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Wang JT, Han J, Wang MG, Hou XH, Gao ZF, Zhang YF, Liang JM. The EEG Features of Four Cases of Subacute Sclerosing Panencephalitis in North China: SSPE EEG Features. Clin EEG Neurosci 2024; 55:354-361. [PMID: 36341690 DOI: 10.1177/15500594221137050] [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: 11/09/2022]
Abstract
Objective. To analyze the EEG features of four subacute sclerosing panencephalitis cases in North China. Methods. We retrospectively analyzed the EEG features in four patients with subacute sclerosing panencephalitis and 12 patients in control group from North China. Results. The periodic long-interval diffuse discharges were found in all of the four cases with subacute sclerosing panencephalitis. The morphology and component of periodic complexes were varied in different patients and different wakefulness states. Some EEG parameter settings help to identify periodic long-interval diffuse discharges including the slowed sweep speed, decreased sensitivity and reduced number of montages. In each patient with subacute sclerosing panencephalitis, the periodic long-interval diffuse discharges associated with two types of brief episodes (1:1) during awake period were found and none of the patients in the control group had this EEG pattern. The score system based on the periodic discharges and brief episodes also shows that all the patients with SSPE reached score 5 while none of the patients in the control group has a score greater than 3, which suggests that this EEG pattern may have diagnostic value. Conclusions. In subacute sclerosing panencephalitis, the morphology and component of periodic long-interval diffuse discharges were varied in different patients and different wakefulness states. Specific EEG parameter settings help to identify periodic long-interval diffuse discharges. Periodic long-interval diffuse discharges associated with two types of brief episodes (1:1) during awake period may strongly suggest the diagnosis of subacute sclerosing panencephalitis.
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Affiliation(s)
- Jiang-Tao Wang
- Department of Pediatric Neurology, First Hospital of Jilin University, Changchun, China
| | - Jie Han
- Electroencephalography Department, HanDan Central Hospital, HanDan, China
| | - Ming-Guang Wang
- Department of Pediatric Neurology, XuZhou Medical University, Xuzhou, China
| | - Xiao-Hua Hou
- Electroencephalography Department, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zai-Fen Gao
- Neurology Department, QiLu Children's Hospital of ShanDong University, Jinan, China
| | - Yan-Feng Zhang
- Department of Pediatric Neurology, First Hospital of Jilin University, Changchun, China
| | - Jian-Min Liang
- Department of Pediatric Neurology, First Hospital of Jilin University, Changchun, China
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Keerthiraj DB, Pandey S, Kumar Garg R, Singh Malhotra H, Verma R, Kumar Sharma P, Kumar N, Uniyal R, Rizvi I, Kumar S, Parihar A, Jain A. Neuroimaging Abnormalities in Patients with Subacute Sclerosing Panencephalitis : Prospective Follow-up Study. Clin Neuroradiol 2024:10.1007/s00062-024-01396-1. [PMID: 38451268 DOI: 10.1007/s00062-024-01396-1] [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: 10/16/2023] [Accepted: 01/31/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE This study aimed to assess the neuroimaging abnormalities and their progression in patients with Subacute sclerosing panencephalitis (SSPE) and identify clinical predictors of these imaging findings. METHODS This prospective observational study evaluated clinical and neuroimaging features in patients with SSPE. Patients were categorized using Dyken's criteria, Jabbour's staging system, and the definition of fulminant SSPE. They underwent comprehensive clinical assessments, cerebrospinal fluid examination, Electroencephalogram (EEG), and Magnetic Resonance Imaging (MRI) scans. Treatment involved intrathecal interferon‑α and antiepileptic medications. Functional disability was assessed using the modified Barthel index. Follow-ups were performed at 6 months, including reassessment of Modified Barthel Index (MBI) and Jabbour's staging and EEG and MRI scans. RESULTS The mean age was 13.9 ± 6.7 years, with males comprising 81.5% (44/54) of the cohort. Fulminant SSPE was noted in 33% (18/54) of cases. Disease duration before presentation varied significantly between fulminant and non-fulminant forms (p = 0.001). Neuroimaging abnormalities were more prevalent in JS III stage patients, with diffuse cerebral atrophy being a significant finding (p = 0.011). Basal ganglia involvement correlated with movement disorders. The 6‑month follow-up showed increased cerebral atrophy (p = 0.004). Increasing disease duration was an independent predictor of cerebral atrophy. An Intercomplex interval (ICI) of more than 10 minutes correlated with normal neuroimaging, 10 patients died within the study period, 8 of whom had fulminant SSPE. CONCLUSION Parieto-occipital White matter hyperintensity (WMH) is the most prevalent and sensitive neuroimaging finding for the diagnosis of SSPE. Despite interferon treatment, cerebral atrophy progressed in both aggressive and fulminant SSPE. Increasing disease duration is an independent predictor of cerebral atrophy.
