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Köksaldı S, Ala RT, Oztura I, Emirbayer E, Akdal G, Emre S, Tugal-Tutkun I, Saatci AO. Optical Coherence Tomography Angiographic Follow-Up in a Case of Subacute Sclerosing Panencephalitis and Unilateral Necrotising Retinitis. Neuroophthalmology 2023; 48:142-151. [PMID: 38487359 PMCID: PMC10936593 DOI: 10.1080/01658107.2023.2284914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/31/2023] [Indexed: 03/17/2024] Open
Abstract
We present a 20-year-old woman who was diagnosed with subacute sclerosing panencephalitis (SSPE) 20 months after presenting with unilateral retinitis. At presentation, the patient had two inferotemporal macular lesions in her left eye. Corresponding to these areas, optical coherence tomography (OCT) showed hyporeflective spaces with loss of nearly all of the retinal layers. OCT-angiography (OCTA) demonstrated some flow deficit areas with a reduction in the vessel density. Her serum measles antibody titre was high (IgG >5000.0 mIU/ml). Twenty months later the macular lesions had diminished in size, and there was some focal retinal thinning with interruption of the ellipsoid zone. OCTA showed that the flow deficit areas were diminished in size together with the relatively improved perfusion density. Neurological examination disclosed myoclonic jerks. Neuropsychological assessment demonstrated impaired executive function, attention, and narrowed lexical fluency. Measles IgG antibody was high in the cerebrospinal fluid (>230.0 U/ml). Brain magnetic resonance imaging demonstrated bilateral, non-specific, small foci of T2 hyperintensity in the frontoparietal subcortical white matter and centrum semiovale. The present case is the first where OCTA findings of SSPE-related retinal lesions have been described.
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Affiliation(s)
- Seher Köksaldı
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Rahmi Tumay Ala
- Department of Neurology, Dokuz Eylul University, Izmir, Turkey
| | - Ibrahim Oztura
- Department of Neurology, Dokuz Eylul University, Izmir, Turkey
| | - Emre Emirbayer
- Department of Neurology, Dokuz Eylul University, Izmir, Turkey
| | - Gulden Akdal
- Department of Neurology, Dokuz Eylul University, Izmir, Turkey
| | - Sinan Emre
- Department of Ophthalmology, Batıgöz Private Hospital, Izmir, Turkey
| | | | - Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
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Garg M, Arora A, Kulkarni SD, Hegde AU, Shah KN. Subacute Sclerosing Panencephalitis (SSPE): Experience from a Tertiary-Care Pediatric Center. J Neurosci Rural Pract 2022; 13:315-320. [PMID: 35694059 PMCID: PMC9187417 DOI: 10.1055/s-0041-1740612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction
Subacute sclerosing panencephalitis (SSPE) is a devastating neurodegenerative disease occurring as a complication of measles infection that is still prevalent in low-resource countries. Clinical and electrographical variability in SSPE can lead to diagnostic delays.
Methods
Children diagnosed with SSPE in a tertiary care pediatric hospital in India in a period of 8 years were included in the study. The diagnosis was established on the basis of Dyken's criteria. The demographic data, clinical presentations, investigations, treatment approaches, and outcomes were reviewed and recorded.
Results
Thirty-four patients were included in the analysis. Average age at symptom onset was 7 years, 5 months. Majority of the children were not vaccinated for measles. Most patients (80%) presented with stage 2 of illness. Nearly 25% presented with atypical clinical features. Myoclonus was the most predominant feature seen after diagnosis. Electroencephalography (EEG) was the most useful investigation for suspecting the diagnosis. All patients showed deterioration in neurological status with time and 20% died during follow-up.
Conclusion
Atypical presentations of SSPE must be recognized in areas with high incidence to institute timely treatment and establish prognosis. EEG findings were found to be the most important indicator for diagnosis. Measles eradication will pave the way for elimination of this dreaded disease.
