ADULT-ONSET TEMPORAL-LOBE EPILEPSY ASSOCIATED WITH SMOLDERING HERPES-SIMPLEX-2 INFECTION

A 40-year-old man with chronic genital herpes simplex infection develo ped partial complex temporal lobe seizures of insidious onset, with EE G and MRI evidence of a unilateral temporal lobe destructive, atrophic process. Extensive workup did not reveal an infectious etiology. Thre e years of escalating number and severity of daily seizures with memor y loss led to temporal lobectomy. Histologic study revealed active, lo w-level viral infection in the resected hippocampus and temporal lobe cortex, with immunohistochemical evidence for infection by herpes simp lex 2, principally in neurons. In situ hybridization confirmed the pre sence of herpes simplex virus in neurons. Anticonvulsant-resistant sei zure episodes began to recur several times daily soon after surgery, b ut the addition of acyclovir to the treatment regimen resulted in a su bstantial reduction in seizure occurrence, maintained for the subseque nt 2.5 years.