Aims of treatment
There are three important objectives in the treating encephalitis. Treatment aims to:
- halt and reverse the process of infection by using anti-viral medication or other appropriate medication
- control any immediate complications of encephalitis, such as seizures or dehydration, that are caused by fever
- prevent long-term complications developing, such as injury to the brain
Most people being treated for encephalitis will be admitted to an intensive care unit (ICU). An oxygen mask will be used to help with breathing. Feeding tubes will provide nutrition and help to keep the body hydrated.
Infectious encephalitis
In England, a medicine called aciclovir is the most widely used treatment for infectious encephalitis. However, it is only effective in treating cases of encephalitis that are caused by herpes viruses.
In encephalitis, the earlier that aciclovir is used the lower the risk of death and long-term complications. Therefore, treatment with aciclovir is usually started before all the diagnostic tests are complete. If tests reveal that encephalitis is being caused by something different, such as another type of infection, the use of aciclovir may be stopped and alternative treatments considered.
Aciclovir works by directly attacking the deoxyribonucleic acid (DNA) inside viral cells. This stops the virus from reproducing and spreading further into the brain. It is given intravenously via a tube into the body, usually three times a day for 14 to 21 days.
Common side effects of aciclovir include:
Less common side effects include:
- liver damage
- hallucinations (seeing things that are not real)
- a decrease in the number of white blood cells that are produced by the bone marrow, which can make you more vulnerable to infection
If you fail to respond to treatment with aciclovir, or you have had a previous allergic reaction after taking the medication, an alternative anti-viral medication may be considered.
Post-infectious encephalitis
Post-infectious encephalitis is usually treated with injections of high-dose corticosteroids. This may last several days, depending on the severity of the condition.
Corticosteroids work by calming the immune system (the body’s natural defence against infection and illness). This reduces the levels of inflammation inside the brain.
Some people’s symptoms may improve a few hours after treatment. But in most cases it will take a few days before symptoms start to improve.
Side effects of corticosteroids include:
- nausea and vomiting
- indigestion
- increased appetite
- skin irritation at the site of the injection
- rapid mood changes, such as feeling very happy one moment and very depressed the next
See the Health A-Z topic about corticosteroids for more information.
If your symptoms fail to respond to treatment with corticosteroids, an additional medication called immunoglobulin therapy may be used. This is a type of donated blood product that contains a number of specific antibodies, which help to regulate the abnormal function of the immune system.
If your symptoms do not improve despite having treatments such as those described above, a therapy called plasmapharesis may be considered. Plasmapharesis involves removing the blood and discarding the parts that contain antibodies. After the blood has been treated, it is returned to your body.
Autoimmune encephalitis
Autoimmune encephalitis can be treated with corticosteroids, immunoglobulin therapy and plasmapharesis. An additional medication known as an immunosuppressant may also be recommended.
As the name suggests, immunosuppressants suppress the workings of your immune system, which should help to prevent your immune system from attacking healthy tissue.
Ciclosporin is a widely used immunosuppressant in the treatment of autoimmune encephalitis.
Common side effects of ciclosporin include:
- numbness or tingling in different parts of your body
- loss of appetite
- nausea and vomiting
- high blood pressure
- headaches
- tremor (uncontrollable shaking or trembling)
- muscle pains or cramps
- increased growth of hair on your skin
Chronic encephalitis
There is currently no cure for the subacute sclerosing panencephalitis type of chronic encephalitis. Anti-viral medication can slow the progression of the disease but this condition inevitably proves fatal within 1-2 years after receiving a diagnosis.
The recommended treatment for progressive multifocal leukoencephalopathy type of chronic encephalitis will usually depend on what is causing the immune system to weaken.
If the immune system is weakened due to a complication of a treatment such as chemotherapy or taking immunosuppressants, then treatment may have to be temporarily withdrawn.
If your immune system is weakened due to a HIV infection, a type of medication known as highly active antiretroviral therapy may be effective. For more information see HIV – treatment