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Affiliation(s)
- Meenal Garg
- Department of Pediatric Neurology, Surya Hospitals, Jaipur, Rajasthan, India
| | - Anshita Arora
- Division of Pediatric Neurology, Department of Pediatric Neurosciences, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Shilpa D. Kulkarni
- Department of Pediatric Neurosciences, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Anaita Udwadia Hegde
- Department of Pediatric Neurosciences, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Krishnakumar N. Shah
- Department of Pediatric Neurosciences, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
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Chaurasia R, Saurabh K, Singh V, Pathak A, Verma A, Mishra V, Joshi D, Kumar A. Clinical Profile and Diffusion Tensor Imaging in Patients of Subacute Sclerosing Pan Encephalitis: A Prospective Follow-up Study from Eastern Part of India. Neurol India 2022; 70:197-202. [DOI: 10.4103/0028-3886.336333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Valente M, Del Negro I, Bagatto D, Garbo R, Lettieri C, Bernardini A, Nilo A, Peri MR, Pecori D, Gigli GL. Clinical and magnetic resonance study of a case of subacute sclerosing panencephalitis treated with ketogenic diet. BMJ Neurol Open 2021; 3:e000176. [PMID: 34396129 PMCID: PMC8313867 DOI: 10.1136/bmjno-2021-000176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Subacute sclerosing panencephalitis is a progressive neurodegenerative disorder caused by a latent and mutant measles virus which is extremely rare in developed countries. The lack of effective treatments leads to the research of other anti-inflammatory and neuroprotective treatments. Case Here we present a case of a 17-year-old patient affected by subacute sclerosing panencephalitis who manifest a dramatic improvement in neurological and general clinical conditions, as well as an arrest in the progression of demyelinating process in the central nervous system, after the beginning of a high ratio ketogenic diet. Conclusions Given its anti-inflammatory, antioxidant and metabolic effects, we believe that ketogenic diet utilisation could be a rational approach, can be considered a safe add-on therapy, carrying on with only a minimal risk of adverse effects or interactions.
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Affiliation(s)
- Mariarosaria Valente
- Department of Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital, Clinical Neurology Unit, Udine, Italy.,Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Ilaria Del Negro
- Department of Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital, Clinical Neurology Unit, Udine, Italy
| | - Daniele Bagatto
- Department of Diagnostic Imaging, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital, Neuroradiology Unit, Udine, Italy
| | - Riccardo Garbo
- Department of Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital, Clinical Neurology Unit, Udine, Italy
| | - Christian Lettieri
- Department of Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital, Neurology Unit, Udine, Italy
| | - Andrea Bernardini
- Department of Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital, Clinical Neurology Unit, Udine, Italy
| | - Annacarmen Nilo
- Department of Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital, Clinical Neurology Unit, Udine, Italy
| | - Maria Rosaria Peri
- Department of Internal Medicine, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital, Clinical Nutrition Unit, Udine, Italy
| | - Davide Pecori
- Specialist Medicine Department, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital, Infectious Diseases Unit, Udine, Italy
| | - Gian Luigi Gigli
- Department of Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale, University Hospital, Clinical Neurology Unit, Udine, Italy.,Department of Medicine (DAME), University of Udine, Udine, Italy
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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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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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Nair SS, Vysakha KV, Menon RN, Sundaram S. Adult-onset subacute sclerosing panencephalitis. Pract Neurol 2021; 21:practneurol-2020-002880. [PMID: 33850035 DOI: 10.1136/practneurol-2020-002880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/04/2022]
Abstract
Subacute sclerosing panencephalitis (SSPE) is a lethal slow viral disease of the central nervous system caused by a defective measles virus. The onset is mostly in childhood, manifesting clinically as decline in academic performance, behavioural changes, motor dysfunction and myoclonus. Adult-onset SSPE is rare and can present as rapidly progressive dementia. We present a young man of Indian origin with adult-onset SSPE with rapidly progressive dementia but no localising neurological signs. The diagnostic clues were parieto-occipital white matter changes on MR brain scan and history of childhood fever with rash. High titres of antimeasles antibody in cerebrospinal fluid confirmed the diagnosis. The long latency from primary measles virus infection to symptom onset can be misleading in adults. SSPE should be considered in adults with dementia, especially in tropical countries where vaccination coverage is suboptimal.
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Affiliation(s)
- Sruthi S Nair
- Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - K V Vysakha
- Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Ramshekhar N Menon
- Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Soumya Sundaram
- Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
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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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9
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Garg D, Reddy V, Singh RK, Dash D, Bhatia R, Tripathi M. Neuroleptic malignant syndrome as a presenting feature of subacute sclerosing panencephalitis. J Neurovirol 2017; 24:128-131. [PMID: 29243130 DOI: 10.1007/s13365-017-0602-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/31/2017] [Accepted: 11/09/2017] [Indexed: 11/29/2022]
Abstract
Subacute sclerosing panencephalitis (SSPE) is a slowly progressive degenerative disorder caused by measles virus. It is characterised by typical clinical and electrophysiological features in the form of slow myoclonic jerks, with progressive cognitive impairment, visual symptoms, and periodic complexes on EEG, with raised titres of anti-measles antibodies in CSF and serum. Atypical presentations of SSPE have been reported including brainstem involvement, ADEM-like presentation, acute encephalitis, and cerebellar ataxia. Presentation with predominant extrapyramidal features is uncommon. We describe a case of SSPE presenting with extensive rigidity with highly elevated CPK values, mimicking neuroleptic malignant syndrome (NMS) which was most probably due to central dopaminergic blockade induced by the disease process. To our knowledge, this is the first case of SSPE presenting with a NMS-like syndrome.
