Treatment of Herpes Simplex Virus Encephalitis

TWO ARTICLES in this issue of theArchives of Neurologyhighlight our dilemma in applying rational therapy for herpes simplex virus encephalitis. Since 1966, when Breeden et al1reported apparent improvement of this disease after idoxuridine treatment, we have been presented with numerous reports of the salutory effects of this thymidine analogue on herpetic encephalitis. On the other hand, we have remained largely ignorant of the natural history of the untreated disease. In this issue, Farris and Blaw (p 99) report treatment of a patient with herpetic encephalitis with cytarabine and present cogent arguments for the theoretical superiority of this drug. However, in the report by Johnson and associates (p 103), three patients are included with biopsy proven herpetic encephalitis whose outcome without specific therapy was as good or better than that often reported after "successful" antiviral therapy. Our dilemma arises from the difficulty in establishing a diagnosis