1
|
Garg D, Patel S, Sankhla CS, Holla VV, Paramanandam V, Kukkle PL, Pandey S, Schneider SA, Pal PK. Movement Disorders in Patients with Subacute Sclerosing Panencephalitis: A Systematic Review. Mov Disord Clin Pract 2024; 11:770-785. [PMID: 38748762 PMCID: PMC11233848 DOI: 10.1002/mdc3.14062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/27/2024] [Accepted: 04/14/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Subacute sclerosing panencephalitis (SSPE) is a complication of measles, occurring after a latency of 4-10 years. It continues to occur in developing countries although resurgence is being reported from developed countries. Characteristic features include progressive neuropsychiatric issues, myoclonus, seizures, movement disorders and visual impairment. Electroencephalography (EEG) typically shows periodic generalized discharges, and elevated CSF anti-measles antibodies are diagnostic. Movement disorders are being increasingly recognized as part of the clinical spectrum, and range from hyperkinetic (chorea, dystonia, tremor, tics) to hypokinetic (parkinsonism) disorders and ataxia. OBJECTIVES This article aims to comprehensively review the spectrum of movement disorders associated with SSPE. METHODS A literature search was conducted in PubMed and EMBASE databases in December 2023 and articles were identified for review. RESULTS Movement disorders reported in SSPE included hyperkinetic (chorea, dystonia, tremor and tics), hypokinetic (parkinsonism), ataxia and extraocular movement disorders. Myoclonus, a core clinical feature, was the most frequent "abnormal movement." Movement disorders were observed in all clinical stages, and could also be a presenting feature, even sans myoclonus. Hyperkinetic movement disorders were more common than hypokinetic movement disorders. An evolution of movement disorders was observed, with ataxia, chorea and dystonia occurring earlier, and parkinsonism later in the disease. Neuroradiological correlates of movement disorders remained unclear. CONCLUSION A wide spectrum of movement disorders was observed throughout the clinical stages of SSPE. Most data were derived from case reports and small case series. Multicentric longitudinal studies are required to better delineate the spectrum and evolution of movement disorders in SSPE.
Collapse
Affiliation(s)
- Divyani Garg
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Sahil Patel
- Department of NeurologyP. D. Hinduja National Hospital & Medical Research CentreMumbaiIndia
| | - Charulata S. Sankhla
- Department of NeurologyP. D. Hinduja National Hospital & Medical Research CentreMumbaiIndia
| | - Vikram V. Holla
- Department of NeurologyNational Institute of Mental Health and Neurosciences (NIMHANS)BangaloreIndia
| | | | | | - Sanjay Pandey
- Department of Neurology and Stroke MedicineAmrita Institute of Medical SciencesFaridabadIndia
| | | | - Pramod K. Pal
- Department of NeurologyNational Institute of Mental Health and Neurosciences (NIMHANS)BangaloreIndia
| |
Collapse
|
2
|
Viswanathan LG, Nagaraj BC, Mundlamuri R, Thennarasu K, Kenchaiah R, Asranna A, Nagappa M, Seshagiri D, Saini J, Sinha S. Cardiac Rhythm Aberrations in Subacute Sclerosing Panencephalitis: Insights From Heart Rate Variability Analysis. J Clin Neurophysiol 2024:00004691-990000000-00129. [PMID: 38587485 DOI: 10.1097/wnp.0000000000001079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
PURPOSE Subacute sclerosing panencephalitis (SSPE) is a fatal neurological disorder resulting from persistent measles virus infection within the brain. Although neurological manifestations have been well-documented, the impact of SSPE on cardiac autonomic function, assessed through heart rate variability (HRV), remains understudied. METHODS In this prospective single-center study conducted from January 2022 to March 2023 in Southern India, 30 consecutive SSPE patients and age- and sex-matched controls underwent electrocardiogram recordings for HRV analysis. Various HRV parameters were assessed, including time-domain metrics (SD of normal-to-normal intervals, root mean square of successive differences between normal heartbeats, percentage of successive normal interbeat intervals greater than 50 msec), SD1 and SD2 for Poincaré plot analysis, and frequency-domain metrics (low frequency %, high frequency %, low frequency:high frequency ratio). RESULTS In the study, SSPE patients exhibited markedly reduced HRV. Specifically, SD of normal-to-normal intervals (P = 0.003), percentage of successive normal interbeat intervals greater than 50 msec (P = 0.03), and SD2 (P = 0.0016) were significantly lower compared with controls. Frequency-domain analysis did not reveal significant distinctions. Correlation analysis demonstrated a negative relationship between percentage of successive normal interbeat intervals greater than 50 msec and SSPE severity (r = -0.37, P = 0.042). Heart rate variability did not significantly differ between SSPE stages or with clinical variables. The interbeat interval range showed a narrower distribution in SSPE subjects. CONCLUSIONS Our study highlights the clinical relevance of HRV analysis in SSPE and autonomic dysfunction throughout the disease course underscoring its importance in SSPE. This investigation provides valuable insights into cardiac autonomic dysfunction probably because of affliction of the central autonomic networks caused by the disease process and may be a contributing factor to mortality in SSPE.
Collapse
Affiliation(s)
| | | | | | | | | | - Ajay Asranna
- Department of Neurology, NIMHANS, Bangalore, India
| | | | | | | | - Sanjib Sinha
- Department of Neurology, NIMHANS, Bangalore, India
| |
Collapse
|
3
|
Sulaiman SA, Vora NM, Chhabra K, Bashir MA, Awan Z. Pediatric Subacute Sclerosing Panencephalitis: A Narrative Review on Measles and the Future of Vaccination. J Child Neurol 2024; 39:89-97. [PMID: 38477320 DOI: 10.1177/08830738241238860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Subacute sclerosing panencephalitis is a rare complication due to persistent measles infection, characterized by cognitive and motor deterioration. Because subacute sclerosing panencephalitis is considered a potentially fatal complication of measles and usually presents in young populations, particularly those with measles infection under the age of 2 years, new approaches to implement vaccination programs must be devised to help avoid the worsening of patient outcome. Until the disease is eradicated globally, children in all regions of the world remain at risk of measles infection and its respective complications, and therefore, the vaccine is considered the optimal preventative measure. The legacy of measles virus goes beyond the immediate complications. Our study, therefore, aims to provide a comprehensive review on the updated insights into subacute sclerosing panencephalitis as a complication, as well as the extent and future considerations pertaining to vaccination programs in the pediatric population.