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Affiliation(s)
- D B Keerthiraj
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shweta Pandey
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India.
| | - Ravindra Kumar Garg
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Hardeep Singh Malhotra
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rajesh Verma
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Praveen Kumar Sharma
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Neeraj Kumar
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ravi Uniyal
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Imran Rizvi
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sukriti Kumar
- Department of Radiodiagnosis, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Anit Parihar
- Department of Radiodiagnosis, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Amita Jain
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Gowda VK, Jetha K. Subacute Sclerosing Panencephalitis (SSPE): A Wolf in Sheep's Clothing-Infantile Presentation Masquerading as Autoimmune Encephalitis. Indian J Pediatr 2024; 91:316. [PMID: 38079071 DOI: 10.1007/s12098-023-04975-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/01/2023] [Indexed: 02/15/2024]
Affiliation(s)
- Vykuntaraju K Gowda
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Near NIMHANS, Bengaluru, Karnataka, 560029, India.
| | - Kapil Jetha
- Department of Pediatrics, AIIMS Rajkot, Anandpar, Gujarat, India
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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 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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Jahanshahi A, Salarinejad S, Oraee-Yazdani S, Chehresonboll Y, Morsali S, Jafarizadeh A, Falahatian M, Rahimi F, Jaberinezhad M. Gliomatosis cerebri with blindness: A case report with literature review. Radiol Case Rep 2023; 18:2884-2894. [PMID: 37388536 PMCID: PMC10300258 DOI: 10.1016/j.radcr.2023.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 07/01/2023] Open
Abstract
Cerebral gliomatosis (GC) is a rare diffuse infiltrative growth pattern of glioma with nonspecific clinical manifestations like visual impairment that may involve bilateral temporal lobes. Herpes simplex encephalitis (HSE) and limbic encephalitis (LE) can also lead to temporal lobe involvement. Differentiating these entities is necessary for patients with misleading presentations and imaging findings. To the best of our knowledge, this is the third case of GC presenting with blindness. The patient was a 35 years-old male in a drug rehabilitation center for heroin addiction. He presented with a headache, a single episode of seizure, and a 2-month history of bilateral decrease in visual acuity, which had acutely worsened. Magnetic resonance imaging (MRI) and computed tomography (CT) showed bilateral temporal lobe involvement. Ophthalmological studies showed bilateral papilledema, absence of visual evoked potential, and thickening of the retinal nerve fiber layer. Due to this clinical presentation, normal laboratory data, and suspicious MRI findings, further investigation with magnetic resonance spectroscopy (MRS) was performed. Results showed a greatly increased ratio of choline to creatinine(Cr) or N-acetyl aspartate (NAA), suggesting a neoplastic nature of the disease. Subsequently, the patient was referred for a brain tissue biopsy with a suspicion of malignancy. The pathology results revealed adult-type diffuse glioma with isocitrate dehydrogenase (IDH) mutation. Bilateral blindness, as well as bilateral temporal lobe involvement, each has many different causes. However, as demonstrated in this study, adult-type diffuse glioma must be considered a rare cause of concomitant bilateral temporal lobe involvement and blindness.
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Affiliation(s)
- Amirreza Jahanshahi
- Department of Radiology, Emam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
- Medical Radiation Sciences Research Group, Imam Reza Hosptial, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sareh Salarinejad
- Department of Pathology, Faculty of Medicine, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Saeed Oraee-Yazdani
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yasaman Chehresonboll
- Department of Surgical and Clinical Pathology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soroush Morsali
- Neuroscience Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Jafarizadeh
- Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masih Falahatian
- Medical Radiation Sciences Research Group, Imam Reza Hosptial, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Faezeh Rahimi
- Department of Radiology, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mehran Jaberinezhad
- Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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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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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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Garg RK, Paliwal V, Rizvi I, Pandey S, Uniyal R, Agrawal S, Khanna R. Obstetric outcomes in pregnant women with subacute sclerosing panencephalitis (SSPE): a systematic review of case reports and case series. Neurol Sci 2023; 44:1959-1968. [PMID: 36729186 DOI: 10.1007/s10072-023-06650-x] [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: 08/30/2022] [Accepted: 01/28/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Subacute sclerosing panencephalitis (SSPE) is a devastating brain disease caused by persistent infection by the measles virus. Several cases of SSPE in pregnant ladies have been described. This systematic review is focused on maternal and foetal outcomes among pregnant women with SSPE. METHODS We searched four databases (PubMed, Embase, Scopus, and Google Scholar). We reviewed all relevant cases, published until 14 August 2022. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol was registered with PROSPERO (CRD42022348630). The search items that we used were "((Pregnancy) OR (delivery)) AND (Subacute sclerosing panencephalitis (SSPE))". Dyken's criteria were used for the diagnosis of SSPE in pregnant women. The extracted data was recorded in an Excel sheet. The Joanna Briggs Institute Critical Appraisal tool for case reports was used to assess the quality of published cases. RESULTS We came across 19 reports describing details of 21 cases. The age of SSPE-affected women varied from 14 to 34 years (mean 23 years). In the majority (n=14), clinical manifestations were started in the antepartum period. Nine pregnant SSPE women presented with vision loss. After delivery, 13 SSPE-affected women died. On the contrary, 15 foetuses, though the majority were preterm, were alive. Five foetuses either died soon after birth or were still-born. CONCLUSION In conclusion, SSPE in pregnancy is often missed, as it mimics eclampsia. SSPE in pregnancy usually has a devastating course. Universal early childhood measles vaccination is the only way to fight this menace.
