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Shaligram R, Garud BP, Jadhav RS, Chalipat S, Mane S. A Rare Case of Subacute Sclerosing Panencephalitis in an Immunized Patient. Cureus 2024; 16:e63258. [PMID: 39070335 PMCID: PMC11282383 DOI: 10.7759/cureus.63258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
This study presents a case of subacute sclerosing panencephalitis (SSPE), a rare neurologic disorder characterized by brain inflammation, typically triggered by measles virus reactivation or an abnormal immune response to it. This case involves a five-year-old male child with persistent fever, declining motor function, excessive sleepiness, and myoclonic jerks. MRI indicated potential ischemic changes or encephalitis, while electroencephalography showed SSPE-consistent patterns. Further investigations confirmed SSPE, with elevated IgG levels in serum and cerebrospinal fluid (CSF) and positive measles IgG antibodies in CSF. Treatment included isoprinosine, lamivudine, and intrathecal interferon-alpha for symptom management and disease progression. Despite atypical SSPE features, subclinical measles infection was considered a probable cause. The patient showed partial improvement post-treatment and was discharged for follow-up. By reporting this case, we would like to emphasize clinical judgment, early detection of the symptoms, and lateral thinking to diagnose fatal conditions such as post-measles SSPE, even in fully immunized patients.
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Affiliation(s)
- Ruhi Shaligram
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Balakrushna P Garud
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Renuka S Jadhav
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Shiji Chalipat
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Shailaja Mane
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
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2
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Aygün FB, Ulutas C, Dikmetas O, Kocabeyoglu S, Kadayıfcılar S. Multimodal Imaging for Subacute Sclerosing Panencephalitis: Including Anterior Segment. Ophthalmic Surg Lasers Imaging Retina 2024; 55:344-348. [PMID: 38408226 DOI: 10.3928/23258160-20240205-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Subacute sclerosing panencephalitis (SSPE) is an irreversible and progressive neurological disorder. A 20-year-old woman with SSPE presented with a decline in visual acuity. Anterior segment was evaluated with slit lamp and in vivo confocal microscopy, revealing the presence of dendritiform keratic precipitates and +2 cells in the anterior chamber. In fundus examination, white-yellowish lesions involving the macula and periphery were observed, which gradually progressed into atrophy over time. Optical coherence tomography (OCT) imaging showed progression to atrophy of moth-eaten shaped cavities including all retinal layers due to necrotizing retinitis. OCT angiography (OCTA) further revealed reduced vessel densities and flow void areas. Notably, to the best of our knowledge, this is the first case documenting anterior segment findings in SSPE in detail. [Ophthalmic Surg Lasers Imaging Retina 2024;55:344-348.].
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Lee B, Choi HN, Che YH, Ko M, Seong HM, Jo MG, Kim SH, Song C, Yoon S, Choi J, Kim JH, Kim M, Lee MY, Park SW, Kim HJ, Kim SJ, Moon DS, Lee S, Park JH, Yeo SG, Everson RG, Kim YJ, Hong KW, Roh IS, Lyoo KS, Kim YJ, Yun SP. SARS-CoV-2 infection exacerbates the cellular pathology of Parkinson's disease in human dopaminergic neurons and a mouse model. Cell Rep Med 2024; 5:101570. [PMID: 38749422 PMCID: PMC11148862 DOI: 10.1016/j.xcrm.2024.101570] [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: 06/20/2023] [Revised: 01/23/2024] [Accepted: 04/22/2024] [Indexed: 05/24/2024]
Abstract
While an association between Parkinson's disease (PD) and viral infections has been recognized, the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on PD progression remains unclear. Here, we demonstrate that SARS-CoV-2 infection heightens the risk of PD using human embryonic stem cell (hESC)-derived dopaminergic (DA) neurons and a human angiotensin-converting enzyme 2 (hACE2) transgenic (Tg) mouse model. Our findings reveal that SARS-CoV-2 infection exacerbates PD susceptibility and cellular toxicity in DA neurons pre-treated with human preformed fibrils (hPFFs). Additionally, nasally delivered SARS-CoV-2 infects DA neurons in hACE2 Tg mice, aggravating the damage initiated by hPFFs. Mice infected with SARS-CoV-2 display persisting neuroinflammation even after the virus is no longer detectable in the brain. A comprehensive analysis suggests that the inflammatory response mediated by astrocytes and microglia could contribute to increased PD susceptibility associated with SARS-CoV-2. These findings advance our understanding of the potential long-term effects of SARS-CoV-2 infection on the progression of PD.
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Affiliation(s)
- Bina Lee
- Department of Pharmacology, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Ha Nyeoung Choi
- Department of Pharmacology, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Republic of Korea; Department of Convergence Medical Science, College of Medicine, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Young Hyun Che
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea; Department of Pathology, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Myungjun Ko
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Hye Min Seong
- Department of Ophthalmology, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Min Gi Jo
- Department of Pharmacology, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Republic of Korea; Department of Pathology, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Seon-Hee Kim
- Department of Pharmacology, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Chieun Song
- Department of Ophthalmology, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Subeen Yoon
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea; Department of Pathology, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Jiwoo Choi
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea; Department of Pathology, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Jeong Hee Kim
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea; Department of Pathology, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Minkyeong Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
| | - Min Young Lee
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, BK21 FOUR ERGID, Vessel-Organ Interaction Research Center (MRC), Kyungpook National University, Daegu 4156, Republic of Korea
| | - Sang Won Park
- Department of Pharmacology, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Republic of Korea; Department of Convergence Medical Science, College of Medicine, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Hye Jung Kim
- Department of Pharmacology, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Republic of Korea; Department of Convergence Medical Science, College of Medicine, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Seong Jae Kim
- Department of Ophthalmology, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Do Sik Moon
- Department of Pulmonology and Critical Care Medicine, Chosun University Hospital, Gwangju 61453, Republic of Korea
| | - Sun Lee
- Department of Pathology, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; Research Center, TissueIn, Inc., Seoul 06158, Republic of Korea
| | - Jae-Hoon Park
- Department of Pathology, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Seung-Geun Yeo
- Department of Otorhinolaryngology - Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Richard G Everson
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Young Jin Kim
- Department of Pharmacology, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Republic of Korea; Department of Convergence Medical Science, College of Medicine, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Kyung-Wook Hong
- Division of Infectious Diseases, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - In-Soon Roh
- Division of Foreign Animal Disease, Animal and Plant Quarantine Agency, Gimcheon-si, Gyeongsangbuk-do 39660, Republic of Korea
| | - Kwang-Soo Lyoo
- Department of Veterinary Nursing, College of Health Sciences, Wonkwang University, Iksan 54538, Republic of Korea.
| | - Yong Jun Kim
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea; Department of Pathology, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; Research Center, TissueIn, Inc., Seoul 06158, Republic of Korea; KHU-KIST Department of Converging Science and Technology, Kyung Hee University, Seoul 02447, Republic of Korea.
| | - Seung Pil Yun
- Department of Pharmacology, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, Republic of Korea; Department of Convergence Medical Science, College of Medicine, Gyeongsang National University, Jinju 52727, Republic of Korea.
