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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.
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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
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Saft C, Burgunder JM, Dose M, Jung HH, Katzenschlager R, Priller J, Nguyen HP, Reetz K, Reilmann R, Seppi K, Landwehrmeyer GB. Differential diagnosis of chorea (guidelines of the German Neurological Society). Neurol Res Pract 2023; 5:63. [PMID: 37993913 PMCID: PMC10666412 DOI: 10.1186/s42466-023-00292-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Choreiform movement disorders are characterized by involuntary, rapid, irregular, and unpredictable movements of the limbs, face, neck, and trunk. These movements often initially go unnoticed by the affected individuals and may blend together with seemingly intended, random motions. Choreiform movements can occur both at rest and during voluntary movements. They typically increase in intensity with stress and physical activity and essentially cease during deep sleep stages. In particularly in advanced stages of Huntington disease (HD), choreiform hyperkinesia occurs alongside with dystonic postures of the limbs or trunk before they typically decrease in intensity. The differential diagnosis of HD can be complex. Here, the authors aim to provide guidance for the diagnostic process. This guidance was prepared for the German Neurological Society (DGN) for German-speaking countries. RECOMMENDATIONS Hereditary (inherited) and non-hereditary (non-inherited) forms of chorea can be distinguished. Therefore, the family history is crucial. However, even in conditions with autosomal-dominant transmission such as HD, unremarkable family histories do not necessarily rule out a hereditary form (e.g., in cases of early deceased or unknown parents, uncertainties in familial relationships, as well as in offspring of parents with CAG repeats in the expandable range (27-35 CAG repeats) which may display expansions into the pathogenic range). CONCLUSIONS The differential diagnosis of chorea can be challenging. This guidance prepared for the German Neurological Society (DGN) reflects the state of the art as of 2023.
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Affiliation(s)
- Carsten Saft
- Department of Neurology, St. Josef-Hospital, Huntington-Zentrum NRW, Ruhr-Universität Bochum, Bochum, Germany.
| | - Jean-Marc Burgunder
- Department of Neurology, Schweizerisches Huntington-Zentrum, Bern University, Bern, Switzerland
| | - Matthias Dose
- Kbo-Isar-Amper-Klinikum Taufkirchen/München-Ost, Munich, Germany
| | - Hans Heinrich Jung
- Department of Neurology, University Hospital Zürich, Zurich, Switzerland
| | - Regina Katzenschlager
- Department of Neurology, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Klinik Donaustadt, Vienna, Austria
| | - Josef Priller
- Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Neuropsychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Huu Phuc Nguyen
- Department of Human Genetics, Huntington-Zentrum NRW, Ruhr-Universität Bochum, Bochum, Germany
| | - Kathrin Reetz
- Department of Neurology, Euregional Huntington Centre Aachen, RWTH Aachen University Hospital, Aachen, Germany
| | - Ralf Reilmann
- George-Huntington-Institute, Muenster, Germany
- Department of Radiology, Universitaetsklinikum Muenster (UKM), Westfaelische Wilhelms-University, Muenster, Germany
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Mondal R, Deb S, Mahata M, Saha S, Lahiri D, Benito-León J. Subacute Sclerosing Panencephalitis in a 63-Year-Old Woman Presenting as Generalized Choreoathetosis. Neurohospitalist 2023; 13:381-393. [PMID: 37701261 PMCID: PMC10494821 DOI: 10.1177/19418744231177105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
The persistence of measles virus infection in childhood and early adolescence can rarely lead to a fatal progressive neurodegenerative disorder known as subacute sclerosing panencephalitis (SSPE), characterized by behavioral disturbances and intellectual disability followed by myoclonic jerks and occasional negative myoclonus. Movement disorders are rarely presenting manifestations in SSPE. We herein report a 63-year-old woman with generalized choreoathetosis as the presenting manifestation of stage-I SSPE. Our case was atypical for the patient's age and clinical presentation with generalized choreoathetosis and bilateral putaminal and caudate nucleus signal hyperintensity. Though highly uncommon, neurologists should keep SSPE as a differential diagnosis among patients with movement disorders. Measles-endemic countries should be more vigilant to the atypical and rare presentations of SSPE, such as generalized choreoathetosis.