Collapse
Affiliation(s)
| | - Nilofar M Vora
- Terna Speciality Hospital and Research Centre, Navi Mumbai, India
| | - Kusumita Chhabra
- Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | | | - Zainab Awan
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| |
Collapse
|
4
|
Köksaldı S, Ala RT, Oztura I, Emirbayer E, Akdal G, Emre S, Tugal-Tutkun I, Saatci AO. Optical Coherence Tomography Angiographic Follow-Up in a Case of Subacute Sclerosing Panencephalitis and Unilateral Necrotising Retinitis. Neuroophthalmology 2023; 48:142-151. [PMID: 38487359 PMCID: PMC10936593 DOI: 10.1080/01658107.2023.2284914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/31/2023] [Indexed: 03/17/2024] Open
Abstract
We present a 20-year-old woman who was diagnosed with subacute sclerosing panencephalitis (SSPE) 20 months after presenting with unilateral retinitis. At presentation, the patient had two inferotemporal macular lesions in her left eye. Corresponding to these areas, optical coherence tomography (OCT) showed hyporeflective spaces with loss of nearly all of the retinal layers. OCT-angiography (OCTA) demonstrated some flow deficit areas with a reduction in the vessel density. Her serum measles antibody titre was high (IgG >5000.0 mIU/ml). Twenty months later the macular lesions had diminished in size, and there was some focal retinal thinning with interruption of the ellipsoid zone. OCTA showed that the flow deficit areas were diminished in size together with the relatively improved perfusion density. Neurological examination disclosed myoclonic jerks. Neuropsychological assessment demonstrated impaired executive function, attention, and narrowed lexical fluency. Measles IgG antibody was high in the cerebrospinal fluid (>230.0 U/ml). Brain magnetic resonance imaging demonstrated bilateral, non-specific, small foci of T2 hyperintensity in the frontoparietal subcortical white matter and centrum semiovale. The present case is the first where OCTA findings of SSPE-related retinal lesions have been described.
Collapse
Affiliation(s)
- Seher Köksaldı
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Rahmi Tumay Ala
- Department of Neurology, Dokuz Eylul University, Izmir, Turkey
| | - Ibrahim Oztura
- Department of Neurology, Dokuz Eylul University, Izmir, Turkey
| | - Emre Emirbayer
- Department of Neurology, Dokuz Eylul University, Izmir, Turkey
| | - Gulden Akdal
- Department of Neurology, Dokuz Eylul University, Izmir, Turkey
| | - Sinan Emre
- Department of Ophthalmology, Batıgöz Private Hospital, Izmir, Turkey
| | | | - Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| |
Collapse
|
5
|
Kaur S, Singh AS, Prabhakar S, Singhvi JP, Mann HS, Kaul A. Pisa Syndrome in Subacute Sclerosing Panencephalitis: A Case Report and Review of the Literature. J Mov Disord 2023; 16:336-338. [PMID: 37424073 PMCID: PMC10548073 DOI: 10.14802/jmd.23052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/20/2023] [Accepted: 07/09/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
- Sandeep Kaur
- Department of Neurology, Fortis Hospital Mohali, Punjab, India
| | | | | | | | | | - Arun Kaul
- Department of Neurology, G B pant Hospital, New Delhi, India
| |
Collapse
|
6
|
Preliminary seroprevalence study of neurotropic virus antibodies in Nodding syndrome. eNeurologicalSci 2022; 29:100423. [PMID: 36133256 PMCID: PMC9483776 DOI: 10.1016/j.ensci.2022.100423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 11/22/2022] Open
Abstract
Nodding syndrome (NS) is a mostly East African pediatric epileptiform encephalopathy of unknown etiology that shares some clinical features with measles-associated subacute sclerosing panencephalitis (SSPE) and progressive rubella panencephalitis. Two independent studies in northern Uganda identified an association between NS and prior measles infection, while an earlier study in South Sudan found an inverse association. We report preliminary serologic analyses of antibodies to measles (MV), rubella (RV), HSV-1, and CMV viruses in northern Ugandan children with NS and Household (HC) and Community (CC) Controls. Only MV-positive titers were significantly different (3-fold and > 2-fold) in NS relative to HC and HC + CC, respectively. While these results are consistent with greater prior measles infection in Ugandan persons with NS, further studies are needed to determine whether Measles virus (MV) plays any role in the etiology and pathogenesis of NS. Resolving this issue will be invaluable for the thousands of children at risk for this devastating yet often neglected condition. Nodding syndrome (NS) is an enigmatic pediatric epileptiform encephalopathy. We report an association between NS and measles virus (MV)-positive titers. Further studies should assess whether MV plays any role in the etiology of NS.
Collapse
|
7
|
Garg D, Kakkar V, Kumar A, Kapoor D, Abbey P, Pemde H, Mukherjee SB, Sharma S. Spectrum of Movement Disorders Among Children With Subacute Sclerosing Panencephalitis: A Cross-Sectional Study. J Child Neurol 2022; 37:491-496. [PMID: 35262436 DOI: 10.1177/08830738221085158] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Subacute sclerosing panencephalitis is a progressive devastating condition due to persistence of mutant measles virus, affecting children and adolescents, characterised by myoclonus, seizures, and neuropsychiatric issues. Movement disorders apart from myoclonus are reportedly uncommon. We aimed to describe frequency and proportion of movement disorders among children with subacute sclerosing panencephalitis, hypothesizing that these occur more frequently than previously reported. Methods: In this cross-sectional study, we enrolled children with subacute sclerosing panencephalitis between 1 month and 18 years of age who fulfilled the diagnosis of subacute sclerosing panencephalitis as per modified Dyken criteria, and examined them for movement disorders. We also assessed their clinical profile and disease severity via Jabbour staging and modified Rankin Scale score. We compared demographic, clinical, and laboratory features of children with and without movement disorders. Results: We enrolled 50 children (36 males; 72%) (age range 1.5-14 years). Of these, 28 (56%) had movement disorders. Among movement disorders, the most frequent was myoclonus (92%), followed by ataxia (9; 18%), chorea-athetosis (7; 14%), dystonia (6; 12%), tremor (4; 8%), repetitive behavior (4; 8%), and parkinsonism (3; 6%). Movement disorders were the presenting feature of subacute sclerosing panencephalitis among 7 children. There were no significant differences in clinical or laboratory features among children with and without movement disorders. Conclusions: Movement disorders were frequent in subacute sclerosing panencephalitis. Hyperkinetic disorders were dominant. Dystonia and chorea-athetosis occurred more commonly among nonmyoclonus movement disorders. Movement disorders may manifest even in earlier stages of subacute sclerosing panencephalitis and may be the heralding feature. Recognition of these features is important to plan management and reduce morbidity.