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Affiliation(s)
- Divyani Garg
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Varun Reddy
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumar Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
| | - Deepa Dash
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Bertrand A, Leclercq D, Martinez-Almoyna L, Girard N, Stahl JP, De-Broucker T. MR imaging of adult acute infectious encephalitis. Med Mal Infect 2017; 47:195-205. [PMID: 28268128 DOI: 10.1016/j.medmal.2017.01.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/11/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Imaging is a key tool for the diagnosis of acute encephalitis. Brain CT scan must be urgently performed to rule out a brain lesion with mass effect that would contraindicate lumbar puncture. Brain MRI is less accessible than CT scan, but can provide crucial information with patients presenting with acute encephalitis. METHOD We performed a literature review on PubMed on April 1, 2015 with the search terms "MRI" and "encephalitis". RESULTS We first described the various brain MRI abnormalities associated with each pathogen of acute encephalitis (HSV, VZV, other viral agents targeting immunocompromised patients or travelers; tuberculosis, listeriosis, other less frequent bacterial agents). Then, we identified specific patterns of brain MRI abnomalies that may suggest a particular pathogen. Limbic encephalitis is highly suggestive of HSV; it also occurs less frequently in encephalitis due to HHV6, syphillis, Whipple's disease and HIV primary infection. Rhombencephalitis is suggestive of tuberculosis and listeriosis. Acute ischemic lesions can occur in patients presenting with severe bacterial encephalitis, tuberculosis, VZV encephalitis, syphilis, and fungal infections. CONCLUSION Brain MRI plays a crucial role in the diagnosis of acute encephalitis. It detects brain signal changes that reinforce the clinical suspicion of encephalitis, especially when the causative agent is not identified by lumbar puncture; it can suggest a particular pathogen based on the pattern of brain abnormalities and it rules out important differential diagnosis (vascular, tumoral or inflammatory causes).
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Affiliation(s)
- A Bertrand
- Service de neuroradiologie diagnostique et fonctionnelle, groupe hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'hôpital, 75651 Paris cedex 13, France; Sorbonne universités, UPMC université Paris 06, Inserm, CNRS, institut du cerveau et la moelle (ICM), Inria Paris, Aramis project-team, 75013 Paris, France
| | - D Leclercq
- Service de neuroradiologie diagnostique et fonctionnelle, groupe hospitalier Pitié-Salpêtrière, 47-83 boulevard de l'hôpital, 75651 Paris cedex 13, France
| | | | - N Girard
- Service de neuroradiologie, CHU La-Timone, AP-HM, 13015 Marseille, France
| | - J-P Stahl
- Service d'infectiologie, CHU de Grenoble, « European study Group for the Infections of the Brain (ESGIB) », 38043 Grenoble, France.
| | - T De-Broucker
- Service de neurologie, CH Saint-Denis, BP 279, 93205, France
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Spencer PS, Mazumder R, Palmer VS, Lasarev MR, Stadnik RC, King P, Kabahenda M, Kitara DL, Stadler D, McArdle B, Tumwine JK. Environmental, dietary and case-control study of Nodding Syndrome in Uganda: A post-measles brain disorder triggered by malnutrition? J Neurol Sci 2016; 369:191-203. [PMID: 27653888 DOI: 10.1016/j.jns.2016.08.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/10/2016] [Indexed: 11/29/2022]
Abstract
Nodding Syndrome (NS) is an epileptic encephalopathy characterized by involuntary vertical head nodding, other types of seizures, and progressive neurological deficits. The etiology of the east African NS epidemic is unknown. In March 2014, we conducted a case-control study of medical, nutritional and other risk factors associated with NS among children (aged 5-18years) of Kitgum District, northern Uganda (Acholiland). Data on food availability, rainfall, and prevalent disease temporally related to the NS epidemic were also analyzed. In NS Cases, the mean age of reported head nodding onset was 7.6years (range 1-17years). The epidemiologic curve of NS incidence spanned 2000-2013, with peaks in 2003 and 2008. Month of onset of head nodding was non-uniform, with all-year-aggregated peaks in April and June when food availability was low. Families with one or more NS Cases had been significantly more dependent on emergency food and, immediately prior to head nodding onset in the child, subsistence on moldy plant materials, specifically moldy maize. Medical history revealed a single significant association with NS, namely prior measles infection. NS is compared with the post-measles disorder subacute sclerosing panencephalitis, with clinical expression triggered by factors associated with poor nutrition.