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Affiliation(s)
- Ravindra Kumar Garg
- Department of Neurology, King George's Medical University, Lucknow, 226003, India.
| | - Vimal Paliwal
- Department of Neurology, Sanjay Gandhi Institute of Medical Sciences, Lucknow, 226001, India
| | - Imran Rizvi
- Department of Neurology, King George's Medical University, Lucknow, 226003, India
| | - Shweta Pandey
- Department of Neurology, King George's Medical University, Lucknow, 226003, India
| | - Ravi Uniyal
- Department of Neurology, King George's Medical University, Lucknow, 226003, India
| | - Smriti Agrawal
- Department of Obstetrics and Gynaecology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, 226001, India
| | - Richa Khanna
- Department of Pedodontics, King George's Medical University, Lucknow, 226003, India
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Vijayavarman V, Malhotra HS, Rizvi I, Kumar N, Pandey S, Jain M, Ali W, Suresh V, Garg RK, Jain A, Verma R, Sharma P, Uniyal R. Immune-dysregulation in subacute sclerosing panencephalitis: An exploratory case-control study. J Med Virol 2023; 95:e28504. [PMID: 36655739 DOI: 10.1002/jmv.28504] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/20/2023]
Abstract
Subacute sclerosing panencephalitis (SSPE) is a chronic progressive neurological condition caused by a defective measles virus. It is postulated that immune-dysregulation might result in persistent infection (immune evasion) as well as initiation of autoimmune phenomenon (via natural killer cells) leading to panencephalitis. The primary objective of this case-control study was to analyse the pattern of immune dysregulation in cases with SSPE. The secondary objective was to assess the correlation between the measured immunological variables and disability/death at 6 months. This was an exploratory case-control study conducted at a tertiary-care referral-facility from January 2020 to September 2021. Thirty consecutive patients fulfilling the Dyken's criteria for SSPE and 30 age-and-sex-matched healthy controls were enrolled. Immunological profile constituted by lymphocyte subset analysis, immunoglobulin levels and complement levels were done in all cases and controls. Cases were staged as per Jabbour's system; disability was assessed using the modified Rankin Scale (mRS). Patients with SSPE had a mean age of 14.76 years (±6.9 years). There were 25 males and 5 females; 6.7% cases belonged to Jabbour's first stage, 40% to second stage and 53.3% to third stage. At least 1/4th had evidence of measles vaccination. Levels of absolute lymphocyte count, B-cells, T cells, helper T-cells, and cytotoxic T-cells were significantly higher in cases. IgG, IgM, and IgE levels were significantly higher while IgD levels were significantly lower in cases. At baseline, 13.3% of cases had a mRS score of 0-2 and 86.7% had a score of 3-6; at 6 months 10% had a mRS score 0-2 (favorable outcome) while 90% had a mRS score 3-6 (poor outcome). Higher IgE levels were found to correlate significantly with favorable outcome. Immune-dysregulation may play a significant role in shaping one's response to measles infection as well as in determining vaccine-efficacy.
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Affiliation(s)
| | - Hardeep S Malhotra
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Imran Rizvi
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Neeraj Kumar
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shweta Pandey
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Mili Jain
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Wahid Ali
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vinay Suresh
- King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ravindra K Garg
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Amita Jain
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rajesh Verma
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Praveen Sharma
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ravi Uniyal
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Preliminary seroprevalence study of neurotropic virus antibodies in Nodding syndrome. eNeurologicalSci 2022; 29:100423. [PMID: 36133256 PMCID: PMC9483776 DOI: 10.1016/j.ensci.2022.100423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 11/22/2022] Open
Abstract
Nodding syndrome (NS) is a mostly East African pediatric epileptiform encephalopathy of unknown etiology that shares some clinical features with measles-associated subacute sclerosing panencephalitis (SSPE) and progressive rubella panencephalitis. Two independent studies in northern Uganda identified an association between NS and prior measles infection, while an earlier study in South Sudan found an inverse association. We report preliminary serologic analyses of antibodies to measles (MV), rubella (RV), HSV-1, and CMV viruses in northern Ugandan children with NS and Household (HC) and Community (CC) Controls. Only MV-positive titers were significantly different (3-fold and > 2-fold) in NS relative to HC and HC + CC, respectively. While these results are consistent with greater prior measles infection in Ugandan persons with NS, further studies are needed to determine whether Measles virus (MV) plays any role in the etiology and pathogenesis of NS. Resolving this issue will be invaluable for the thousands of children at risk for this devastating yet often neglected condition. Nodding syndrome (NS) is an enigmatic pediatric epileptiform encephalopathy. We report an association between NS and measles virus (MV)-positive titers. Further studies should assess whether MV plays any role in the etiology of NS.