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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.
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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
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Kilich G, Perelygina L, Sullivan KE. Rubella virus chronic inflammatory disease and other unusual viral phenotypes in inborn errors of immunity. Immunol Rev 2024; 322:113-137. [PMID: 38009321 DOI: 10.1111/imr.13290] [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] [Indexed: 11/28/2023]
Abstract
Infectious susceptibility is a component of many inborn errors of immunity. Nevertheless, antibiotic use is often used as a surrogate in history taking for infectious susceptibility, thereby disadvantaging patients who present with viral infections as their phenotype. Further complicating clinical evaluations are unusual manifestations of viral infections which may be less familiar that the typical respiratory viral infections. This review covers several unusual viral phenotypes arising in patients with inborn errors of immunity and other settings of immune compromise. In some cases, chronic infections lead to oncogenesis or tumor-like growths and the conditions and mechanisms of viral-induced oncogenesis will be described. This review covers enterovirus, rubella, measles, papillomavirus, and parvovirus B19. It does not cover EBV and hemophagocytic lymphohistiocytosis nor lymphomagenesis related to EBV. EBV susceptibility has been recently reviewed. Our goal is to increase awareness of the unusual manifestations of viral infections in patients with IEI and to describe treatment modalities utilized in this setting. Coincidentally, each of the discussed viral infections can have a cutaneous component and figures will serve as a reminder of the physical features of these viruses. Given the high morbidity and mortality, early recognition can only improve outcomes.
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Affiliation(s)
- Gonench Kilich
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ludmila Perelygina
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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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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7
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Garg D, Kakkar V, Sharma S. Periodic Laughter-like Episodes in Subacute Sclerosing Panencephalitis-Is it Gelastic Myoclonus? Mov Disord Clin Pract 2023; 10:1547-1548. [PMID: 37868918 PMCID: PMC10585968 DOI: 10.1002/mdc3.13848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 10/24/2023] Open
Affiliation(s)
- Divyani Garg
- Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Vanshika Kakkar
- Department of Pediatrics (Neurology Division)Lady Hardinge Medical College and Associated HospitalsNew DelhiIndia
| | - Suvasini Sharma
- Department of Pediatrics (Neurology Division)Lady Hardinge Medical College and Associated HospitalsNew DelhiIndia
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Ibrahim SH, Farooq H. Low glycemic index therapy in children with sub-acute sclerosing panencephalitis (SSPE): an experience from a measles-endemic country. Front Nutr 2023; 10:1203144. [PMID: 37554700 PMCID: PMC10406380 DOI: 10.3389/fnut.2023.1203144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/27/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Sub-acute sclerosing panencephalitis (SSPE) is a chronic, progressive neurodegenerative disorder, commonly seen in measles-endemic countries leading to progressive neuronal loss and death. Currently, there is no proven cure for this devastating disease. We started a low glycemic index therapy (LGIT) in children with SSPE using the same principle as per its role in intractable epilepsy. METHODOLOGY Low glycemic index diet was started in children with a confirmed diagnosis of SSPE based on Dyken's criteria. All children were then classified into four stages according to disease progression. The response to diet was evaluated by improvement in their myoclonic jerks, motor activities, and changes in their stage of the disease. RESULTS A total of 12 children were enrolled. The mean age was 6.65 years (range 3.3-10 years), with a male-to-female ratio of 2:1. Five children were at stage IV, five were at stage III, and two were at stage II at the start of the diet. Nine (75%) children showed improvement in their stage of illness. Of three children who were at stage IV at the initiation of the diet, one improved to stage II and two to stage III. Four children at stage III reverted to stage II. Two children initiated at stage II went into total remission. Seven (58.3%) children showed a >50% reduction in myoclonic jerks with three (25%) having a 100% reduction. Three (25%) children died due to pneumonia. CONCLUSION LGIT may play an effective role in the management of SSPE and gives hope to families having children with this potentially life-threatening disease.
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Affiliation(s)
- Shahnaz H. Ibrahim
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Hira Farooq
- Department of Nutrition, Aga Khan University, Karachi, Pakistan
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Yong HYF, Pastula DM, Kapadia RK. Diagnosing viral encephalitis and emerging concepts. Curr Opin Neurol 2023; 36:175-184. [PMID: 37078655 DOI: 10.1097/wco.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
PURPOSE OF REVIEW This review offers a contemporary clinical approach to the diagnosis of viral encephalitis and discusses recent advances in the field. The neurologic effects of coronaviruses, including COVID-19, as well as management of encephalitis are not covered in this review. RECENT FINDINGS The diagnostic tools for evaluating patients with viral encephalitis are evolving quickly. Multiplex PCR panels are now in widespread use and allow for rapid pathogen detection and potentially reduce empiric antimicrobial exposure in certain patients, while metagenomic next-generation sequencing holds great promise in diagnosing challenging and rarer causes of viral encephalitis. We also review topical and emerging infections pertinent to neuroinfectious disease practice, including emerging arboviruses, monkeypox virus (mpox), and measles. SUMMARY Although etiological diagnosis remains challenging in viral encephalitis, recent advances may soon provide the clinician with additional tools. Environmental changes, host factors (such as ubiquitous use of immunosuppression), and societal trends (re-emergence of vaccine preventable diseases) are likely to change the landscape of neurologic infections that are considered and treated in clinical practice.
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Affiliation(s)
- Heather Y F Yong
- Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Cummings School of Medicine, Calgary, Alberta, Canada
| | - Daniel M Pastula
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Ronak K Kapadia
- Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Cummings School of Medicine, Calgary, Alberta, Canada
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Rana V, Sharma KM, Arora A, Dogra M, Thakkar A, Sharma A, Lal V, Gupta V. A 12-YEAR-OLD ASIAN INDIAN BOY WITH BILATERAL RAPIDLY PROGRESSIVE NECROTIZING MACULAR RETINITIS. Retin Cases Brief Rep 2023; 17:S6-S10. [PMID: 36026695 DOI: 10.1097/icb.0000000000001344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE To describe clinical and imaging findings in a young boy presenting with bilateral rapidly progressive necrotizing macular retinitis. METHODS A 12-year-old Asian Indian boy developed bilateral progressive macular retinitis. He had generalized tonic-clonic seizures for the past 3 months and gave a history of poor scholastic performance with dementia of recent onset. Multimodal imaging comprising and detailed systemic and laboratory work-up was performed. RESULTS Both eyes showed rapidly progressive full-thickness retinitis lesions observed as disruption of retinal architecture in both eyes. Left eye optical coherence tomography shows full-thickness retinal involvement with sparing of the internal limiting membrane. Electroencephalogram and magnetic resonance imaging (brain) were suggestive of subacute sclerosing panencephalitis and the diagnosis was confirmed by elevated cerebrospinal fluid and serum IgG measles. The patient did not survive despite treatment with systemic interferon therapy. CONCLUSION It is important to look for the measles virus as a probable cause of necrotizing retinitis and neurologic symptoms in immunocompetent unvaccinated young patients. Early referral to a neurologist may assist in the early diagnosis of subacute sclerosing panencephalitis and targeted therapy.
