Corticosteroid Treatment for Acute Meningoencephalitis: a Retrospective Study of 346 Cases.

The use of corticosteroids in the treatment of severe infectious diseases is still a controversial matter. In the case of bacterial infections thorough investigations have been carried out, and the initial enthusiasm has been replaced by a more sceptical attitude. The urgent need for a controlled investigation was met by the Cooperative Study Group (1963), and the results of this study have probably contributed more than anything else to the change of opinion. The results in viral infections are even more difficult to evaluate. Because of this, and also because of lack of effective antiviral treatment, corticosteroids are still in common use in many severe viral infections. They are used especially in the treatment of meningoencephalitis and other, more obscure, diseases of the nervous system (Foster, 1962). Theoretically there are indications both for and against the use of corticosteroids. They can enhance a viral infection in animals. On the other hand, they can inhibit the development of experimental allergic encephalomyelitis, a condition thought to have some features in common with the para-infectious or postinfectious meningoencephalitis in humans. Publications on the clinical investigations of these drugs in meningoencephalitis are deficient in many ways. The literature is full of reports of favourable but uncontrolled observations in seemingly hopeless cases. These reports may in fact describe nothing more than the natural history of the disease. For obvious reasons the unsuccessful cases are not recorded; and since the individual physician sees only a few cases of meningoencephalitis it is difficult for him to reach any conclusion about the value of corticosteroid treatment. Unfortunately there has been no double-blind study similar to that mentioned above for bacterial infections. A few investigators have tried to compare a group of corticoid-treated patients with a control group of untreated patients. Karelitz and Eisenberg (1961) studied 42 patients with measles encephalitis, 20 of whom were given A.C.T.H. and corticosteroids in varying doses. These authors raised serious doubts about the advisability of using these drugs in the management of measles encephalitis. Ziegra (1961) undertook a controlled study on 32 patients with measles encephalitis, half of them being treated with A.C.T.H., hydrocortisone, and cortisone in the dosage and regimen reported so favourably by Allen (1957). There was no apparent benefit related to corticosteroid therapy. The present report is a retrospective study on 346 cases of meningoencephalitis, 106 of whom were comatose during the acute stage of the illness.