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Affiliation(s)
- Ritwick Mondal
- Department of Clinical Pharmacology and Therapeutic Medicine, IPGMER and SSKM Hospital, Kolkata, India
| | - Shramana Deb
- Department of Neuroscience, S.N.Pradhan Centre for Neuroscience, Kolkata, India
| | - Manoj Mahata
- Department of Interventional Neurology, Bellevue Clinic, Kolkata, India
| | - Somesh Saha
- Department of Critical Care Medicine, Bellevue clinic, Kolkata, India
| | - Durjoy Lahiri
- Department of Cognitive Neurology, Baycrest Health Sciences and Rotman Research Institute, University of Toronto, Canada, India
| | - Julián Benito-León
- Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
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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.
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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
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Jain R, Aulakh R. Measles-Associated CNS Complications: A Review. JOURNAL OF CHILD SCIENCE 2022. [DOI: 10.1055/s-0042-1757914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AbstractMeasles virus infection is a common infectious disease of childhood, incidence of which is still high in developing countries. Other than the morbidity associated with the acute systemic infection, the measles virus can cause serious fatal neural complications. It can either enter the brain leading to acute encephalitis like primary measles encephalitis and acute post infectious measles encephalomyelitis or it may persist in brain cells (as mutated virus) leading to long-term neurodegenerative diseases like measles inclusion body encephalitis and subacute sclerosing pan encephalitis. The patho-clinical features, treatment, and the outcomes of these complications are different and should be identified in time for early diagnosis and management.
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Affiliation(s)
- Reena Jain
- Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India
| | - Roosy Aulakh
- Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India
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Liu YX, Li B, Wu KR, Tang LY, Lin Q, Li QH, Yuan Q, Shi WQ, Liang RB, Ge QM, Shao Y. Altered white matter integrity in patients with monocular blindness: A diffusion tensor imaging and tract-based spatial statistics study. Brain Behav 2020; 10:e01720. [PMID: 32558355 PMCID: PMC7428480 DOI: 10.1002/brb3.1720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Visual deprivation can lead to abnormal and plastic changes in the brain's visual system and other systems. Although the secondary changes of gray matter in patients have been well studied, the study of white matter is rare. In fact, subtle changes in white matter may be revealed by diffusion tensor imaging, and tract-based spatial statistics can be used to analyze DTI image data. PURPOSE In the present study, diffusion tensor imaging (DTI) and tract-based spatial statistics (TBSS) were used to investigate abnormal structural changes in the white matter (WM) of patients with monocular blindness (MB). METHODS We recruited 16 healthy controls (HC) (fourteen males and two females) and 16 patients (fifteen males and one female) with right-eye blindness (without differences in left-eye vision). All patients were of similar age. Data acquisition was performed using magnetic resonance imaging (MRI) and DTI. Voxel-based whole brain comparisons of fractional anisotropy (FA) and radial diffusivity (RD) of WM fibers in patients and HC were performed using the TBSS method. The mean FA and RD values for altered brain regions in MB patients were analyzed via the receiver operating characteristic (ROC) curve. Correlation analysis was performed to investigate the relationships between the average FA (RD) value of the whole brain and anxiety score, depression score, and visual function questionnaire score in MB patients. RESULTS In MB patients, the mean FA of the whole brain was decreased versus HC. Moreover, the FA values of the corpus callosum, the corona radiata, the posterior thalamic radiation, and the right retrolenticular part of internal capsule were significantly decreased. In addition, the average RD value of the whole brain in MB patients was higher than that observed in HC. The mean FA and RD values of brain regions were analyzed using the ROC curve, and the results showed that the area under the ROC curve was more accurate. Furthermore, the average FA and RD values of the whole brain were significantly correlated with anxiety score, depression score, and visual function-related quality of life score. CONCLUSION DTI and TBSS may be useful in examining abnormal spontaneous alterations in the WM of MB patients. The observed changes in FA and RD values may imply the larvaceous neurological mechanism involved in MB.
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Affiliation(s)
- Yu-Xin Liu
- Department of Ophthalmology, Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Biao Li
- Department of Ophthalmology, Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kang-Rui Wu
- Department of Ophthalmology, Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li-Ying Tang
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, Xiamen University School of Medicine, Xiamen, China
| | - Qi Lin
- Department of Ophthalmology, Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qing-Hai Li
- Department of Ophthalmology, Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qing Yuan
- Department of Ophthalmology, Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wen-Qing Shi
- Department of Ophthalmology, Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Rong-Bin Liang
- Department of Ophthalmology, Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qian-Min Ge
- Department of Ophthalmology, Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yi Shao
- Department of Ophthalmology, Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
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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.