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Affiliation(s)
- Vipin Rana
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kopal Mithal Sharma
- Dr Sandeep Mithal Advanced Phaco-refractive and Vitreo-retina Centre, Meerut, India
| | - Atul Arora
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aastha Thakkar
- Department of Neurosciences, Post Graduate Institute of Medical Education and Research, Chandigarh, India; and
| | - Aman Sharma
- Department of Rheumatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Lal
- Department of Neurosciences, Post Graduate Institute of Medical Education and Research, Chandigarh, India; and
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Pajantoy AIJA, Dimzon LD, Camara PTA, San Luis AM. The Enigma of Autoimmunity: A Case of Subacute Sclerosing Panencephalitis in a Patient Diagnosed With Systemic Lupus Erythematosus. Cureus 2023; 15:e37602. [PMID: 37197115 PMCID: PMC10184722 DOI: 10.7759/cureus.37602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/19/2023] Open
Abstract
Subacute sclerosing panencephalitis (SSPE) is a rare complication of measles characterized by progressive neurological deterioration. The onset usually occurs about seven to 10 years after the measles infection. Aside from an earlier age of measles infection, factors that may influence the susceptibility for its development is unknown. There is a paucity of data regarding the course of SSPE in the presence of concomitant autoimmune conditions such as systemic lupus erythematosus (SLE). We report a case of a 19-year-old female who presented with new onset recurrent generalized tonic-clonic seizures, malar rash, and cutaneous erythematous, maculopapular eruptions. Antinuclear antibodies (ANA) and anti-double stranded DNA (anti-dsDNA) serologic examination yielded positive results favoring the diagnosis of SLE. Further in the course of illness, the patient developed generalized myoclonic jerks and progressive decline in language, cognitive, and motor functions. Subsequent investigation showed an elevated anti-measles antibody titer in the cerebrospinal fluid, and periodic generalized, bilaterally synchronous, and symmetric high voltage slow-wave complexes in the EEG. These findings and the typical evolution of neurologic manifestations fulfilled two major and one minor Dyken's criteria for the diagnosis of SSPE. It is postulated that some autoimmune-mediated responses may contribute to the evolution of SSPE. Autoimmune complexes in SLE induce downregulation of T-cell responses which accelerate the loss of antibodies formed against other diseases such as the measles virus that may lead to increased susceptibility to infection. SSPE is hypothesized to result from the downregulation of host-immune responses which leads to incomplete measles viral clearance. To the best of the authors' knowledge, this is the first published case of SSPE with active SLE.
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Affiliation(s)
- Al Inde John A Pajantoy
- Department of Adult Neurology, Center for Neurological Sciences, Quirino Memorial Medical Center, Quezon City, PHL
| | - Lester D Dimzon
- Department of Adult Neurology, Center for Neurological Sciences, Quirino Memorial Medical Center, Quezon City, PHL
| | - Pia Teresa A Camara
- Department of Adult Neurology, Center for Neurological Sciences, Quirino Memorial Medical Center, Quezon City, PHL
- Department of Clinical Neurosciences, University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, PHL
| | - Amado M San Luis
- Department of Adult Neurology, Center for Neurological Sciences, Quirino Memorial Medical Center, Quezon City, PHL
- Department of Clinical Neurosciences, University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, PHL
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Measles Induced Encephalitis: Recent Interventions to Overcome the Obstacles Encountered in the Management Amidst the COVID-19 Pandemic. Diseases 2022; 10:diseases10040104. [PMID: 36412598 PMCID: PMC9680274 DOI: 10.3390/diseases10040104] [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: 05/29/2022] [Revised: 09/14/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
Encephalitis, a well-known complication of measles, is inflammation of the brain parenchyma which is mostly due to the viral invasion of neurons. It presents with a variety of symptoms ranging from mild to severe depending on the extent of the damaged neurons. The diagnosis is based on clinical symptoms such as fever, headache, altered level of consciousness, focal neurological deficits, etc. A detailed history and physical examination facilitate the diagnosis. Investigations include blood tests for measles-specific antibodies, CT, MRI, and analysis of the CSF. The management of measles-induced encephalitis mainly revolves around prevention against contracting the disease and providing supportive care if acquired. The administration of the measles vaccine is the major means of preventing this disease in childhood. Two doses are required to achieve sufficient immunity against measles, the first at the age of 12-15 months and the second at 4-6 years of age. Supportive care includes administering acetaminophen for fever, oral rehydrating salt (ORS) for diarrhea and vomiting, antibiotics for otitis media and pneumonia, and using anti-epileptics such as sodium valproate for seizures. Vitamin A can be given to prevent severe effects in children. The specific treatment would depend on the type of encephalitis the patient has developed.
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Agarwal A, Garg D, Tayade K, Vaigankar A, Saikrishna K, Anand P, Goel V, Radhakrishna DM, Garg A, Srivastava AK. Subacute Sclerosing Panencephalitis: A Name with Many Faces. Ann Indian Acad Neurol 2022; 25:1252-1254. [PMID: 36911488 PMCID: PMC9996529 DOI: 10.4103/aian.aian_807_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Divyani Garg
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Kamlesh Tayade
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Vaigankar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Pooja Anand
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Goel
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Achal K. Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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14
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Ghosh R, Dubey S, Mukherjee A, Benito-León J. Rapidly progressive dementia with generalized myoclonus in an adult: Do not forget subacute sclerosing panencephalitis. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:415-418. [PMID: 35672127 DOI: 10.1016/j.nrleng.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/30/2021] [Indexed: 10/18/2022] Open
Affiliation(s)
- R Ghosh
- Department of General Medicine, Burdwan Medical College & Hospital, Burdwan, West Bengal, India
| | - S Dubey
- Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata, India
| | - A Mukherjee
- Department of General Medicine, Burdwan Medical College & Hospital, Burdwan, West Bengal, India
| | - J Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain; Department of Neurology, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Department of Medicine, Complutense University, Madrid, Spain.
