title: A systematic review on the role of adjunctive corticosteroids in herpes simplex virus encephalitis: is timing critical for safety and efficacy?
abstract: BACKGROUND
  Most herpes simplex virus encephalitis (HSVE) patients become disabled despite antiviral therapy. Adjunctive corticosteroid therapy may improve outcomes.
  
  
  METHODS
  This was a systematic review of the literature addressing the use of corticosteroids in HSVE.
  
  
  RESULTS
  Data suggesting that steroids decrease the immunological response and enhance viral replication originated from non-neural microenvironments. Early steroid administration might be harmful because initial damage in HSVE is mediated by viral replication. Steroid treatment improves outcomes in animal models by inhibiting the subsequent inflammatory response. Clinical observations support a similar benefit in symptomatic HSVE patients. Cerebrospinal fluid inflammatory markers might guide appropriate timing in future clinical practice.
  
  
  CONCLUSIONS
  Experimental and clinical observations suggest a benefit from adjunctive steroid therapy in HSVE. Nevertheless, current evidence is not yet sufficient to endorse this approach as a standard of practice.
authors.affiliation: Neurocritical Care Division, Department of Neurology, Case Western University, Cleveland, OH, USA. Ciro.RamosEstebanez@UHhospitals.org.
authors.forename: Ciro
authors.initials: C
authors.lastname: Ramos-Estebanez
authors.forename: Karlo J
authors.initials: KJ
authors.lastname: Lizarraga
authors.forename: Amedeo
authors.initials: A
authors.lastname: Merenda
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D000818:Animals; D004334:Drug Administration Schedule; D020803:Encephalitis, Herpes Simplex / Q000188:drug therapy*; D006801:Humans
chemical_list: D000305:Adrenal Cortex Hormones