treatment of encephalitis

Symptomatic therapy includes the following components.

• Anticonculsant therapy. To arrest the epileptic status, diazepam is used in a dose of 5-10 mg intravenously on a dextrose solution, 1-2% hexobarbital intravenously, 1% solution of sodium thiopental intravenously, inhalation anesthesia, phenobarbital, primidone.
• Antipyretic therapy. To reduce the temperature, use lytic mixtures, 2 ml of a 50% solution of metamizole sodium, droperidol, local hypothermia, ibuprofen.
• Therapy of delirious syndrome. Apply lytic mixtures, chlorpromazine, droperidol. It is advisable to prescribe magnesium sulfate, acetazolamide. For the normalization of consciousness used biostimulants, metabolic drugs (choline alfoscerate), for the normalization of the psyche - tranquilizers, antidepressants.
• Normalization of sleep. Apply benzodiazepines (nitrazepam) and other hypnotics.

Restorative treatment of encephalitis

Restorative treatment includes several components.

• Treatment of Parkinsonism. Applied holinolitiki, drugs levodopa (levodopa + benserazid), muscle relaxants (tolperisone, tizanidine), drugs that affect the metabolism of the brain. Stereotactic operations are indicated with increasing rigidity and failure of drug therapy.
• Treatment of hyperkinesia. Assign metabolic drugs, a-adrenoblockers, neuroleptics (haloperidol, chlorpromazine), tranquilizers. Stereotactic operations are indicated for severe hyperkinesia, which can not be medicated.
• Treatment of kozhevnikovskoy epilepsy. Apply drugs that improve brain metabolism, anticonvulsants (valproic acid, carbamazepine), tranquilizers (chlordiazepoxide, meprobamate, tetramethyltetraazobicyclooctanedione), neuroleptics (chlorpromazine). With progressive forms, surgical treatment is possible.
• Treatment of paresis. Assign drugs that improve metabolism in the brain and muscle tissue (trifosadenin, cortex brain polypeptides, glutamic acid, B vitamins, vitamin E), energy correctors (carnitine and its analogues, idebenon), drugs that improve neuromuscular conduction (bendazole, galantamine, neostigmine methyl sulfate, ambenonium chloride, ipidacrin). Of great importance in restoring the motor functions are therapeutic physical training and massage, physiotherapy.
• Treatment of neuroendocrine disorders. Apply metabolic drugs, desensitizing agents, tranquilizers, neuroleptics.