Treatment

Initial stabilization for acute seizures.

Seizure management: antiepileptic drugs

Empiric treatment should not be delayed. Once the responsible pathogen or autoantibody is identified, therapy should be tailored accordingly.

Monitor intracranial pressure (see “ICP management”)

Viral encephalitis

• Start immediate antiviral therapy with acyclovir for all patients with suspected viral encephalitis (see “Antimicrobial treatment for herpes simplex encephalitis”).

• CMV encephalitis: IV ganciclovir AND IV foscarnet

Bacterial encephalitis [8]

• Start immediate empiric antibiotic therapy for all patients with suspected bacterial encephalitis or meningitis (see also “Empiric antibiotic therapy for bacterial meningitis”).

• Initiate definitive antibiotic treatment as soon as microbiological results become available

  • Neuroborreliosis: ceftriaxone, cefotaxime, or penicillin G

  • Neurosyphilis: penicillin G

  • Listeria encephalitis: ampicillin plus gentamycin

  • Rocky Mountain spotted fever: doxycycline

  • Ehrlichiosis: doxycycline

Paraneoplastic encephalitis: treatment of primary tumor and immunotherapy

Autoimmune encephalitis

• First-line: high-dose corticosteroids, intravenous immunoglobulin (IVIG), plasmapheresis

• Second-line: rituximab, cyclophosphamide