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15
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Ghosh R, Dubey S, Mukherjee A, Benito-León J. Rapidly progressive dementia with generalized myoclonus in an adult: Do not forget subacute sclerosing panencephalitis. Neurologia 2022. [DOI: 10.1016/j.nrl.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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16
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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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17
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Papetti L, Amodeo ME, Sabatini L, Baggieri M, Capuano A, Graziola F, Marchi A, Bucci P, D’Ugo E, Kojouri M, Gioacchini S, Marras CE, Nucci CG, Ursitti F, Sforza G, Ferilli MAN, Monte G, Moavero R, Vigevano F, Valeriani M, Magurano F. Subacute Sclerosing Panencephalitis in Children: The Archetype of Non-Vaccination. Viruses 2022; 14:v14040733. [PMID: 35458463 PMCID: PMC9029616 DOI: 10.3390/v14040733] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/22/2022] Open
Abstract
Subacute sclerosing panencephalitis (SSPE) is a late complication of measles virus infection that occurs in previously healthy children. This disease has no specific cure and is associated with a high degree of disability and mortality. In recent years, there has been an increase in its incidence in relation to a reduction in vaccination adherence, accentuated by the COVID-19 pandemic. In this article, we take stock of the current evidence on SSPE and report our personal clinical experience. We emphasise that, to date, the only effective protection strategy against this disease is vaccination against the measles virus.
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Affiliation(s)
- Laura Papetti
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
- Correspondence: (L.P.); (F.M.)
| | - Maria Elisa Amodeo
- Department of Pediatrics, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (M.E.A.); (L.S.)
- Department of System Medicine, Tor Vergata University of Rome, Viale Oxford 81, 00133 Roma, Italy;
| | - Letizia Sabatini
- Department of Pediatrics, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (M.E.A.); (L.S.)
- Department of System Medicine, Tor Vergata University of Rome, Viale Oxford 81, 00133 Roma, Italy;
| | - Melissa Baggieri
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
| | - Alessandro Capuano
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Federica Graziola
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Antonella Marchi
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
| | - Paola Bucci
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
| | - Emilio D’Ugo
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
| | - Maedeh Kojouri
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
| | - Silvia Gioacchini
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
| | - Carlo Efisio Marras
- Unit of Neurosurgery, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (C.E.M.); (C.G.N.)
| | - Carlotta Ginevra Nucci
- Unit of Neurosurgery, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (C.E.M.); (C.G.N.)
| | - Fabiana Ursitti
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Giorgia Sforza
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Michela Ada Noris Ferilli
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Gabriele Monte
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Romina Moavero
- Department of System Medicine, Tor Vergata University of Rome, Viale Oxford 81, 00133 Roma, Italy;
- Child Neurology and Psychiatry Unit, Department of System Medicine, Tor Vergata University of Rome, Viale Oxford 81, 00133 Rome, Italy
| | - Federico Vigevano
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Massimiliano Valeriani
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Fabio Magurano
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
- Correspondence: (L.P.); (F.M.)
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Samia P, Oyieke K, Tunje D, Udwadia-Hegde A, Feemster K, Oncel I, Anlar B. Options in the Treatment of Subacute Sclerosing Panencephalitis: Implications for Low Resource Areas. Curr Treat Options Neurol 2022; 24:99-110. [PMID: 35340572 PMCID: PMC8933242 DOI: 10.1007/s11940-022-00710-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 12/11/2022]
Abstract
Abstract
Purpose of the review
Subacute sclerosing panencephalitis (SSPE) is a rare, slowly progressive, and frequently fatal neurodegenerative disorder caused by measles virus. The risk of SSPE remains significant globally, with fluctuating incidence noted in in tandem with measles vaccine uptake. This review aims to explore the current global status of SSPE, its treatment, and preventive measures.
Recent findings
An increase in measles cases have been reported in various parts of the world for different reasons related to the regional context of the outbreak. With reduction in measles vaccine doses since the onset of the COVID-19 pandemic, the future risk of SSPE can only accelerate. In recent years, subsequent cases of SSPE have been reported in the period following documented measles outbreaks in different settings. Concomitantly, there have been efforts to evaluate the efficacy of immunomodulatory, antiviral, and anti-seizure therapies that could ameliorate the devastating effects of this disease. This review elucidates on these approaches and their limitations, reasons for poor vaccine coverage in low- and middle-income countries, as well as the possible solutions to the prevention of measles and eventual avoidance of SSPE.
Summary
Prevention of measles virus infection with the resultant sequelae would be the most effective strategy for the management of SSPE. This approach would be particularly important in low resource setting that currently bears the double burden of widespread communicable diseases and malnutrition.
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Affiliation(s)
- Pauline Samia
- Department of Paediatrics and Child Health, Medical College, Aga Khan University, 3rd Parklands Avenue, P.O BOX 30270 00100, East Tower block, fourth floor Nairobi, Kenya
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Katherine Oyieke
- Department of Paediatrics and Child Health, Medical College, Aga Khan University, 3rd Parklands Avenue, P.O BOX 30270 00100, East Tower block, fourth floor Nairobi, Kenya
| | - Dorcas Tunje
- Department of Paediatrics and Child Health, Medical College, Aga Khan University, 3rd Parklands Avenue, P.O BOX 30270 00100, East Tower block, fourth floor Nairobi, Kenya
| | - Anaita Udwadia-Hegde
- Department of Pediatric Neurosciences, SRCC NH Children’s Hospital, Mumbai, India
- Department of Pediatric Neurosciences, Jaslok Hospital & Research Center, Mumbai, India
| | - Kristen Feemster
- Department of Pediatrics, Division of Infectious Diseases, Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Ibrahim Oncel
- Department of Pediatric Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Banu Anlar
- Department of Pediatric Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Datta AK, Ghosh PC, Bera M, Mukherjee A, Chaudhuri J, Pandit A. A video-based discussion of movement disorders in paediatric anti NMDAR encephalitis: A case series from Eastern India. Eur J Paediatr Neurol 2022; 37:40-45. [PMID: 35051735 DOI: 10.1016/j.ejpn.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/12/2021] [Accepted: 01/02/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE The spectrum of movement disorders associated with anti N-Methyl-d-Aspartate-Receptor (NMDAR) encephalitis is myriad, particularly in children, possibilities of which were investigated from two tertiary care centres. METHODS A retrospective study was conducted in two tertiary referral centres in Eastern India, analysing data of 8 paediatric patients diagnosed as anti NMDAR encephalitis, presenting with one or more movement disorders (MDs). RESULTS All the patients were of Bengali ethnicity with a median age of 9 years (3-16 years) and with female predilection (62.5%). CSF pleocytosis was a common feature in all. Seizures were described in 62.5%% of patients with a solitary patient exhibiting abnormalities on brain imaging. 3 out of 8 (37.5%) of patients presented with a single MD while the remaining had more than one type. Oro-linguo-facial dyskinesias and dystonia (37.5% each) were the most common movement type followed by chorea (12.5%). Complex stereotypies, myoclonus and facial tics were noted in one patient each. All patients received pulse methyl prednisolone. Escalation to second line therapy in form of rituximab was done for 5 patients (62.5%). Following immunotherapy, hyperkinetic movements resolved in 50% of patients, with persistence of movements in one (12.5%). A mortality of 37.5% was noted. Median duration of follow up was 26 months, during which none of the patients had evidence of systemic neoplasm. CONCLUSION MDs are a core feature of anti NMDAR encephalitis, particularly in the paediatric age group, understanding and characterization of which, is the key to early diagnosis and effective therapy.
