Protocol for DexEnceph: A randomised controlled trial of dexamethasone therapy in adults with herpes simplex virus encephalitis

Thomas Whitfield, Cristina Fernandez, Kelly Davies, Sylviane Defres, Michael Griffiths, Cory Hooper, Rebecca Tangney, Girvan Burnside, Anna Rosala- Hallas, Perry Moore, Kumar Das, Mark Zuckerman, Laura Parkes, Simon Keller, Neil Roberts, Ava Easton, Saber Touati, Rachel Kneen, J. P. Stahl, Tom Solomon

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction Herpes simplex virus (HSV) encephalitis is a rare severe form of brain inflammation that commonly leaves survivors and their families with devastating long-term consequences. The virus particularly targets the temporal lobe of the brain causing debilitating problems in memory, especially verbal memory. It is postulated that immunomodulation with the corticosteroid, dexamethasone, could improve outcomes by reducing brain swelling. However, there are concerns (so far not observed) that such immunosuppression might facilitate increased viral replication with resultant worsening of disease. A previous trail closed early because of slow recruitment. Method DexEnceph is a pragmatic multicentre, randomised, controlled, open-label, observer-blind trial to determine whether adults with HSV encephalitis who receive dexamethasone alongside standard antiviral treatment with aciclovir for have improved clinical outcomes compared with those who receive standard treatment alone. Overall, 90 patients with HSV encephalitis are being recruited from a target of 45 recruiting sites; patients are randomised 1:1 to the dexamethasone or control arms of the study. The primary outcome measured is verbal memory as assessed by the Weschler Memory Scale fourth edition Auditory Memory Index at 26 weeks after randomisation. Secondary outcomes are measured up to 72 weeks include additional neuropsychological, clinical and functional outcomes as well as comparison of neuroimaging findings. Patient safety monitoring occurs throughout and includes the detection of HSV DNA in cerebrospinal fluid 2 weeks after randomisation, which is indicative of ongoing viral replication. Innovative methods are being used to ensure recrutiment targets are met for this rare disease. Discussion DexEnceph aims to be the first completed randomised controlled trial of corticosteroid therapy in HSV encephalitis. The results will provide evidence for future practice in managing adults with the condition and has the potential to improve outcomes. Ethics and dissemination The trial has ethical approval from the UK National Research Ethics Committee (Liverpool Central, REF: 15/NW/0545, 10 August 2015). Protocol V.2.1, July 2019. The results will be published and presented as soon as possible on completion. Trial registration numbers ISRCTN11774734, EUDRACT 2015-001609-16.
Original languageEnglish
Article numbere041808
JournalBMJ Open
Volume11
Issue number7
DOIs
Publication statusPublished - 22 Jul 2021

Keywords

  • neurological injury
  • neurology
  • virology

Research Beacons, Institutes and Platforms

  • Manchester Institute for Collaborative Research on Ageing

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