Dr Parrino claims that "brain biopsy in a high-probability population can no longer be rationally defended" for diagnosis of herpes simplex encephalitis. This issue has been raised on several occasions and addressed. To clarify our use of mathematical models further, in addition to the one reported, we have also applied our data to the model of Dr P. Braun.1 Alternative diagnoses and outcome, results of therapy for herpes simplex encephalitis, as well as possible complications of brain biopsy or of therapy itself were all evaluated, based on the data generated by the National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. By so doing, we find that overall survival is enhanced by more than 10% with our diagnostic approach, a figure substantially high enough to warrant continued diagnostic brain biopsy.Dr Parrino states that we have failed to consider three issues. We will reiterate: Regarding
Whitley RJ, Alford CA. Diagnosis of Herpes Simplex Encephalitis-Reply. JAMA. 1982;248(5):547–548. doi:10.1001/jama.1982.03330050031019
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