title: Chronic herpes simplex type-1 encephalitis with intractable epilepsy in an immunosuppressed patient.
abstract: BACKGROUND
  Chronic herpes simplex virus type-1 encephalitis (HSE-1) is uncommon. Past reports focused on its association with prior documented acute infection. Here, we describe a patient with increasingly intractable epilepsy from chronic HSE-1 reactivation without history of acute central nervous system infection.
  
  
  METHODS
  A 49-year-old liver transplant patient with 4-year history of epilepsy after initiation of cyclosporine developed increasingly frequent seizures over 3 months. Serial brain magnetic resonance imaging showed left temporoparietal cortical edema that gradually improved despite clinical decline. Herpes simplex virus type-1 (HSV-1) DNA was detected in cerebrospinal fluid by polymerase chain reaction. Cerebrospinal fluid HSV-1&2 IgM was negative. Seizures were controlled after acyclovir treatment, and the patient remained seizure free at 1-year follow-up.
  
  
  CONCLUSIONS
  Chronic HSE is a cause of intractable epilepsy, can occur without a recognized preceding acute phase, and the clinical course of infection may not directly correlate with neuroimaging changes.
authors.affiliation: Department of Neurology and Psychiatry, Saint Louis University, 1438 South Grand Blvd., Saint Louis, MO, 63104, USA. claohath@slu.edu.
authors.forename: Christopher
authors.initials: C
authors.lastname: Laohathai
authors.affiliation: Department of Neurology and Psychiatry, Saint Louis University, 1438 South Grand Blvd., Saint Louis, MO, 63104, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weber
authors.affiliation: Department of Neurology and Psychiatry, Saint Louis University, 1438 South Grand Blvd., Saint Louis, MO, 63104, USA.
authors.forename: Ghazala
authors.initials: G
authors.lastname: Hayat
authors.affiliation: Department of Neurology and Psychiatry, Saint Louis University, 1438 South Grand Blvd., Saint Louis, MO, 63104, USA.
authors.forename: Florian P
authors.initials: FP
authors.lastname: Thomas
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging; D002555:Cerebrospinal Fluid / Q000821:virology; D002908:Chronic Disease; D004279:DNA, Viral / Q000032:analysis / Q000235:genetics; D000069279:Drug Resistant Epilepsy / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D020803:Encephalitis, Herpes Simplex / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D018259:Herpesvirus 1, Human / Q000302:isolation & purification*; D006801:Humans; D016867:Immunocompromised Host; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D066027:Transplant Recipients
chemical_list: D004279:DNA, Viral
keywords: Cyclosporine; Encephalitis; Epilepsy; Herpes simplex; Immunosuppression; Seizure