Collapse
Affiliation(s)
- Divyani Garg
- Department of Neurology, 28856Lady Hardinge Medical College, New Delhi, India
| | - Vanshika Kakkar
- Department of Pediatrics (Neurology Division), 28856Lady Hardinge Medical College, New Delhi, India
| | - Ashna Kumar
- Department of Pediatrics (Neurology Division), 28856Lady Hardinge Medical College, New Delhi, India
| | - Dipti Kapoor
- Department of Pediatrics (Neurology Division), 28856Lady Hardinge Medical College, New Delhi, India
| | - Pooja Abbey
- Department of Radiology, 28856Lady Hardinge Medical College, New Delhi, India
| | - Harish Pemde
- Department of Pediatrics (Neurology Division), 28856Lady Hardinge Medical College, New Delhi, India
| | - Sharmila B Mukherjee
- Department of Pediatrics (Neurology Division), 28856Lady Hardinge Medical College, New Delhi, India
| | - Suvasini Sharma
- Department of Pediatrics (Neurology Division), 28856Lady Hardinge Medical College, New Delhi, India
| |
Collapse
|
8
|
Memon SA, Afzal SS, Tukruna A, Khan AT, Tebha SS, Zaidi ZA. Trends and Treatment of Sub-Acute Sclerosing Panencephalitis: An Updated Review. Glob Pediatr Health 2022; 8:2333794X211065330. [PMID: 34988262 PMCID: PMC8721695 DOI: 10.1177/2333794x211065330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/19/2021] [Indexed: 11/16/2022] Open
Abstract
Measles infection, caused by the “Rubeola” virus is a highly contagious disease with outrageously fatal consequences. Initiating with a variety of symptoms including fever, cough, conjunctivitis, and runny nose, it can lead to more severe sequelae including sub-acute sclerosing pan-encephalitis which is a potentially fatal and serious complication of measles. The lackluster vaccination processes in underdeveloped areas of the world due to suboptimal immunization programs, scarce resources, and insufficient political constancy still leads to increased cases of measles and its complications. A variety of management programs including the use of several medications have been introduced according to the literature in order to counter this dreadful disease. In this review article, we focus on assessment of the previous literature and discussing the possible treatment modalities of this currently irremediable disease.
Collapse
Affiliation(s)
| | | | | | | | | | - Zain Ali Zaidi
- Jinnah Medical and Dental College, Karachi, Sindh, Pakistan
| |
Collapse
|
9
|
Aggarwal A, Adukia S, Bhatt M. Video Anthology of Movement Disorders Due to Infections in South Asia. Mov Disord Clin Pract 2021; 8:843-858. [PMID: 34405094 DOI: 10.1002/mdc3.13275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/23/2021] [Accepted: 06/16/2021] [Indexed: 12/13/2022] Open
Abstract
South Asia, encompassing many populous countries including India, Pakistan, and Bangladesh, is home to a wide variety of infectious diseases several of which are disproportionately prevalent, endemic or distinctive to the region. These result in considerable morbidity and mortality, which can be greatly reduced through public-health measures, timely diagnosis and treatment. Some of these infectious diseases have neurological manifestations including movement disorders either due to the pathogen being neuroinvasive or via an immune-mediated response. For diseases such as Japanese encephalitis, movement disorders are the primary manifestation while for others, they can be a presenting feature. Thus, recognizing these movement disorders is often crucial to the diagnosis of the particular infection, and/or to exclude infection as a cause and arrive at the correct alternate diagnosis. Once diagnosed, the infection-related movement disorders are treated by targeting the infectious agent, or symptomatically. In this article, we describe and illustrate a variety of movement disorders that are seen in patients infected by viruses, bacteria and parasites in South Asia. This would be of value to neurologists practicing in the region and, with the increasing ease in movement of people and pathogens, those practicing elsewhere.
Collapse
Affiliation(s)
- Annu Aggarwal
- Movement Disorder Clinic, Department of Neurosciences Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute Mumbai India
| | - Sachin Adukia
- Movement Disorder Clinic, Department of Neurosciences Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute Mumbai India
| | - Mohit Bhatt
- Movement Disorder Clinic, Department of Neurosciences Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute Mumbai India
| |
Collapse
|
10
|
Nair SS, Vysakha KV, Menon RN, Sundaram S. Adult-onset subacute sclerosing panencephalitis. Pract Neurol 2021; 21:practneurol-2020-002880. [PMID: 33850035 DOI: 10.1136/practneurol-2020-002880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/04/2022]
Abstract
Subacute sclerosing panencephalitis (SSPE) is a lethal slow viral disease of the central nervous system caused by a defective measles virus. The onset is mostly in childhood, manifesting clinically as decline in academic performance, behavioural changes, motor dysfunction and myoclonus. Adult-onset SSPE is rare and can present as rapidly progressive dementia. We present a young man of Indian origin with adult-onset SSPE with rapidly progressive dementia but no localising neurological signs. The diagnostic clues were parieto-occipital white matter changes on MR brain scan and history of childhood fever with rash. High titres of antimeasles antibody in cerebrospinal fluid confirmed the diagnosis. The long latency from primary measles virus infection to symptom onset can be misleading in adults. SSPE should be considered in adults with dementia, especially in tropical countries where vaccination coverage is suboptimal.
Collapse
Affiliation(s)
- Sruthi S Nair
- Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - K V Vysakha
- Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Ramshekhar N Menon
- Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Soumya Sundaram
- Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| |
Collapse
|
11
|
Stemberger Marić L, Đaković Rode O, Višković K, Hećimović H, Lambaša S, Lepur D. Atypical adult-onset subacute sclerosing panencephalitis. Acta Clin Croat 2020; 59:543-548. [PMID: 34177067 PMCID: PMC8212648 DOI: 10.20471/acc.2020.59.03.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Although subacute sclerosing panencephalitis is almost exclusively a childhood disease, it can occur in adults as well. We present an atypical case of adult-onset subacute sclerosing panencephalitis. The disease was characterized by prolonged insidious course followed by accelerated and aggressive phase, atypical EEG findings, and absence of myoclonic jerks. The diagnostic and treatment-related pitfalls are discussed.
