CHOREOATHETOSIS AS AN INITIAL SIGN OF RELAPSING OF HERPES-SIMPLEX ENCEPHALITIS

Twelve children with type 1 herpes simplex encephalitis (3 with relaps e, 9 without) have been monitored during the past 7 years, Ten of the children received intravenous infusion of acyclovir (30 mg/kg/day) for 10 days, 1 child who experienced relapse received 15 mg/kg/day, and a nother relapsed child received no antiviral agents until relapse, Rela pse occurred 20-36 days after initial onset, All relapsed patients und erwent another 10 days of acyclovir treatment (30 mg/kg/day), Choreoat hetosis appeared as the initial sign of relapse followed by rapidly pr ogressive unresponsiveness in all 3 relapsed patients: in 1 nonrelapse d patient choreoathetosis occurred during the recovery period, In thes e 4 patients involuntary movement was remitted within 3 months to 2 ye ars. One patient with choreoathetosis died of measles pneumonia 4 mont hs after onset of herpes simplex encephalitis and the surviving 3 were severely retarded, Although neuroimaging sparing of basal ganglia doe s not indicate structural and functional normalities, the disturbance of the neural connection among the basal ganglia and the cerebral cort ex, which manifested severe damage over frontal, temporal, and parieta l mantles on CT, may be the source of movement disorders in these pati ents, We conclude that choreoathetosis may be the first sign of relaps e of herpes simplex encephalitis in children and may be an indicator o f poor prognosis, The neuropathogenesis of choreoathetosis requires fu rther investigation.