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Gupta D, Gupta H, Patel A, Dugani P, Pradeep R, Mehta A, Javali M, Acharya PT, Srinivasa R. Teaching Video NeuroImage: Slow Axial Myoclonus in Subacute Sclerosing Panencephalitis. Neurology 2022; 99:864-865. [PMID: 36240086 DOI: 10.1212/wnl.0000000000201283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/09/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Dhananjay Gupta
- From the Department of Neurology (D.G., P.D., R.P., A.M., M.J., P.T.A., R.S.), Ramaiah Medical College, Bangalore; and Doaba Hospital and Neurocare Centre (D.G., H.G., A.P.), Jalandhar, India
| | - Haripriya Gupta
- From the Department of Neurology (D.G., P.D., R.P., A.M., M.J., P.T.A., R.S.), Ramaiah Medical College, Bangalore; and Doaba Hospital and Neurocare Centre (D.G., H.G., A.P.), Jalandhar, India
| | - Anuja Patel
- From the Department of Neurology (D.G., P.D., R.P., A.M., M.J., P.T.A., R.S.), Ramaiah Medical College, Bangalore; and Doaba Hospital and Neurocare Centre (D.G., H.G., A.P.), Jalandhar, India
| | - Pooja Dugani
- From the Department of Neurology (D.G., P.D., R.P., A.M., M.J., P.T.A., R.S.), Ramaiah Medical College, Bangalore; and Doaba Hospital and Neurocare Centre (D.G., H.G., A.P.), Jalandhar, India
| | - R Pradeep
- From the Department of Neurology (D.G., P.D., R.P., A.M., M.J., P.T.A., R.S.), Ramaiah Medical College, Bangalore; and Doaba Hospital and Neurocare Centre (D.G., H.G., A.P.), Jalandhar, India.
| | - Anish Mehta
- From the Department of Neurology (D.G., P.D., R.P., A.M., M.J., P.T.A., R.S.), Ramaiah Medical College, Bangalore; and Doaba Hospital and Neurocare Centre (D.G., H.G., A.P.), Jalandhar, India
| | - Mahendra Javali
- From the Department of Neurology (D.G., P.D., R.P., A.M., M.J., P.T.A., R.S.), Ramaiah Medical College, Bangalore; and Doaba Hospital and Neurocare Centre (D.G., H.G., A.P.), Jalandhar, India
| | - Purshottam T Acharya
- From the Department of Neurology (D.G., P.D., R.P., A.M., M.J., P.T.A., R.S.), Ramaiah Medical College, Bangalore; and Doaba Hospital and Neurocare Centre (D.G., H.G., A.P.), Jalandhar, India
| | - Rangasetty Srinivasa
- From the Department of Neurology (D.G., P.D., R.P., A.M., M.J., P.T.A., R.S.), Ramaiah Medical College, Bangalore; and Doaba Hospital and Neurocare Centre (D.G., H.G., A.P.), Jalandhar, India
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Sinha R, Singh S, Balamurugan N, Pandey A. Myoclonic-Atonic Epilepsy Masquerading as Subacute Sclerosing Panencephalitis: A Clinical Conundrum. ANNALS OF CHILD NEUROLOGY 2022. [DOI: 10.26815/acn.2022.00227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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14
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Silva DP, Coelho P, Silva CS, Campos CF, Franco AC, Valadas A, Antunes AP, Albuquerque L. Slow Periodic Spasms and Rapidly Progressive Parkinsonism Due to Cerebral Amyloid Angiopathy. Mov Disord Clin Pract 2022; 9:S21-S25. [PMID: 36118512 PMCID: PMC9464995 DOI: 10.1002/mdc3.13539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 04/24/2022] [Accepted: 04/29/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Daniela Pimenta Silva
- Department of Neurosciences and Mental HealthHospital de Santa Maria, Centro Hospitalar Universitário de Lisboa NorteLisbonPortugal
- Laboratory of Clinical Pharmacology and TherapeuticsFaculty of Medicine of the University of LisbonLisbonPortugal
- Faculdade de Medicina da Universidade de LisboaLisbonPortugal
| | - Pedro Coelho
- Department of Neurosciences and Mental HealthHospital de Santa Maria, Centro Hospitalar Universitário de Lisboa NorteLisbonPortugal
| | - Cláudia Santos Silva
- Department of Neurosciences and Mental HealthHospital de Santa Maria, Centro Hospitalar Universitário de Lisboa NorteLisbonPortugal
- Institute of PhysiologyInstituto de Medicina Molecular, Faculdade de Medicina da Universidade de LisboaLisbonPortugal
| | - Catarina Falcão Campos
- Department of Neurosciences and Mental HealthHospital de Santa Maria, Centro Hospitalar Universitário de Lisboa NorteLisbonPortugal
- Faculdade de Medicina da Universidade de LisboaLisbonPortugal
- Institute of PhysiologyInstituto de Medicina Molecular, Faculdade de Medicina da Universidade de LisboaLisbonPortugal
| | - Ana Catarina Franco
- Department of Neurosciences and Mental HealthHospital de Santa Maria, Centro Hospitalar Universitário de Lisboa NorteLisbonPortugal
- Faculdade de Medicina da Universidade de LisboaLisbonPortugal