Collapse
Affiliation(s)
| | - Oktavija Đaković Rode
- 1School of Dental Medicine, University of Zagreb, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Department of Microbiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 3Department of Radiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 4Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 6School of Dental Medicine, University of Zagreb, Department of Intensive Care Medicine and Neuroinfectology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Klaudija Višković
- 1School of Dental Medicine, University of Zagreb, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Department of Microbiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 3Department of Radiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 4Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 6School of Dental Medicine, University of Zagreb, Department of Intensive Care Medicine and Neuroinfectology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Hrvoje Hećimović
- 1School of Dental Medicine, University of Zagreb, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Department of Microbiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 3Department of Radiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 4Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 6School of Dental Medicine, University of Zagreb, Department of Intensive Care Medicine and Neuroinfectology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Smiljka Lambaša
- 1School of Dental Medicine, University of Zagreb, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Department of Microbiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 3Department of Radiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 4Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 6School of Dental Medicine, University of Zagreb, Department of Intensive Care Medicine and Neuroinfectology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Dragan Lepur
- 1School of Dental Medicine, University of Zagreb, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Department of Microbiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 3Department of Radiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 4Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 6School of Dental Medicine, University of Zagreb, Department of Intensive Care Medicine and Neuroinfectology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia
| |
Collapse
|
12
|
Herath H, Nandasiri S, Chandrakumara A, Jayamaha J, Senanayake S, Goonaratne K. Subacute sclerosing panencephalitis: a rare cause of acute cortical visual impairment in an adult. Trop Doct 2020; 50:354-358. [PMID: 32664798 DOI: 10.1177/0049475520939325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adult onset subacute sclerosing panencephalitis (SSPE) after the third decade of life is rare and the manifestations can mimic disorders such as dysmyelinating and metabolic disorders. This case report presents a patient with acute binocular visual impairment in his fifth decade as the first manifestation of SSPE. This is preventable with immunisation against measles. A prior history of measles infection may not be forthcoming in adult onset SSPE. This should be kept in mind as a differential diagnosis when a patient from endemic area presents with acute visual loss even in the absence of classic features. Periodic generalised discharges on the EEG without myoclonus may be seen in this condition rarely as in this case.
Collapse
Affiliation(s)
- Hmmtb Herath
- Senior registrar in neurology, 294945National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Shanika Nandasiri
- Senior registrar in neurology, 294945National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Amila Chandrakumara
- Senior Registrar in neuroradiology, Department of Neuroradiology, 294945National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Jude Jayamaha
- Department of Virology, Medical Research Institute, Colombo, Sri Lanka
| | - Sunethra Senanayake
- Consultant neurologist, 294945National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Kishara Goonaratne
- Consultant neurologist, 294945National Hospital of Sri Lanka, Colombo, Sri Lanka
| |
Collapse
|
13
|
Holmes BB, Conell-Price J, Kreple CJ, Ashraf D, Betjemann J, Rosendale N. Adult-Onset Subacute Sclerosing Panencephalitis With a 30-Year Latent Period. Neurohospitalist 2020; 10:127-132. [PMID: 32373277 DOI: 10.1177/1941874419869713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Subacute sclerosing panencephalitis (SSPE) is a rare progressive neuroinfectious disease due to a late complication of the measles virus. The hallmark clinical features of this disease include behavioral changes, myoclonus, dementia, visual disturbances, and pyramidal and extrapyramidal signs. The presence of characteristic high-amplitude periodic complexes on electroencephalography and raised antibody titers against measles in the cerebrospinal fluid help solidify the diagnosis. We present a case of a 40-year-old patient with SSPE who initially developed ophthalmologic manifestations 30 years after the primary measles infection. This case highlights both typical and atypical features of SSPE and provides a diagnostic framework for evaluating cases that fall outside of the standard scope of this disease.
Collapse
Affiliation(s)
- Brandon B Holmes
- Department of Neurology, University of California, San Francisco, CA, USA
| | | | - Collin J Kreple
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Davin Ashraf
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - John Betjemann
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Nicole Rosendale
- Department of Neurology, University of California, San Francisco, CA, USA
| |
Collapse
|
14
|
Yagcioglu Yassa O, Kenangil G, Yalcin AD. Adult-onset subacute sclerosing panencephalitis presenting with tonic motor seizures. Int J Neurosci 2020; 131:914-918. [PMID: 32370641 DOI: 10.1080/00207454.2020.1759584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE/AIM OF THE STUDY Subacute sclerosing panencephalitis (SSPE) is a degenerative disease of the brain caused by a persistent measles virus infection occurring mostly in childhood or early adolescence. The spectrum of epileptic phenomena associated with SSPE is wide, varying from partial or generalized tonic-clonic seizures and atypical absences to myoclonic-atonic attacks. Tonic seizures are very rare in SSPE. MATERIALS AND METHODS Herein, we discuss a case of 25 years old male that presented with adult-onset SSPE with tonic seizures accompanying myoclonic seizures. RESULTS Patient was treated with clonazepam 5 mg/day and an isoprinosine regimen with a dose of 70 mg/kg/day. This is the fourth case of SSPE presenting with myoclonic and tonic seizures and the first case of SSPE with myoclonic and tonic seizures reported in an adult-onset case in the English literature. CONCLUSIONS Adult-onset SSPE with tonic seizures is rare and may be confusing, thus, it is important to recognize the presence of this type of tonic motor seizures in SSPE patients.
Collapse
Affiliation(s)
- Ozge Yagcioglu Yassa
- Department of Neurology, Medical Park Goztepe Hospital, Bahcesehir University, Istanbul, Turkey
| | - Gulay Kenangil
- Department of Neurology, Medical Park Goztepe Hospital, Bahcesehir University, Istanbul, Turkey
| | - Ayse Destina Yalcin
- Department of Neurology, Umraniye Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| |
Collapse
|
15
|
Garg RK, Sharma PK, Kumar N, Pandey S. Subacute Sclerosing Panencephalitis in Older Adulthood. Tremor Other Hyperkinet Mov (N Y) 2019; 9:tre-09-719. [PMID: 31566624 PMCID: PMC6744812 DOI: 10.7916/tohm.v0.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 12/01/2022] Open
Affiliation(s)
- Ravindra Kumar Garg
- Department of Neurology, King George Medical University, Uttar Pradesh, Lucknow, IN
| | - Praveen Kumar Sharma
- Department of Neurology, King George Medical University, Uttar Pradesh, Lucknow, IN
| | - Neeraj Kumar
- Department of Neurology, King George Medical University, Uttar Pradesh, Lucknow, IN
| | - Shweta Pandey
- Department of Neurology, King George Medical University, Uttar Pradesh, Lucknow, IN
| |
Collapse
|
16
|
Vural E, Engin E, Demir N, Agan K, Midi I. Unusual progression of an adult-onset subacute sclerosing panencephalitis (SSPE) in Turkey. Epilepsy Behav Rep 2019; 12:100332. [PMID: 31453567 PMCID: PMC6700497 DOI: 10.1016/j.ebr.2019.100332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/06/2019] [Accepted: 07/03/2019] [Indexed: 12/28/2022] Open
Abstract
SSPE diagnosis can be missed in adult cases if not included in the differential diagnosis. Adult cases may present with atypical clinical features and with an aggressive course. Antiviral drugs and immunomodulatory modalities have been tried alone or in combination, but there is no cure for SSPE. Measles vaccination is the only measure that can reduce the risk of SSPE.
