INTRACTABLE SEIZURE DISORDER ASSOCIATED WITH CHRONIC HERPES INFECTION- HSV1 DETECTION IN TISSUE BY THE POLYMERASE-CHAIN-REACTION

We describe the pathological findings and report the detection of herp es simplex virus 1 (HSV1) in the brain in three patients who presented with intractable seizures. All three patients had a previous history of HSV1 encephalitis and went on to develop a medically refractory sei zure disorder necessitating surgical intervention. HSV1 encephalitis w as clinically diagnosed and treated at 6 months, 3 years, and 7 months and surgical resection was done at 8.5 years, 6 years, and 3 years, i n cases 1, 2 and 3, respectively. Pathological examination revealed ch ronic encephalitis in all three cases, with microglial nodules, intrap arenchymal, perivascular and meningeal lymphocytic infiltrates, and gl iosis. While immunohistochemical and ultrastructural studies were nega tive for viral pathogens, polymerase chain reaction (PCR) analysis rev ealed HSV1 genome. These cases represent examples of chronic herpes en cephalitis and seizure disorder with presence of viral genome in the b rain long after the initial episode of treated herpes encephalitis.