- EEG/Sleep Laboratory and Neurophysiology Monitoring Unit, Department of Neurosciences and Mental HealthHospital de Santa Maria, Centro Hospitalar Universitário Lisboa NorteLisbonPortugal
| | - Anabela Valadas
- Department of Neurosciences and Mental HealthHospital de Santa Maria, Centro Hospitalar Universitário de Lisboa NorteLisbonPortugal
- Faculdade de Medicina da Universidade de LisboaLisbonPortugal
| | - Ana Patrícia Antunes
- Department of Neurosciences and Mental HealthHospital de Santa Maria, Centro Hospitalar Universitário de Lisboa NorteLisbonPortugal
- Faculdade de Medicina da Universidade de LisboaLisbonPortugal
| | - Luísa Albuquerque
- Department of Neurosciences and Mental HealthHospital de Santa Maria, Centro Hospitalar Universitário de Lisboa NorteLisbonPortugal
- Faculdade de Medicina da Universidade de LisboaLisbonPortugal
- Instituto de Medicina MolecularLisbonPortugal
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15
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Pritha A, Medha TN, Garg RK. A Comprehensive Investigation of the Current Subacute Sclerosing Panencephalitis (SSPE) Treatment Options to Improve Patient Quality of Life. Cureus 2022; 14:e28389. [PMID: 36171840 PMCID: PMC9508860 DOI: 10.7759/cureus.28389] [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] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Subacute sclerosing panencephalitis (SSPE) is a progressive, disabling, and deadly neurological disorder related to measles (rubeola) infection occurring primarily in children. The slow but persistent viral infection occurs in children or young adults and affects their central nervous system (CNS). There have been plenty of reports on SSPE throughout the world, but it is considered a rare disease in developed countries. This research focuses on comparing the current treatments available to prolong the life of patients for over three years after the onset of SSPE. The goal was to identify possible patterns or trends among the treatments in order to find the best possible method to lengthen a patient's life. The results indicated that interferon alpha, inosine pranobex, and ribavirin display the most effective treatment plan and indicate the most potential in discovering a more effective therapeutic for SSPE.
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16
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Kume Y, Hashimoto K, Iida K, Maeda H, Miyazaki K, Ono T, Chishiki M, Suzuki Y, Go H, Suyama K, Hosoya M. Diagnostic reference value of antibody levels measured using enzyme immunoassay for subacute sclerosing panencephalitis. Microbiol Immunol 2022; 66:418-425. [PMID: 35766430 DOI: 10.1111/1348-0421.13017] [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: 01/11/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022]
Abstract
High measles-specific antibody titers in the cerebrospinal fluid (CSF) have important diagnostic significance for subacute sclerosing panencephalitis (SSPE), a progressive neurological disorder caused by measles virus variants. However, the diagnostic reference value of antibody levels and the usefulness of the CSF/serum ratio measured using enzyme immunoassays (EIAs) for SSPE diagnosis remain unclear. To facilitate SSPE diagnosis using EIAs, measles immunoglobulin G (IgG) titers in the CSF and serum of patients with and without SSPE were measured and their CSF/serum antibody ratios evaluated. Serum and CSF antibody levels were compared among three patients with SSPE (59 paired samples), 37 non-SSPE patients, and 2618 patients of unknown backgrounds. Of the 59 paired samples from three patients with SSPE, 56 paired samples (94.9%) showed CSF measles IgG levels ≥0.5 IU/mL and a CSF/serum ratio ≥0.05, whereas non-SSPE cases showed CSF measles IgG levels <0.1 IU/mL and a CSF/serum ratio <0.03. Of the 2618 CSF samples with unknown backgrounds, 951 showed measurable IgG levels with EIA, with a CSF/serum ratio peak of 0.005-0.02, with a 90th percentile of 0.05. Assuming the SSPE criteria as CSF measles IgG ≥0.5 IU/mL and a CSF/serum ratio ≥0.05, only 20 samples (0.8%) with unknown backgrounds were categorized as having SSPE. Conversely, assuming the non-SSPE criteria as CSF measles IgG <0.1 IU/mL and a CSF/serum ratio <0.03, 2403 samples (92%) with unknown backgrounds were categorized as not having SSPE. In conclusion, high CSF/serum ratios (≥0.05) and high measles CSF IgG levels (≥0.5 IU/mL) may be useful for diagnosing SSPE.