Collapse
Affiliation(s)
- Ezgi Vural
- Department of Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | - Esin Engin
- Department of Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nurhak Demir
- Department of Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | - Kadriye Agan
- Department of Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ipek Midi
- Department of Neurology, Marmara University School of Medicine, Istanbul, Turkey
| |
Collapse
|
17
|
Garg RK, Mahadevan A, Malhotra HS, Rizvi I, Kumar N, Uniyal R. Subacute sclerosing panencephalitis. Rev Med Virol 2019; 29:e2058. [PMID: 31237061 DOI: 10.1002/rmv.2058] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/05/2019] [Accepted: 05/07/2019] [Indexed: 12/12/2022]
Abstract
Subacute sclerosing panencephalitis (SSPE) is a slowly progressive brain disorder caused by mutant measles virus. SSPE affects younger age groups. SSPE incidence is proportional to that of measles. High-income countries have seen substantial decline in SSPE incidence following universal vaccination against measles. SSPE virus differs from wild measles virus. Measles virus genome recovered from the autopsied brain tissues demonstrates clustered mutations in virus genome particularly in the M gene. These mutations destroy the structure and functioning of the encoded proteins. Complete infectious virus particle has rarely been recovered from the brain. Human neurons lack required receptor for entry of measles virus inside the neurons. Recent in vitro studies suggest that mutations in F protein confer hyperfusogenic properties to measles virus facilitating transneuronal viral spread. The inflammatory response in the brain leads to extensive tissue damage. Clinically, SSPE is characterized by florid panencephalitis. Clinically, SSPE is characterized by cognitive decline, periodic myoclonus, gait abnormalities, vision loss, and ultimately to a vegetative state. Chorioretinitis is a common ocular abnormality. Electroencephalography (EEG) shows characteristic periodic discharges. Neuroimaging demonstrates periventricular white matter signal abnormalities. In advanced stages, there is marked cerebral atrophy. Definitive diagnosis requires demonstration of elevated measles antibody titers in cerebrospinal fluid (CSF). Many drugs have been used to stabilize the course of the disease but without evidence from randomized clinical trials. Six percent of patients may experience prolonged spontaneous remission. Fusion inhibitor peptide may, in the future, be exploited to treat SSPE. A universal vaccination against measles is the only proven way to tackle this menace currently.
Collapse
Affiliation(s)
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Hardeep Singh Malhotra
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Imran Rizvi
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Neeraj Kumar
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ravi Uniyal
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| |
Collapse
|
18
|
Subacute sclerosing panencephalitis presenting as rapidly progressive dementia in a young adult. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2017.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
19
|
Geschwind MD, Murray K. Differential diagnosis with other rapid progressive dementias in human prion diseases. HANDBOOK OF CLINICAL NEUROLOGY 2018; 153:371-397. [PMID: 29887146 DOI: 10.1016/b978-0-444-63945-5.00020-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Prion diseases are unique in medicine as in humans they occur in sporadic, genetic, and acquired forms. The most common human prion disease is sporadic Creutzfeldt-Jakob disease (CJD), which commonly presents as a rapidly progressive dementia (RPD) with behavioral, cerebellar, extrapyramidal, and some pyramidal features, with the median survival from symptom onset to death of just a few months. Because human prion diseases, as well as other RPDs, are relatively rare, they can be difficult to diagnose, as most clinicians have seen few, if any, cases. Not only can prion diseases mimic many other conditions that present as RPD, but some of those conditions can present similarly to prion disease. In this article, the authors discuss the different etiologic categories of conditions that often present as RPD and also present RPDs that had been misdiagnosed clinically as CJD. Etiologic categories of conditions are presented in order of the mnemonic used for remembering the various categories of RPDs: VITAMINS-D, for vascular, infectious, toxic-metabolic, autoimmune, mitochondrial/metastases, iatrogenic, neurodegenerative, system/seizures/sarcoid, and demyelinating. When relevant, clinical, imaging, or other features of an RPD that overlap with those of CJD are presented.
Collapse
Affiliation(s)
- Michael D Geschwind
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, United States.
| | - Katy Murray
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
20
|
Garg D, Reddy V, Singh RK, Dash D, Bhatia R, Tripathi M. Neuroleptic malignant syndrome as a presenting feature of subacute sclerosing panencephalitis. J Neurovirol 2017; 24:128-131. [PMID: 29243130 DOI: 10.1007/s13365-017-0602-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/31/2017] [Accepted: 11/09/2017] [Indexed: 11/29/2022]
Abstract
Subacute sclerosing panencephalitis (SSPE) is a slowly progressive degenerative disorder caused by measles virus. It is characterised by typical clinical and electrophysiological features in the form of slow myoclonic jerks, with progressive cognitive impairment, visual symptoms, and periodic complexes on EEG, with raised titres of anti-measles antibodies in CSF and serum. Atypical presentations of SSPE have been reported including brainstem involvement, ADEM-like presentation, acute encephalitis, and cerebellar ataxia. Presentation with predominant extrapyramidal features is uncommon. We describe a case of SSPE presenting with extensive rigidity with highly elevated CPK values, mimicking neuroleptic malignant syndrome (NMS) which was most probably due to central dopaminergic blockade induced by the disease process. To our knowledge, this is the first case of SSPE presenting with a NMS-like syndrome.