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Affiliation(s)
- Peter S Spencer
- Global Health Center (former), Oregon Health & Science University, Portland, OR, USA; Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA; Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA; Faculty of Medicine, Gulu University, Gulu, Uganda.
| | - Rajarshi Mazumder
- Global Health Center (former), Oregon Health & Science University, Portland, OR, USA
| | - Valerie S Palmer
- Global Health Center (former), Oregon Health & Science University, Portland, OR, USA; Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA; Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Michael R Lasarev
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA
| | - Ryan C Stadnik
- Global Health Center (former), Oregon Health & Science University, Portland, OR, USA
| | - Peter King
- Global Health Center (former), Oregon Health & Science University, Portland, OR, USA
| | - Margaret Kabahenda
- Department of Food Technology and Nutrition, College of Agricultural and Environmental Sciences, Makerere University, Kampala, Uganda
| | - David L Kitara
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA
| | - Diane Stadler
- Graduate Program in Human Nutrition, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Breanna McArdle
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR, USA
| | - James K Tumwine
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
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Garzuly F, Schneider F, Iványi JL, Nagy Z, Varga M, Sütő K, Tolvaj B, Kálmán B. [Changing times - changing diseases. Review of the neuropathological autopsy documentations at the Markusovszky University Teaching Hospital (1964-2014)]. Orv Hetil 2014; 155:1722-8. [PMID: 25327462 DOI: 10.1556/oh.2014.29996] [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: 11/19/2022]
Abstract
INTRODUCTION Nearly 6000 autoptic studies were carried out during the last 50 years at the Laboratory of Neuropathology, Markusovszky University Teaching Hospital, Hungary. AIM The aim of the authors was to present those previously frequent and often fatal conditions that can be prevented or treated today. METHOD Retrospective analyses of the neuropathological documentations. RESULTS Measles-related subacute sclerosing panencephalitis caused death in 13 cases, the last occurred in 1991. The mandatory vaccination against the causative virus has eliminated this severe neurological complication. Fourteen lives were lost due to herpes simplex encephalitis, including the last case seen in 1999. Feasibility of early diagnosis and the availability of acyclovir therapy resulted in better outcome without fatality. Tuberculous meningitis still occurred in most recent years, although only sporadically. Recognition of this condition is not straightforward due to its rarity, and considerations for this disease are often omitted from the routine differential diagnosis. The generally low mortality rates in tick borne encephalitis further dropped after the introduction of vaccination. Altogether only 8 such cases were documented. The last fatal cases of neurolues were seen in the 1990s. However, syphilis itself has not disappeared, and the number of cases with newly acquired infection continues to rise. The introduction of intrathecal methotrexate and radiotherapy made possible the prevention or effective treatment of meningeal leukosis. A careful coordination of these treatment modalities, however, is important as nervous system complications may develop in the form of disseminated necrotizing leukoencephalopathy that is also reflected in the records. CONCLUSIONS The 50-year neuropathology documentation reflects changes in the occurrence of diseases, and it calls attention to those disorders which can be prevented or treated today, but may represent diagnostic challenges.
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Affiliation(s)
- Ferenc Garzuly
- Markusovszky Egyetemi Oktatókórház Patológiai Osztály Szombathely Markusovszky u. 5. 9700
| | - Ferenc Schneider
- Markusovszky Egyetemi Oktatókórház Infektológiai Osztály Szombathely
| | - János László Iványi
- Markusovszky Egyetemi Oktatókórház Haematológiai és Haemosztazeológiai Osztály Szombathely
| | - Zsuzsanna Nagy
- Markusovszky Egyetemi Oktatókórház Neurológiai Osztály Szombathely
| | - Mariann Varga
- Markusovszky Egyetemi Oktatókórház Bőrgyógyászati Osztály Szombathely
| | - Krisztián Sütő
- Markusovszky Egyetemi Oktatókórház Központi Aneszteziológiai és Intenzív Betegellátó Osztály Szombathely
| | - Balázs Tolvaj
- Markusovszky Egyetemi Oktatókórház Patológiai Osztály Szombathely Markusovszky u. 5. 9700
| | - Bernadette Kálmán
- Markusovszky Egyetemi Oktatókórház Kutatási és Oktatási Centrum Szombathely Pécsi Tudomány Egyetem Egészségtudományi Kar Pécs
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Arboix A. Commentary. J Neurosci Rural Pract 2014; 5:313-4. [PMID: 25002788 PMCID: PMC4078633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Adrià Arboix
- Department of Neurology, Cerebrovascular Division, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Catalonia, Spain,Address for correspondence: Dr. Adrià Arboix, Department of Neurology, Cerebrovascular Division, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Viladomat 288, E-08029 Barcelona, Catalonia, Spain. E-mail:
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