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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
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Tandra HV, Roy PS, Sharma R, Bhatia V, Saini AG. Subacute Sclerosing Panencephalitis Presenting as Choreoathetosis and Basal Ganglia Hyperintensities. Neurohospitalist 2018; 9:26-29. [PMID: 30671161 DOI: 10.1177/1941874418776902] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Subacute sclerosing panencephalitis is a devastating neurodegenerative disorder characterized by cognitive and memory deterioration, personality changes, behavior abnormalities, and a steady motor decline. Extrapyramidal manifestations are commonly seen in the advanced stage of the disease. We discuss a 10-year-old boy with subacute sclerosing panencephalitis presenting with generalized choreoathetosis, myoclonus, and cognitive decline. He had not been immunized for measles. His elder sister had a viral exanthematous illness 4 years ago. Magnetic resonance imaging revealed bilateral, asymmetric putaminal hyperintensities. A diagnosis of subacute sclerosing panencephalitis was confirmed by periodic complexes in the electroencephalograph and elevated antimeasles antibody titers in the blood and cerebrospinal fluid (1:625). Our case highlights that atypical clinical and radiological features of subacute sclerosing panencephalitis should always be borne in mind in children from endemic areas. Generalized choreoathetosis and bilateral putaminal involvement in the index case add to the spectrum of atypical presentations of subacute sclerosing panencephalitis in children.
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Affiliation(s)
- Harish Varma Tandra
- Pediatric Neurology and Neurodevelopment Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pritam Singha Roy
- Pediatric Neurology and Neurodevelopment Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Sharma
- Pediatric Neurology and Neurodevelopment Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Bhatia
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arushi Gahlot Saini
- Pediatric Neurology and Neurodevelopment Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Saini AG, Sankhyan N, Padmanabh H, Sahu JK, Vyas S, Singhi P. Subacute sclerosing panencephalitis presenting as acute cerebellar ataxia and brain stem hyperintensities. Eur J Paediatr Neurol 2016; 20:435-8. [PMID: 26968729 DOI: 10.1016/j.ejpn.2016.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/15/2016] [Accepted: 02/07/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Subacute sclerosing panencephalitis is a devastating neurodegenerative disease with a characteristic clinical course. Atypical presentations may be seen in 10% of the cases. AIMS To describe the atypical clinical and radiological features of SSPE in a child form endemic country. METHODS A 5-year-old boy presented with acute-onset cerebellar ataxia without associated encephalopathy, focal motor deficits, seizures or cognitive decline. He had varicella-like illness with vesicular, itchy truncal rash erupting one month prior to the onset of these symptoms. He underwent detailed neurological assessment, relevant laboratory and radiological investigations. RESULTS Neuroimaging revealed peculiar brain stem lesions involving the pons and cerebellum suggestive of demyelination. With a presumptive diagnosis of clinically isolated syndrome of demyelination, he was administered pulse methylprednisolone (30 mg/kg/day for 5 days). Four weeks later he developed myoclonic jerks. Electroencephalogram showed characteristic periodic complexes time-locked with myoclonus. CSF and serum anti-measles antibody titres were elevated (1:625). CONCLUSION Our report highlights that subacute sclerosing panencephalitis can present atypically as isolated acute cerebellar ataxia and peculiar involvement of longitudinal and sparing of transverse pontine fibres. The predominant brainstem abnormalities in the clinical setting may mimick acute demyelinating syndrome. Hence, it is important to recognize these features of subacute sclerosing panencephalitis in children, especially in the endemic countries.
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Affiliation(s)
- Arushi Gahlot Saini
- Pediatric Neurology and Neurodevelopment Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Naveen Sankhyan
- Pediatric Neurology and Neurodevelopment Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Hansashree Padmanabh
- Pediatric Neurology and Neurodevelopment Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Jitendra Kumar Sahu
- Pediatric Neurology and Neurodevelopment Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sameer Vyas
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Pratibha Singhi
- Pediatric Neurology and Neurodevelopment Unit, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
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