Collapse
Affiliation(s)
- Divyani Garg
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Varun Reddy
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumar Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
| | - Deepa Dash
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
21
|
Martins R, Peres J, Casimiro C, Valverde A. Subacute sclerosing panencephalitis presenting as rapidly progressive dementia in a young adult. Neurologia 2017; 33:206-207. [PMID: 28318730 DOI: 10.1016/j.nrl.2017.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 01/08/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- R Martins
- Servicio de Neurología, Hospital Prof. Doutor Fernando Fonseca, Amadora, Lisboa, Portugal.
| | - J Peres
- Servicio de Neurología, Hospital Prof. Doutor Fernando Fonseca, Amadora, Lisboa, Portugal
| | - C Casimiro
- Servicio de Neurorradiología, Hospital Prof. Doutor Fernando Fonseca, Amadora, Lisboa, Portugal
| | - A Valverde
- Servicio de Neurología, Hospital Prof. Doutor Fernando Fonseca, Amadora, Lisboa, Portugal; CEDOC, Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| |
Collapse
|
22
|
Maller VV, Bathla G, Moritani T, Helton KJ. Imaging in viral infections of the central nervous system: can images speak for an acutely ill brain? Emerg Radiol 2016; 24:287-300. [DOI: 10.1007/s10140-016-1463-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/02/2016] [Indexed: 12/22/2022]
|
23
|
Williams E, Abbott IJ, Law LY, Guy SD. A case of subacute sclerosing panencephalitis in a 23-year-old recent immigrant to Australia. Med J Aust 2016; 204:264. [PMID: 27078597 DOI: 10.5694/mja15.01341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 01/15/2016] [Indexed: 11/17/2022]
Affiliation(s)
| | - Iain J Abbott
- Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC
| | | | | |
Collapse
|
24
|
Spencer PS, Mazumder R, Palmer VS, Lasarev MR, Stadnik RC, King P, Kabahenda M, Kitara DL, Stadler D, McArdle B, Tumwine JK. Environmental, dietary and case-control study of Nodding Syndrome in Uganda: A post-measles brain disorder triggered by malnutrition? J Neurol Sci 2016; 369:191-203. [PMID: 27653888 DOI: 10.1016/j.jns.2016.08.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/10/2016] [Indexed: 11/29/2022]
Abstract
Nodding Syndrome (NS) is an epileptic encephalopathy characterized by involuntary vertical head nodding, other types of seizures, and progressive neurological deficits. The etiology of the east African NS epidemic is unknown. In March 2014, we conducted a case-control study of medical, nutritional and other risk factors associated with NS among children (aged 5-18years) of Kitgum District, northern Uganda (Acholiland). Data on food availability, rainfall, and prevalent disease temporally related to the NS epidemic were also analyzed. In NS Cases, the mean age of reported head nodding onset was 7.6years (range 1-17years). The epidemiologic curve of NS incidence spanned 2000-2013, with peaks in 2003 and 2008. Month of onset of head nodding was non-uniform, with all-year-aggregated peaks in April and June when food availability was low. Families with one or more NS Cases had been significantly more dependent on emergency food and, immediately prior to head nodding onset in the child, subsistence on moldy plant materials, specifically moldy maize. Medical history revealed a single significant association with NS, namely prior measles infection. NS is compared with the post-measles disorder subacute sclerosing panencephalitis, with clinical expression triggered by factors associated with poor nutrition.
Collapse
Affiliation(s)
- Peter S Spencer
- Global Health Center (former), Oregon Health & Science University, Portland, OR, USA; Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA; Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA; Faculty of Medicine, Gulu University, Gulu, Uganda.
| | - Rajarshi Mazumder
- Global Health Center (former), Oregon Health & Science University, Portland, OR, USA
| | - Valerie S Palmer
- Global Health Center (former), Oregon Health & Science University, Portland, OR, USA; Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA; Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Michael R Lasarev
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA
| | - Ryan C Stadnik
- Global Health Center (former), Oregon Health & Science University, Portland, OR, USA
| | - Peter King
- Global Health Center (former), Oregon Health & Science University, Portland, OR, USA
| | - Margaret Kabahenda
- Department of Food Technology and Nutrition, College of Agricultural and Environmental Sciences, Makerere University, Kampala, Uganda
| | - David L Kitara
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA
| | - Diane Stadler
- Graduate Program in Human Nutrition, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Breanna McArdle
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR, USA
| | - James K Tumwine
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
| | | |
Collapse
|
25
|
Manoj S, Mukherjee A, Kumar KVSH. Subacute sclerosing panencephalitis presenting with hypersexual behavior. Indian J Psychiatry 2015; 57:321-2. [PMID: 26600593 PMCID: PMC4623658 DOI: 10.4103/0019-5545.166632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- S Manoj
- Department of Neurology, Command Hospital, Lucknow, Uttar Pradesh, India
| | - Arindam Mukherjee
- Department of Neurology, Command Hospital, Lucknow, Uttar Pradesh, India
| | - K V S Hari Kumar
- Department of Endocrinology, Command Hospital, Panchkula, Haryana, India. E-mail:
| |
Collapse
|
26
|
Studart Neto A, Nóbrega PR, Duarte MIS, Lucato LT, Castro LHM, Nitrini R. Adult-onset subacute sclerosing panencephalitis manifesting as slowly progressive dementia. J Neurovirol 2015; 21:468-71. [PMID: 25851779 DOI: 10.1007/s13365-015-0336-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/13/2015] [Accepted: 02/25/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Adalberto Studart Neto
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Cerqueira César, São Paulo, SP, 05403-000, Brazil,
| | | | | | | | | | | |
Collapse
|
27
|
Steiner I, Livneh V, Hoffmann C, Nass D, Mor O, Chapman J. Steroid-responsive, progressive, focal measles virus brain infection. Ann Neurol 2014; 75:967-70. [PMID: 24817010 DOI: 10.1002/ana.24183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 05/09/2014] [Accepted: 05/09/2014] [Indexed: 11/06/2022]
Abstract
Chronic measles virus infection of the brain causes subacute sclerosing panencephalitis (SSPE), a progressive, relentless fatal disorder. We report a 52-year-old male who developed focal, chronic persistent measles virus infection of the brain following interferon and ribavirin therapy for hepatitis C, and who responded to steroid therapy. This case, diametrically different from SSPE, has 2 unique features, its focal nature and its permissive response to steroids, that may add to the understanding of the pathogenesis of SSPE and the mechanism enabling viruses to evade the immune response and establish persistent brain infection.