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Affiliation(s)
- Amlan Kusum Datta
- Department of Neurology, Bangur Institute of Neurology, IPGMER SSKM Hospital, Kolkata, West Bengal, India.
| | - Prakash Chandra Ghosh
- Department of Paediatrics, Midnapur Medical College and Hospital, West Bengal, India.
| | - Mitali Bera
- Department of Paediatrics, Midnapur Medical College and Hospital, West Bengal, India.
| | - Adreesh Mukherjee
- Department of Neurology, Bangur Institute of Neurology, IPGMER SSKM Hospital, Kolkata, West Bengal, India.
| | - Jasodhara Chaudhuri
- Department of Neurology, Bangur Institute of Neurology, IPGMER SSKM Hospital, Kolkata, West Bengal, India.
| | - Alak Pandit
- Department of Neurology, Bangur Institute of Neurology, IPGMER SSKM Hospital, Kolkata, West Bengal, India.
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20
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Ser MH, Gündüz A, Demirbilek V, Yalçınkaya C, Nalbantoğlu M, Coşkun T, Kızıltan M. Progression of myoclonus subtypes in subacute sclerosing panencephalitis. Neurophysiol Clin 2021; 51:533-540. [PMID: 34772596 DOI: 10.1016/j.neucli.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/18/2021] [Accepted: 07/18/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Diagnostic criteria of subacute sclerosing panencephalitis (SSPE) include myoclonus, a well-recognized clinical feature. Here, we studied the electrophysiological features of myoclonus with regards to disease staging in SSPE patients. METHODS We included 10 patients diagnosed with SSPE between 2010 and 2018, along with 21 healthy subjects. All participants had detailed electrophysiological evaluation including polymyographic analysis, blink reflex after trigeminal stimulation, auditory startle response, startle response after somatosensory stimuli, F-waves, and long-loop reflexes. Clinical findings were retrieved from the medical records. RESULTS Patients were categorized into Gascon stage 2B (n = 5, 50%), 2A (n = 2, 20%), 3B (n = 2, 20%) and 4A (n = 1, 10%) at the time of electrophysiological evaluation. Two patients had cortical myoclonus, four had possible cortico-subcortical myoclonus, and four had brainstem myoclonus. Patients were categorized into Gascon stages 2a and 2b had possible cortico-subcortical myoclonus (85.7%). However, none of the patients with stage 3b or 4a had possible cortico-subcortical subtype but all had the brainstem subtype. CONCLUSION Association was seen between subtypes of myoclonus and clinical staging in SSPE. This suggests that myoclonus in SSPE may primarily involve the cortex and cortico-subcortical structures such as the thalamus at earlier stages of disease, and then involve more caudal structures as the disease progresses.
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Affiliation(s)
- Merve Hazal Ser
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Ayşegül Gündüz
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Veysi Demirbilek
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cengiz Yalçınkaya
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mecbure Nalbantoğlu
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tülin Coşkun
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Meral Kızıltan
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Srivastava K, Agarwal E, Rajadhyaksha S. Resurgence of Subacute Sclerosing Panencephalitis: Case Series and Global Epidemiological Trends. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1728774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractResurgence of subacute sclerosing panencephalitis (SSPE)—case series and global epidemiological trends. We noted a recent increase in cases of SSPE admitted in our institute, even though they had received measles vaccination. We did a detailed study of our cases and compared with global epidemiological trends of SSPE in preimmunization and era of developed immunity. Out of total 23 cases of SSPE, 12 presented in the year 2017 alone, reflecting a steep rise in incidence. Sixteen patients had received measles vaccine and never had prior measles infection. Mean age of onset was 8.2 years and average time of progression to advanced stage of disease was 65 days. Global data showed similar trends, that is, earlier age of onset with a faster rate of progression in the postvaccination era as compared with prevaccine era. Possible mechanisms to account for this trend include an early wild measles infection in the critical age of 6 to 9 months, before vaccination. There is a changing epidemiological trend of SSPE in terms of lower age of onset and faster rate of progression, also reflected in global data. There is a need for multicenter studies to verify the findings and explore possible measures like lowering the age of measles vaccination to halt this alarming trend.
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Affiliation(s)
- Kavita Srivastava
- Pediatric Neurology Unit, Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
| | - Ekta Agarwal
- Pediatric Neurology Unit, Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
| | - Surekha Rajadhyaksha
- Pediatric Neurology Unit, Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
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22
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Iglesias-Hernandez D, Chapman S, Radler K, Dowd H, Huey ED, Cosentino S, Louis ED. Baseline Infection Burden and Cognitive Function in Elders with Essential Tremor. Tremor Other Hyperkinet Mov (N Y) 2021; 11:16. [PMID: 34026322 PMCID: PMC8121006 DOI: 10.5334/tohm.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background Patients with essential tremor (ET) have an increased risk of cognitive impairment, yet little is known about the predictors of cognitive decline in these patients. Exposures to infectious agents throughout the lifespan may impact the later development of cognitive impairment. For example, high Infection exposure has been associated with lower cognitive performance in Alzheimer's and Parkinson's disease. However, this predictor has not been examined in ET. Objectives To determine whether a higher baseline infection burden is associated with worse cognitive performance at baseline and greater cognitive decline over time in an ET cohort. Method/Design 160 elderly non-demented ET participants (80.0 ± 9.5 years) underwent an extensive cognitive evaluation at three time points. At baseline, participants completed an infection burden questionnaire (t-IBQ) that elicited information on previous exposure to infectious agents and number of episodes per disease. Analysis of covariance and generalized estimated equations (GEEs) were used. Results Overall, infection burden was not associated baseline cognitive performance. Adjusted GEE models for repeated measures yielded a significant time interaction between moderate infection burden at baseline and better performance in the attention domain over time (p = 0.013). Previous history of rubella was associated with faster rate of decline in visuospatial performance (p = 0.046). Conclusion The data were mixed. Moderate self-reported infection burden was associated with better attention performance over time. Self-reported history of rubella infection was related to lower visuospatial performance over time in this cohort. Follow-up studies with additional design elements would be of value.