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Affiliation(s)
- Yohei Kume
- Department of Pediatrics, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Koichi Hashimoto
- Department of Pediatrics, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Keiji Iida
- H.U. Frontier, Inc. (formerly SRL, Inc.), 2-1-1 Nishishinjuku, Shinjuku, Tokyo, Japan
| | - Hajime Maeda
- Department of Pediatrics, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Kyohei Miyazaki
- Department of Pediatrics, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Takashi Ono
- Department of Pediatrics, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Mina Chishiki
- Department of Pediatrics, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Yuichi Suzuki
- Department of Pediatrics, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Hayato Go
- Department of Pediatrics, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Kazuhide Suyama
- Department of Pediatrics, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | - Mitsuaki Hosoya
- Department of Pediatrics, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
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17
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Bapat P, Kushwaha S, R K, Gunasekaran A, Seth V. Relapsing Remitting Subacute Sclerosing Panencephalitis: A Case Report. J Med Virol 2022; 94:2933-2935. [PMID: 35257393 DOI: 10.1002/jmv.27702] [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: 12/21/2021] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/07/2022]
Abstract
Subacute sclerosing panencephalitis is a neurological complication of measles virus infection. It can have a typical or atypical clinical history. Typical presentation includes acute or rapidly progressive, subacute progressive, chronic progressive and chronic relapsing-remitting. We present a patient of chronic relapsing-remitting variety which is uncommon as compared to other typical presentations and hence, should be kept in mind by the treating clinician before counselling the relatives and to avoid diagnostic dilemma. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Prateek Bapat
- Department of Neurology, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, Delhi, India, PIN-110095
| | - Suman Kushwaha
- Department of Neurology, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, Delhi, India, PIN-110095
| | - KiranGowda R
- Department of Neurology, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, Delhi, India, PIN-110095
| | - Aravind Gunasekaran
- Department of Neurology, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, Delhi, India, PIN-110095
| | - Vaibhav Seth
- Department of Neurology, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, Delhi, India, PIN-110095
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18
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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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19
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Abd-Elfarag GOE, Edridge AWD, Spijker R, Sebit MB, van Hensbroek MB. Nodding Syndrome: A Scoping Review. Trop Med Infect Dis 2021; 6:tropicalmed6040211. [PMID: 34941667 PMCID: PMC8703395 DOI: 10.3390/tropicalmed6040211] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 12/23/2022] Open
Abstract
Nodding syndrome (NS) is a debilitating yet often neglected neurological disease affecting thousands of children in several sub-Saharan African countries. The cause of NS remains unknown, and effective treatment options are lacking. Moreover, knowledge regarding NS is scarce and is based on a limited number of publications, with no comprehensive overview published to date. Therefore, the aim of this scoping review was to summarise the current evidence and identify existing knowledge gaps in order to help clinicians, scientists, and policymakers develop guidelines for prioritising this severe condition. We searched the Medline (Ovid), Embase (Ovid), Scopus, and Global Health Library databases in accordance with the PRISMA extension for scoping review guidance and in accordance with the Joanna Briggs Institute guidelines and methodology for a scoping review, using keywords describing NS. We then extracted and presented the original data regarding the epidemiology, aetiology, pathophysiology, clinical features, diagnosis, management, and outcomes of NS, as well as community perceptions and the psychosocial and economic impact of NS. Out of 1470 identified articles, a total of 69 were included in this scoping review. Major gaps exist in understanding the aetiology and pathogenesis of NS. Future research is urgently needed not only to address these gaps, but also to study the treatment options, epidemiology, and psychosocial and economic impacts of NS. Innovative interventions and rehabilitation programmes designed to address the psychosocial and economic burdens associated with NS are also urgently needed.
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Affiliation(s)
- Gasim Omer Elkhalifa Abd-Elfarag
- Amsterdam Center for Global Health, Department of Pediatrics and Department of Global Health, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (A.W.D.E.); (M.B.v.H.)
- Correspondence:
| | - Arthur Wouter Dante Edridge
- Amsterdam Center for Global Health, Department of Pediatrics and Department of Global Health, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (A.W.D.E.); (M.B.v.H.)
- Laboratory of Experimental Virology, Department of Medical Microbiology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - René Spijker
- Amsterdam Public Health, Medical Library, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands;
| | - Mohamed Boy Sebit
- Department of Psychiatry, College of Medicine, University of Juba, Juba P.O. Box 82, Sudan;
| | - Michaël B. van Hensbroek
- Amsterdam Center for Global Health, Department of Pediatrics and Department of Global Health, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (A.W.D.E.); (M.B.v.H.)
