Encephalitis Treatment in Indore

Encephalitis is inflammation of the brain, usually caused by viral infections, although it also may be caused by bacteria, autoimmune diseases, or an unknown cause.

Because it can progress rapidly and become life-threatening, treatment is initiated urgently, often before the exact cause is confirmed.

Management usually involves the treatment of:

The likely cause - empiric therapy

Complications: swelling, seizures, fever

Supportive care in the hospital or ICU

1. Initial Emergency Management

When clinicians suspect encephalitis, they usually don't take the time.

Immediate priorities include:

Stabilisation of airway, breathing, circulation (ABC)

Oxygen level and vital sign monitoring

IV access and blood tests

Brain imaging: CT/MRI

Lumbar puncture (when safe) to analyse cerebrospinal fluid

Because early intervention is important, empiric therapy is started even before lab confirmation.

2. Antiviral Therapy For Viral Encephalitis

Acyclovir (First-Line Medication)

Most cases of severe viral encephalitis, especially Herpes Simplex Virus (HSV-1), are treated with IV acyclovir as soon as possible.

Reasons:

HSV encephalitis is common and highly lethal if untreated.

Early acyclovir significantly improves outcomes

Acyclovir is continued until CSF PCR results clarify the diagnosis.

Other antivirals (used in specific situations)

Ganciclovir / Foscarnet – for CMV encephalitis (often in immunocompromised patients)

Oseltamivir- for confirmed influenza-associated encephalitis

Ribavirin, for some rare viral causes, such as specific hemorrhagic viruses

For many common viruses [e.g., enterovirus, West Nile], no antiviral exists; thus, treatment is supportive.

3. Antibiotics & Antimicrobials (If Bacterial or Uncertain Cause)

Early symptoms may mimic bacterial meningitis, so clinicians will often initiate broad-spectrum IV antibiotics pending ruling out bacterial infection.

Examples commonly used empirically (educational purposes only):

Third-generation cephalosporin

Vancomycin (for areas with resistance)

If there is confirmation of bacterial or mycobacterial infection, the regimen is tailored; for example, anti-TB therapy in tubercular encephalitis.

4. Anti-inflammatory & Immunomodulatory Therapy

These are used in cases of:

Autoimmune encephalitis

Severe brain swelling

Post-infectious immune reactions, e.g. ADEM

Common strategies include:

1. Corticosteroids (e.g., IV methylprednisolone)

Reduces inflammation and swelling in the brain.

2. Intravenous Immunoglobulin (IVIG)

Used for autoimmune or post-infectious forms.

3. Plasmapheresis (Plasma Exchange)

It removes injurious autoantibodies from the circulation.

4. Immunosuppressants for chronic autoimmune encephalitis

e.g. rituximab, cyclophosphamide

Used under specialist supervision.

5. Management of Brain Swelling (Cerebral Oedema)

Because swelling can cause life-threatening pressure inside the skull, treatment may include the following:

Commonly used in hospitals:

Elevation of the head of the bed

Careful fluid balance

Osmotherapy-suspension of mannitol or hypertonic saline by clinicians

Ventilator support to control carbon dioxide levels

Monitoring intracranial pressure, in severe cases

6. Seizure Management

Seizures or status epilepticus are common.

Management encompasses:

Antiepileptic medications, for example, levetiracetam, phenytoin

Continuous EEG monitoring in severe cases

Seizures should be promptly treated to avoid further damage to the brain.

7. Supportive Care (Important Principle)

Supportive care does not treat the infection itself but is crucial to recovery.

Includes:

IV fluids for hydration and circulation

Fever control (cooling, medications)

Pain management

Respiratory support: supplemental oxygen, or mechanical ventilation if necessary

Nutritional support, feeding tubes if the patient is unable to eat

Prevention of complications such as pressure sores, blood clots, or aspiration pneumonia

8. Rehabilitation and Long-Term Management

Many patients experience this during recovery because their brains become inflamed.

Rehabilitation may include the following:

Physical Therapy (movement, strength)

Occupational therapy (daily skills)

Speech and language therapy

Cognitive rehabilitation: memory, attention

Psychological support (behavioural or mood effects)

Long-term follow-up can help in the management of:

Memory problems

Seizures

Motor impairments

Emotional or behavioural changes

9. Prognosis and Recovery

The outcomes depend on:

Cause-HSV and autoimmune causes can be very severe. Speed of treatment initiation, Severity of brain swelling, Age and underlying health. Early antiviral or immunotherapy greatly improves survival and neurological outcomes.