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Affiliation(s)
| | - Silvia Chapman
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, US
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, US
| | - Keith Radler
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, US
| | - Hollie Dowd
- Movement Disorder Division, Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut, US
| | - Edward D. Huey
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, US
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, US
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, US
| | - Stephanie Cosentino
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, US
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, US
| | - Elan D. Louis
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, US
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Paul SA, Mondal GP, Bhattacharyya R, Ghosh KC, Das S, Das S, Krishna H, Patra C. Clinical Spectrum of Movement Disorders in Neurology Inpatients in a Tertiary Care Centre. J Neurosci Rural Pract 2021; 12:581-585. [PMID: 34295115 PMCID: PMC8289529 DOI: 10.1055/s-0041-1730086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background
Little data are available on the spectrum of movement disorders in inpatients, particularly those admitted in neurology specialty. This may be related to the fact that patients presenting with movement disorders are usually evaluated from outpatient clinics.
Objective
The aim of this study is to provide data on the pattern of movement disorders in neurology inpatients.
Materials and Methods
Patients admitted through emergency department or neurology clinic with complaints of movement abnormalities were recruited in this study from October 2019 to September 2020. Cases were subjected to proforma-based detailed history, examination, and appropriate investigations.
Statistical Analysis
Descriptive statistics using SPSS 20.
Results and Conclusion
Bradykinesia with or without tremor was the most common movement disorder (28.3%), followed by ataxia and dystonia (24.5% each) and hemifacial spasm and myoclonus (7.5% each). Chorea, tic disorder, and hemiballismus were also reported. Etiologies included Parkinson disease, Wilson’s disease, subacute sclerosing panencephalitis (SSPE), drugs, stroke, spinocerebellar ataxia, Huntington’s disease, neuroacanthocytosis, and others. Dystonia represented the most common disorder in the younger age group (44.4%), whereas bradykinesia and/or tremor represented the most common movement disorder in the older age group (46.4%).
This study demonstrates the characteristic distribution of movement disorders in neurology inpatients.
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Affiliation(s)
- Shabeer Ahmad Paul
- Department of Neurology, Calcutta National Medical College & Hospital, Kolkata, West Bengal, India
| | - Gouranga Prasad Mondal
- Department of Neurology, Calcutta National Medical College & Hospital, Kolkata, West Bengal, India
| | - Ramesh Bhattacharyya
- Department of Neurology, Calcutta National Medical College & Hospital, Kolkata, West Bengal, India
| | - Kartik Chandra Ghosh
- Department of Neurology, Calcutta National Medical College & Hospital, Kolkata, West Bengal, India
| | - Sarbajit Das
- Department of Neurology, Calcutta National Medical College & Hospital, Kolkata, West Bengal, India
| | - Suman Das
- Department of Neurology, Calcutta National Medical College & Hospital, Kolkata, West Bengal, India
| | - Hema Krishna
- Department of Neurology, Calcutta National Medical College & Hospital, Kolkata, West Bengal, India
| | - Chandrakanta Patra
- Department of Neurology, Calcutta National Medical College & Hospital, Kolkata, West Bengal, India
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Paul L, Jain T, Agarwal M, Singh S. Subacute Sclerosing Panencephalitis manifesting as Bell's palsy and bilateral macular necrotizing retinitis: an atypical presenting feature. J Ophthalmic Inflamm Infect 2021; 11:2. [PMID: 33521837 PMCID: PMC7847926 DOI: 10.1186/s12348-020-00223-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/18/2020] [Indexed: 11/12/2022] Open
Abstract
Background Subacute sclerosing panencephalitis (SSPE) is a potentially lethal complication of measles infection. Neurological complications take years to manifest after primary viral infection of brain and can lead to blindness in some individuals. Findings A 13-year-old female patient with history of Bell’s palsy 2 months prior, presented with rapidly progressing necrotizing retinitis in both eyes. Soon after, she was unable to walk, developed myoclonic jerks, altered sensorium and loss of bowel and bladder control. Her clinical history, CSF IgG measles antibody analysis, MRI brain and EEG findings confirmed the diagnosis of SSPE. Conclusion SSPE in our case presented as Bell’s palsy and sudden painless diminution of vision due to ocular involvement, and developed full blown disease within 2 months. SSPE can present as a diagnostic challenge and warrants early identification and referral for timely diagnosis and management.
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Affiliation(s)
- Lagan Paul
- Vitreo-retina Department, Dr. Shroff's Charity Eye Hospital, 5027, Kedarnath Road, Daryaganj, New Delhi, 110002, India.
| | - Tanya Jain
- Vitreo-retina Department, Dr. Shroff's Charity Eye Hospital, 5027, Kedarnath Road, Daryaganj, New Delhi, 110002, India
| | - Manisha Agarwal
- Vitreo-retina Department, Dr. Shroff's Charity Eye Hospital, 5027, Kedarnath Road, Daryaganj, New Delhi, 110002, India
| | - Shalini Singh
- Vitreo-retina Department, Dr. Shroff's Charity Eye Hospital, 5027, Kedarnath Road, Daryaganj, New Delhi, 110002, India
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Joshi D, Reddy R, Kumar A. Subacute sclerosing panencephalitis with an atypical presentation. Ann Indian Acad Neurol 2021; 24:946-947. [PMID: 35359521 PMCID: PMC8965937 DOI: 10.4103/aian.aian_791_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/02/2020] [Accepted: 08/23/2020] [Indexed: 11/21/2022] Open
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Host Cell Restriction Factors of Paramyxoviruses and Pneumoviruses. Viruses 2020; 12:v12121381. [PMID: 33276587 PMCID: PMC7761617 DOI: 10.3390/v12121381] [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] [Received: 11/13/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 01/04/2023] Open
Abstract
The paramyxo- and pneumovirus family includes a wide range of viruses that can cause respiratory and/or systemic infections in humans and animals. The significant disease burden of these viruses is further exacerbated by the limited therapeutics that are currently available. Host cellular proteins that can antagonize or limit virus replication are therefore a promising area of research to identify candidate molecules with the potential for host-targeted therapies. Host proteins known as host cell restriction factors are constitutively expressed and/or induced in response to virus infection and include proteins from interferon-stimulated genes (ISGs). Many ISG proteins have been identified but relatively few have been characterized in detail and most studies have focused on studying their antiviral activities against particular viruses, such as influenza A viruses and human immunodeficiency virus (HIV)-1. This review summarizes current literature regarding host cell restriction factors against paramyxo- and pneumoviruses, on which there is more limited data. Alongside discussion of known restriction factors, this review also considers viral countermeasures in overcoming host restriction, the strengths and limitations in different experimental approaches in studies reported to date, and the challenges in reconciling differences between in vitro and in vivo data. Furthermore, this review provides an outlook regarding the landscape of emerging technologies and tools available to study host cell restriction factors, as well as the suitability of these proteins as targets for broad-spectrum antiviral therapeutics.