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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: 0] [Impact Index Per Article: 0] [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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21
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Bokelmann M, Vogel U, Debeljak F, Düx A, Riesle-Sbarbaro S, Lander A, Wahlbrink A, Kromarek N, Neil S, Couacy-Hymann E, Prescott J, Kurth A. Tolerance and Persistence of Ebola Virus in Primary Cells from Mops condylurus, a Potential Ebola Virus Reservoir. Viruses 2021; 13:v13112186. [PMID: 34834992 PMCID: PMC8622823 DOI: 10.3390/v13112186] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/14/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Although there have been documented Ebola virus disease outbreaks for more than 40 years, the natural reservoir host has not been identified. Recent studies provide evidence that the Angolan free-tailed bat (Mops condylurus), an insectivorous microbat, is a possible ebolavirus reservoir. To investigate the potential role of this bat species in the ecology of ebolaviruses, replication, tolerance, and persistence of Ebola virus (EBOV) were investigated in 10 different primary bat cell isolates from M. condylurus. Varying EBOV replication kinetics corresponded to the expression levels of the integral membrane protein NPC1. All primary cells were highly tolerant to EBOV infection without cytopathic effects. The observed persistent EBOV infection for 150 days in lung primary cells, without resultant selective pressure leading to virus mutation, indicate the intrinsic ability of EBOV to persist in this bat species. These results provide further evidence for this bat species to be a likely reservoir of ebolaviruses.
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Affiliation(s)
- Marcel Bokelmann
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353 Berlin, Germany; (M.B.); (U.V.); (S.R.-S.); (A.L.); (A.W.); (N.K.); (J.P.)
| | - Uwe Vogel
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353 Berlin, Germany; (M.B.); (U.V.); (S.R.-S.); (A.L.); (A.W.); (N.K.); (J.P.)
| | - Franka Debeljak
- Department of Infectious Diseases, King’s College London, London WC2R 2LS, UK; (F.D.); (S.N.)
| | - Ariane Düx
- Epidemiology of Highly Pathogenic Microorganisms, Robert Koch Institute, 13353 Berlin, Germany;
| | - Silke Riesle-Sbarbaro
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353 Berlin, Germany; (M.B.); (U.V.); (S.R.-S.); (A.L.); (A.W.); (N.K.); (J.P.)
| | - Angelika Lander
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353 Berlin, Germany; (M.B.); (U.V.); (S.R.-S.); (A.L.); (A.W.); (N.K.); (J.P.)
| | - Annette Wahlbrink
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353 Berlin, Germany; (M.B.); (U.V.); (S.R.-S.); (A.L.); (A.W.); (N.K.); (J.P.)
| | - Nicole Kromarek
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353 Berlin, Germany; (M.B.); (U.V.); (S.R.-S.); (A.L.); (A.W.); (N.K.); (J.P.)
| | - Stuart Neil
- Department of Infectious Diseases, King’s College London, London WC2R 2LS, UK; (F.D.); (S.N.)
| | - Emmanuel Couacy-Hymann
- Laboratoire National d’Appui au Développement Agricole, Bingerville BP 206, Côte d’Ivoire;
| | - Joseph Prescott
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353 Berlin, Germany; (M.B.); (U.V.); (S.R.-S.); (A.L.); (A.W.); (N.K.); (J.P.)
| | - Andreas Kurth
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353 Berlin, Germany; (M.B.); (U.V.); (S.R.-S.); (A.L.); (A.W.); (N.K.); (J.P.)
- Correspondence:
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22
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Vidhale TA, Gupta HR, Prafulla Jaya R, Pustake M. Fulminant subacute sclerosing panencephalitis (SSPE) presented with acute hemiparesis in a 13-year-old girl with perinatally acquired HIV infection. BMJ Case Rep 2021; 14:e241205. [PMID: 34518172 PMCID: PMC8438743 DOI: 10.1136/bcr-2020-241205] [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] [Accepted: 08/22/2021] [Indexed: 11/03/2022] Open
Abstract
A 13-year-old girl with perinatally acquired HIV infection was admitted to us with acute onset, right-sided hemiparesis of 30 days duration and right-sided myoclonic jerks of 2 days duration affecting the face, upper and lower limbs. On examination, she exhibited increased tone and a pyramidal pattern of weakness in her right upper and lower limbs, along with spontaneous multifocal myoclonic jerks in the affected area. IgG levels in the serum and cerebrospinal fluid for measles were significantly elevated. Brain MRI depicted T2-weighted-hyperintensities in the subcortical white matter. The electroencephalogram demonstrated evidence of lateralised long interval periodic discharges. This patient had no past behavioural problems or poor academic performance. This case underlines the fact that, though subacute sclerosing panencephalitis (SSPE) is a chronic disease, a rare fulminant form of SSPE might develop acutely and atypically, with an increased proclivity for HIV-infected patients.