Collapse
Affiliation(s)
- Israel Steiner
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | | | | | | | | | | |
Collapse
|
28
|
Jagtap SA, Nair MD, Kambale HJ. Subacute sclerosing panencephalitis: A clinical appraisal. Ann Indian Acad Neurol 2013; 16:631-3. [PMID: 24339595 PMCID: PMC3841616 DOI: 10.4103/0972-2327.120497] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 02/14/2013] [Accepted: 02/24/2013] [Indexed: 11/08/2022] Open
Abstract
Introduction: Subacute sclerosing panencephalitis (SSPE) is a rare chronic, progressive encephalitis affecting primarily children and young adults, caused by a persistent infection of immune resistant measles virus. The aim of the present study is to describe the clinical profile and natural history of patients with SSPE. Methods: We collected data of patients with SSPE during 2004-2010 who fulfilled Dyken's criteria. We analyzed demographical, clinical, electrophysiological, and imaging features. Results: Study included 34 patients, 26 (76.5%) males with age of onset from 3 to 31 years. Twenty one patients were below 15 years of age formed childhood SSPE and 13 above 15 years of age constituted adult onset group. 85.3% had low-socioeconomic status. Eleven received measles vaccination and seven were unvaccinated. 59.9% patients had measles history. Most common presenting symptom was scholastic backwardness (52.5%) followed by seizures (23.5%). Three patients each had cortical blindness, macular degeneration, decreased visual acuity, and optic atrophy. Electroencephalographic (EEG) showed long interval periodic complexes and cerebrospinal fluid anti-measles antibody was positive in all. Magnetic resonance imaging was done in 70.5% with was abnormal in 52.5%. Mean incubation period of SSPE after measles was 9.6 years. The follow-up duration was 1-10 years, (average of 2 years). Only one patient died from available data of follow-up, 9 were stable and 10 deteriorated in the form of progression of staging. Conclusion: SSPE is common in low-socioeconomic status. The profile of adult onset did not differ from childhood onset SSPE, except for a longer interval between measles infection and presence of the ophthalmic symptom as presenting feature in adult onset group.
Collapse
Affiliation(s)
- Sujit Abajirao Jagtap
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | | | | |
Collapse
|
29
|
Abstract
PURPOSE To define atypical clinical and EEG features of patients with subacute sclerosing panencephalitis that may require an overview of differential diagnosis. METHODS A total of 66 EEGs belonging to 53 (17 females and 36 males) consecutive patients with serologically confirmed subacute sclerosing panencephalitis were included in this study. Patient files and EEG data were evaluated retrospectively. EEGs included in the study were sleep-waking EEGs and/or sleep-waking video-EEG records with at least 2 hours duration. Cranial MRIs of the patients taken 2 months before or after the EEG records were included. RESULTS Age range at the onset of the disease was 15 to 192 months (mean age: 80.02 months). Epilepsy was diagnosed in 21 (43%) patients. Among epileptic seizures excluding myoclonic jerks, generalized tonic-clonic type constituted the majority (58%). Tonic seizures were documented during the video-EEG recordings in four patients. Epileptogenic activities were found in 56 (83%) EEG recordings. They were localized mainly in frontal (58%), posterior temporal, parietal, occipital (26%), and centrotemporal (8%) regions. Multiple foci were detected in 26 recordings (39%). Epileptiform activities in the 39 (59%) EEGs appeared as unilateral or bilateral diffuse paroxysmal discharges. CONCLUSIONS Recognition of uncommon clinical and EEG findings of subacute sclerosing panencephalitis, especially in countries where subacute sclerosing panencephalitis has not been eliminated yet, could be helpful in prevention of misdiagnosis and delay in the management of improvable conditions.
Collapse
|
30
|
Gadoth N. Subacute sclerosing panencephalitis (SSPE) the story of a vanishing disease. Brain Dev 2012; 34:705-11. [PMID: 22277189 DOI: 10.1016/j.braindev.2011.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 12/02/2011] [Accepted: 12/24/2011] [Indexed: 11/24/2022]
Abstract
Subacute sclerosing panencephalitis (SSPE), is a devastating "slow virus" brain disease which affects young children who had measles some 6-7 years earlier. Although, the pandemic of SSPE during 1960-1980's was almost eradicated due to mass immunization, the disease is still taking the life of young children in countries where measles immunization is incomplete and in world regions where genetic polymorphism to this particular infection is present. The present review was written for the fortunate young generation of pediatricians and pediatric neurologists who probably have not seen a case of SSPE during their career, and for those who work in counties where the disease has not been eradicated. It is also a reminder that with full coverage of measles immunization this devastating disease can be fully eradicated.
Collapse
Affiliation(s)
- Natan Gadoth
- Department of Neurology, Maynei Hayeshua Medical Center, Bnei Barak 54417 and the Sackler Faculty of Medicine, Tel-Aviv University, Israel.
| |
Collapse
|
31
|
Baillif S, Tieulie N, Queyrel V, Cornut PL, Gastaud P. New aspects of viral necrotizing retinitis in subacute sclerosing panencephalitis with spectral-domain optical coherence tomography. Retin Cases Brief Rep 2012; 6:235-241. [PMID: 25389720 DOI: 10.1097/icb.0b013e318224779b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To report the clinical, angiographic, and tomographic features of an adult patient with bilateral occlusive vasculitis and necrotizing retinitis preceding the onset of subacute sclerosing panencephalitis by 3 years. METHODS Observational case report. RESULTS A 39-year-old white man presented with sudden onset of decreased vision in his left eye. The patient reported a history of right visual loss 3 years ago after an episode of retinal vasculitis of unknown origin. At presentation, left fundus examination showed sensory retinal detachment and retinal hemorrhages in the left macula. Fluorescein angiography revealed occlusive vasculitis. Two weeks later, several circumscribed lesions of necrotizing retinitis appeared in the macula and in the midperiphery after a centrifugal linear pattern from the optic nerve. Spectral-domain optical coherence tomography demonstrated focal areas of moth-eaten disorganization of the ganglion cell and nuclear layers with a spreading from the inner layers to the outer layers. CONCLUSION This unusual case of adult-onset subacute sclerosing panencephalitis may help improve our knowledge regarding the mechanism of retinal involvement in this disease. Clinical and tomographic findings suggest a continuous transneuronal spread of the measles virus from ganglion cells to the photoreceptor cells.