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27
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Aldabbour B, El-Salem K, Aqaileh S, Obiedat D, Qasaimeh M, Al Qawasmeh M, Al-Mistarehi AH, Yassin A. Isolated subtle asymmetric slowing on EEG leading to a diagnosis of autoimmune encephalitis. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00180-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract
Background
Autoimmune encephalitis presents with subacute neurological, psychiatric, and behavioral symptoms. In many cases, MRI and CSF studies return normal. Laboratory testing for pathogenic neuronal antibodies is limited by accessibility and sensitivity issues. Finally, the different diagnostic approaches lack consensus and have until recently been largely retrospective. Collectively, these factors predispose for delays in diagnosis and treatment in many cases.
Case presentation
We describe the case of a 42-year-old woman who did not initially meet the newly proposed criteria for probable autoimmune encephalitis, but in whom the detection on electroencephalogram (EEG) of subtle asymmetric slowing of the left hemisphere ultimately led to the diagnosis.
Discussion
EEG is highly sensitive and rarely normal in encephalitis. The recently introduced diagnostic criteria for autoimmune encephalitis included new-onset seizures in the earliest steps in the algorithm but did not yet incorporate EEG findings. We encourage practicing physicians to use EEG as an early, sensitive diagnostic tool for cases suspected to have autoimmune encephalitis.
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Maeda H, Hashimoto K, Miyazaki K, Kanno S, Go H, Suyama K, Sato M, Kawasaki Y, Hosoya M. Utility of enzyme immunoassays for diagnosis of subacute sclerosing panencephalitis. Pediatr Int 2020; 62:920-925. [PMID: 32239783 DOI: 10.1111/ped.14244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/05/2020] [Accepted: 03/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Subacute sclerosing panencephalitis (SSPE) is a progressive neurologic disorder caused by the measles virus (MV) and is identified by positive MV-specific antibody titers, detected mainly by hemagglutination inhibition (HI) tests in the cerebrospinal fluid (CSF). However, an alternative method, the enzyme immunoassay (EIA), has increasingly become a preferred method for detecting MV antibodies. To establish the index for SSPE diagnosis using EIA, we investigated the correlation between HI and EIA titers of MV antibodies in SSPE patients. METHODS Data on MV antibody titers and measurement methods at the time of diagnosis in 89 Japanese SSPE cases diagnosed between 1979 and 2006 were obtained by a survey. We also assessed the serum and CSF MV antibody titers in three patients with SSPE and serum MV antibody titers in 38 healthy adults using immunoglobulin G (IgG)-EIA and HI. RESULTS In all cases diagnosed as SSPE, IgG-EIA titers in the CSF were ≥0.49 IU/mL. There was a positive correlation between serum antibody values in the controls measured by IgG-EIA and HI. In patients with SSPE, both serum and CSF antibody values, measured by IgG-EIA, and HI, were positively correlated, and a positive correlation was found between the serum and CSF MV antibody titers as measured by IgG-EIA. The serum/CSF MV antibody titer ratios determined by IgG-EIA were <20 in most SSPE patients. CONCLUSIONS Immunoglobulin G-EIA may be a suitable alternative method for SSPE diagnosis; however, its potential utility and the cut-off point of ≥0.49 IU/mL should be tested with additional patient cohorts.
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Affiliation(s)
- Hajime Maeda
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
| | - Koichi Hashimoto
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
| | - Kyohei Miyazaki
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
| | - Shuto Kanno
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
| | - Hayato Go
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
| | - Kazuhide Suyama
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
| | - Masatoki Sato
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
| | - Yukihiko Kawasaki
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan.,Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Mitsuaki Hosoya
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
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29
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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.
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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
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30
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Abstract
PURPOSE OF REVIEW Pediatric central nervous system demyelinating diseases include multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and acute disseminated encephalomyelitis (ADEM). As diagnostic criteria become more inclusive, the risk of misdiagnosis of atypical demyelinating diseases of rheumatologic, infectious, and autoimmune etiology increases. RECENT FINDINGS We review mimics of multiple sclerosis, neuromyelitis optica spectrum disorder, and acute disseminated encephalomyelitis, including rheumatologic diseases: systemic lupus erythematosus and neuro-Behçet disease; infectious diseases: human immunodeficiency virus, progressive multifocal leukoencephalopathy, and subacute sclerosis panencephalitis; and autoimmune diseases including X-linked Charcot-Marie-Tooth disease, chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) and autoimmune glial fibrillary acidic protein (GFAP) encephalopathy. Atypical demyelinating disease may mimic classic neuroinflammatory diseases of the central nervous system. Imaging may meet criteria for a diagnosis of multiple sclerosis, or patients may present with optic neuritis and transverse myelitis consistent with neuromyelitis optica spectrum or myelin oligodendrocyte glycoprotein (MOG) antibody disorders. Through careful history-taking and review of atypical MRI findings, we may avoid misdiagnosis and mistreatment.
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31
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Skripchenko NV, Ivanova GP, Skripchenko EY, Murina EA. [Panencephalitis in children in modern conditions: clinical, etiological and mri-aspects]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:20-31. [PMID: 31407678 DOI: 10.17116/jnevro201911906120] [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: 11/17/2022]
Abstract
AIM To characterize the clinical picture, infectious etiology and MRI results of panencephalitis (PANE) in children, depending on the duration of the disease. MATERIAL AND METHODS Children (n=32) with PANE at the age from 3 months up to 17 years were examined for a group of actual viral and bacterial infections. The inclusion criterion was a diffuse lesion of white matter hemispheres on MRI. MRI of the brain and spinal cord, CSF study (pleocytosis, oligoclonal IgG, the main myelin protein (MBP) were performed. The follow-up was 5-10 years. The complex therapy included etiotropic (antiviral) and pathogenetic agents, with priority given to cytoflavin as a drug with a multimodal effect. RESULTS In 84.4% of cases, PANE in children are recorded under the age of 3 years and in 71.9% of cases, are associated with congenital infections with the prevalence of herpes viruses, especially cytomegalovirus (37,8%) and herpes type 6 (21.9%). In 78.3% of cases, PANE have chronic gradual development more often with a delay in the formation of motor and speech/prespeech skills, and manifested with pyramidal, cerebellar and other symptoms in the future. PANE is accompanied by a lesion of the white matter of the hemispheres in 1/2 cases with periventricular localization, less often in infratentorial structures (46.9%) and spinal cord (21.9%). With the duration of symptoms up to 3 months (n=22) PANE are characterized by inflammatory-demyelinating changes, signs of mass effect, contrast+, pleocytosis in CSF and the increase in MBP (average 4.2±0.8 ng/ml), and, with the duration of more than 3 months, by degenerative-sclerosing changes (n=10) and CSF oligoclonal IgG in 90% of cases. CONCLUSION In almost 2/3 of cases, PANE are associated with congenital infections, accompanied by extensive symmetrical foci of demyelination in the CNS, and their clinical and laboratory parameters and outcomes depend on the start of treatment, with the positive dynamics in 75% of cases.