Collapse
Affiliation(s)
- Stéphanie Baillif
- *Department of Ophthalmology, Saint-Roch University Hospital, Nice, France †Department of Internal Medicine, l'Archet University Hospital, Nice, France ‡Department of Ophthalmology, Hospices Civils de Lyon, University Hospital, Claude Bernard University, Lyon, France
| | | | | | | | | |
Collapse
|
32
|
Katrak SM, Mahadevan A, Taly AB, Sinha S, Shankar SK. A 16-year old male with cortical blindness and focal motor seizures. Ann Indian Acad Neurol 2011; 13:225-32. [PMID: 21085540 PMCID: PMC2981767 DOI: 10.4103/0972-2327.70887] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2010] [Accepted: 08/03/2010] [Indexed: 11/08/2022] Open
Affiliation(s)
- S M Katrak
- Department of Neurology, Jaslok Hospital and Research Centre, Mumbai, India
| | | | | | | | | |
Collapse
|
33
|
Har-Even R, Aichenbaum S, Rabey JM, Livne A, Bistritzer T. Measles-vaccinated Israeli boy with subacute sclerosing panencephalitis. Pediatr Neurol 2011; 44:467-70. [PMID: 21555060 DOI: 10.1016/j.pediatrneurol.2011.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 08/19/2010] [Accepted: 01/17/2011] [Indexed: 11/26/2022]
Abstract
Subacute sclerosing panencephalitis is a rare neurologic disorder of childhood and adolescence. We describe a 16-year-old boy who manifested the disease despite proper vaccinations. He was hospitalized because of bedwetting, involuntary limb movements, abnormal speech, and balance disturbances. Immunoglobulin G antibodies against measles were strongly positive, with a high relative cerebrospinal fluid/serum ratio. Polymerase chain reaction for measles produced negative results. Electroencephalography registered slow activity with high voltage discharges every few seconds, and with triphasic complex morphology. Magnetic resonance imaging revealed diffuse white matter changes, mostly around the posterior regions and lateral ventricles. Treatment with valproic acid, levetiracetam, carbamazepine, and intravenous immunoglobulin G was ineffective. Inosiplex and interferon-β-1a were also administrated. The patient became comatose, with generalized myoclonic jerks, and died 1 year later. An autopsy was not performed. This patient illustrates that subacute sclerosing panencephalitis should be suspected among young vaccinated subjects.
Collapse
Affiliation(s)
- Ronly Har-Even
- Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | |
Collapse
|
34
|
Abstract
Subacute sclerosing panencephalitis (SSPE) is a chronic encephalitis occurring after infection with measles virus. The prevalence of the disease varies depending on uptake of measles vaccination, with the virus disproportionally affecting regions with low vaccination rates. The physiopathology of the disease is not fully understood; however, there is evidence that it involves factors that favour humoral over cellular immune response against the virus. As a result, the virus is able to infect the neurons and to survive in a latent form for years. The clinical manifestations occur, on average, 6 years after measles virus infection. The onset of SSPE is insidious, and psychiatric manifestations are prominent. Subsequently, myoclonic seizures usually lead to a final stage of akinetic mutism. The diagnosis is clinical, supported by periodic complexes on electroencephalography, brain imaging suggestive of demyelination, and immunological evidence of measles infection. Management of the disease includes seizure control and avoidance of secondary complications associated with the progressive disability. Trials of treatment with interferon, ribavirin, and isoprinosine using different methodologies have reported beneficial results. However, the disease shows relentless progression; only 5% of individuals with SSPE undergo spontaneous remission, with the remaining 95% dying within 5 years of diagnosis.
Collapse
Affiliation(s)
- Jose Gutierrez
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
| | | | | |
Collapse
|
35
|
Fabian VA, Lee HY, Keith-Rokosh JL, Souza JLD, Stewart-Wynne E. A 22-year-old Australian woman with atypical subacute sclerosing panencephalitis diagnosed at postmortem. J Clin Neurosci 2010; 17:1192-4. [DOI: 10.1016/j.jocn.2009.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 12/01/2009] [Accepted: 12/17/2009] [Indexed: 10/19/2022]
|
36
|
Izycka-Swieszewska E, Swierkocka-Miastkowska M, Szurowska E, Lewandowska E, Wierzba-Bobrowicz T, Jodzio K. 31-year-old man with balint's syndrome and visual problems. Brain Pathol 2009; 19:527-30. [PMID: 19563545 DOI: 10.1111/j.1750-3639.2009.00300.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
37
|
Eroglu E, Gokcil Z, Bek S, Ulas UH, Ozdag MF, Odabasi Z. Long-term follow-up of patients with adult-onset subacute sclerosing panencephalitis. J Neurol Sci 2008; 275:113-6. [DOI: 10.1016/j.jns.2008.07.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 07/31/2008] [Indexed: 11/29/2022]
|
38
|
|
39
|
Campbell H, Andrews N, Brown KE, Miller E. Review of the effect of measles vaccination on the epidemiology of SSPE. Int J Epidemiol 2007; 36:1334-48. [DOI: 10.1093/ije/dym207] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
40
|
Cole AJ, Henson JW, Roehrl MHA, Frosch MP. Case records of the Massachusetts General Hospital. Case 24-2007. A 20-year-old pregnant woman with altered mental status. N Engl J Med 2007; 357:589-600. [PMID: 17687135 DOI: 10.1056/nejmcpc079018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Andrew J Cole
- Neurology Service, Massachusetts General Hospital, USA
| | | | | | | |
Collapse
|
41
|
Prashanth LK, Taly AB, Sinha S, Ravi V. Subacute sclerosing panencephalitis (SSPE): an insight into the diagnostic errors from a tertiary care university hospital. J Child Neurol 2007; 22:683-8. [PMID: 17641252 DOI: 10.1177/0883073807303999] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Subacute sclerosing panencephalitis (SSPE) is a progressive disease caused by wild-type measles virus leading to premature death. Early diagnosis may help in medical interventions and counseling. The aim of this study was to ascertain diagnostic errors and their possible causes. Retrospective case record analysis of patients with subacute sclerosing panencephalitis, evaluated over a 10-year period, was performed. The following data were analyzed: initial symptoms and diagnosis, interval between onset of symptoms to diagnosis, and implications of delayed diagnosis. Among the 307 patients evaluated, initial diagnosis by various health care professionals was other than subacute sclerosing panencephalitis in 242 patients (78.8%). These included seizures, absence seizures, metachromatic leukodystrophy, Schilder's disease, cerebral palsy, hemiparkinsonism, Wilson's disease, vasculitis, spinocerebellar ataxia, motor neuron disease, nutritional amblyopia, tapetoretinal degeneration, catatonic schizophrenia, and malingering, among others. The interval between precise diagnosis and first reported symptom was 6.2 +/- 11.3 months (range, 0.2-96 months; median, 3 months). Forty-four patients (14.3%) who had symptoms for more than 1 year before the precise diagnosis had a protracted course as compared to the rest of the cohort ( P = .0001). Early and accurate diagnosis of subacute sclerosing panencephalitis needs a high index of suspicion.
Collapse
Affiliation(s)
- L K Prashanth
- Department of Neurology and Department of Neurovirology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | | | | | | |
Collapse
|