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Affiliation(s)
- N V Skripchenko
- Children's Research and Clinical Center for Infectious Diseases of the Federal Medical and Biological Agency of Russia, St.-Petersburg, Russia; Saint-Petersburg Pediatric Medical University, St.-Petersburg, Russia
| | - G P Ivanova
- Road Clinical Hospital 'Russian Railways', St.-Petersburg, Russia
| | - E Yu Skripchenko
- Children's Research and Clinical Center for Infectious Diseases of the Federal Medical and Biological Agency of Russia, St.-Petersburg, Russia; Saint-Petersburg Pediatric Medical University, St.-Petersburg, Russia
| | - E A Murina
- Children's Research and Clinical Center for Infectious Diseases of the Federal Medical and Biological Agency of Russia, St.-Petersburg, Russia
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Nathan J, Khedekar Kale D, Naik VD, Thakker F, Bailur S. Substantial Remission in Subacute Sclerosing Panencephalitis by Following the Ketogenic Diet: A Case Report. Cureus 2019; 11:e5485. [PMID: 31489275 PMCID: PMC6713239 DOI: 10.7759/cureus.5485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
An eight-year-old boy presented with rhythmic myoclonic jerks that stretched back to the age of four years. He was diagnosed as having subacute sclerosing panencephalitis (SSPE). This is a progressive and almost uniformly fatal disease. His condition gradually deteriorated till he was unable to speak or walk. He also experienced incontinence and severe cognitive decline (stage 3a in the Risk and Haddad scale). An electroencephalogram (EEG) showed myoclonic jerks with periodic, generalised, high-amplitude and slow-wave complexes. Cerebrospinal fluid (CSF) findings also were supportive of the diagnosis of SSPE. The ketogenic diet (KD) therapy was started on the patient. His myoclonic jerks stopped after 11 months. After 36 months, his cognition and physical abilities vastly improved. His EEG showed no slow-wave complexes and background activity was almost normal. SSPE is secondary to measles and causes inflammatory and neurodegenerative changes. KD has an anti-inflammatory effect and can halt and reverse neurodegenerative changes. Its neuroprotective effects could be due to the reduced oxidative stress, enhanced mitochondrial activity, and the suppression of pro-apoptotic factors. Thus, KD could control the myoclonic jerks and also reverse the cognitive and physical decline arising from SSPE.
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Affiliation(s)
| | | | - Vidula D Naik
- Clinical Nutrition & Dietetics, Dr. Nathan Sanjiv Clinic, Mumbai, IND
| | - Forum Thakker
- Clinical Nutrition & Dietetics, Dr. Nathan Sanjiv Clinic, Mumbai, IND
| | - Sonal Bailur
- Clinical Nutrition & Dietetics, Dr. Nathan Sanjiv Clinic, Mumbai, IND
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McGuire JL, Tuite NV, Swami SK, Avery RA. Assessment of Diagnostic Yield of Nonculture Infection Testing on Cerebrospinal Fluid in Immune-Competent Children. JAMA Netw Open 2019; 2:e197307. [PMID: 31322691 PMCID: PMC6646983 DOI: 10.1001/jamanetworkopen.2019.7307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Nonculture infection tests of cerebrospinal fluid (CSF) samples using polymerase chain reaction and antigen or antibody assays are frequently ordered on lumbar puncture specimens concurrently with routine CSF cell counts, but the value of CSF infection testing in otherwise healthy children is unknown. OBJECTIVE To determine the value of nonculture CSF infection testing in immune-competent children with normal CSF cell counts. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study reviewed screening and diagnostic tests in the electronic medical record system of a large academic tertiary care children's hospital. Records of children aged 0.5 to 18.9 years (n = 4083) who underwent lumbar puncture (n = 4811 procedures) in an inpatient or outpatient facility of Children's Hospital of Philadelphia between July 1, 2007, and December 31, 2016, were reviewed. Those with indwelling CSF shunts or catheters; those with active or past oncologic, immunologic, or rheumatologic conditions; or those taking immune-suppressing medications were excluded from analysis. This study was conducted from July 20, 2017, to March 13, 2019. MAIN OUTCOMES AND MEASURES Outcome variables included frequency of nonculture CSF infection testing and frequency of positive results in the entire cohort, and among those with normal cell counts. Normal cell counts were defined as CSF white blood cell counts lower than 5 cells/μL and CSF red blood cell counts lower than 500 cells/μL. RESULTS In total, 4811 lumbar puncture procedures were performed on 4083 unique children, with a median (range) age of 7.4 (0.5-18.9) years, 2537 boys (52.7%), and 3331 (69.2%) with normal CSF cell counts. At least 1 nonculture CSF infection test was performed on 1270 lumbar puncture specimens with normal cell counts (38.1%; 95% CI, 36%-40%), and more tests were performed in the summer months. Only 18 (1.4%; 95% CI, 0.9%-2.2%) of 1270 lumbar puncture specimens with normal cell counts had at least 1 nonculture infection test with a positive result; 2 of these 18 children required clinical intervention for their positive results, but each also had other clear clinical signs of infection. CONCLUSIONS AND RELEVANCE Nonculture CSF infection testing appeared to be common in immune-competent children with normal CSF cell counts, but positive results were uncommon and were not independently associated with clinical care; delaying the decision to send nonculture infection tests until CSF cell counts are available could reduce unnecessary diagnostic testing and medical costs, which may improve value-based care.
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Affiliation(s)
- Jennifer L. McGuire
- Division of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Neurology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Nichole V. Tuite
- Division of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sanjeev K. Swami
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Division of Infectious Disease, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Robert A. Avery
- Department of Neurology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Division of Ophthalmology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Ophthalmology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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