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Affiliation(s)
- Tushar Ashok Vidhale
- General Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Hemant R Gupta
- General Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Rohan Prafulla Jaya
- Department of Radiology, BGS Global Institute of Medical Sciences, Bangalore, Karnataka, India
| | - Manas Pustake
- General Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
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23
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SSPE - Rare in developed countries, still common elsewhere in the world. Eur J Paediatr Neurol 2021; 34:A3. [PMID: 34535378 DOI: 10.1016/j.ejpn.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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24
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Lam T, Ranjan R, Newark K, Surana S, Bhangu N, Lazenbury A, Childs AM, Abbey I, Gibbon F, Thomas G, Singh J, Prabhakar P, Kaminska M, Lascelles K, Hacohen Y, Brown K, Lim M. A recent surge of fulminant and early onset subacute sclerosing panencephalitis (SSPE) in the United Kingdom: An emergence in a time of measles. Eur J Paediatr Neurol 2021; 34:43-49. [PMID: 34388650 DOI: 10.1016/j.ejpn.2021.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/31/2021] [Accepted: 07/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Subacute Sclerosing Panencephalitis (SSPE) is a fatal progressive neurological disorder following measles infection. METHODS Cases were collated from Paediatric Neurology centres in the UK over 24 months from 2017 to 2019 and represent all cases referred to the National Viral Reference Department (VRD). Diagnosis was established with detection of a raised measles index, demonstrating intrathecal measles antibody production. FINDINGS Six children presented with SSPE over two years, with median age five years (range 2-7 years) and median latency period three years (range 2-6 years). The majority were exposed to measles during infancy. Atypical features were common, including visual impairment, focal and generalised tonic-clonic seizures, headache, vomiting and movement disorders. EEG demonstrated typical features in five cases, though not always at presentation. Initial MRI was normal in four cases, with two showing focal and widespread white matter changes. Antiviral and immunomodulatory treatment led to minimal or no improvement. All progressed to cognitive regression, seizures and neurological decline within six months. INTERPRETATION These cases demonstrate the highest incidence of SSPE in the UK since 2000, all progressing to acute fulminant disease, following younger age of onset, short latency period and atypical presentations. Recent global surges in measles cases raise the importance of clinician awareness of SSPE as a potential diagnosis in children with neurological regression. Herd immunity remains the key protective mechanism for infants and groups that cannot be vaccinated. Health care providers, educators and governments must ensure resources continue to target effective education and access to immunisation programmes, the only means to combat this devastating and fatal condition.
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Affiliation(s)
- Tanya Lam
- Children's Neuroscience Centre, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, UK.
| | - Rajesh Ranjan
- Paediatric Neurology, Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | - Kerensa Newark
- Paediatric Neuroscience Department, Leeds Teaching Hospitals NHS Foundation Trust, Leeds, UK
| | - Snehal Surana
- Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Neeraj Bhangu
- Paediatric Neurology, Southampton Children's Hospital, Southampton, UK
| | - Abigail Lazenbury
- Paediatric Neurology, Southampton Children's Hospital, Southampton, UK
| | - Anne-Marie Childs
- Paediatric Neuroscience Department, Leeds Teaching Hospitals NHS Foundation Trust, Leeds, UK
| | - Ianthe Abbey
- General Paediatrics, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Frances Gibbon
- Paediatric Neurology, Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | - Gareth Thomas
- Paediatric Neurology, Morriston Hospital, Swansea, UK
| | - Jaspal Singh
- Paediatric Neurology, Southampton Children's Hospital, Southampton, UK
| | - Prab Prabhakar
- Paediatric Neurology, Great Ormond Street Hospital & UCL-GOSICH, London, UK
| | - Margaret Kaminska
- Children's Neuroscience Centre, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, UK
| | - Karine Lascelles
- Children's Neuroscience Centre, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, UK
| | - Yael Hacohen
- Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London. Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Kevin Brown
- Consultant Medical Virologist, Virus Reference Department and Immunisation and Countermeasures Division, Public Health England, UK
| | - Ming Lim
- Children's Neuroscience Centre, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, UK; Faculty of Life Sciences, King's College, London, UK.
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25
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Ottesen JT, Andersen M. Potential of Immunotherapies in Treating Hematological Cancer-Infection Comorbidities-A Mathematical Modelling Approach. Cancers (Basel) 2021; 13:3789. [PMID: 34359690 PMCID: PMC8345105 DOI: 10.3390/cancers13153789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/08/2021] [Accepted: 07/23/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The immune system attacks threats like an emerging cancer or infections like COVID-19 but it also plays a role in dealing with autoimmune disease, e.g., inflammatory bowel diseases, and aging. Malignant cells may tend to be eradicated, to appraoch a dormant state or escape the immune system resulting in uncontrolled growth leading to cancer progression. If the immune system is busy fighting a cancer, a severe infection on top of it may compromise the immunoediting and the comorbidity may be too taxing for the immune system to control. METHOD A novel mechanism based computational model coupling a cancer-infection development to the adaptive immune system is presented and analyzed. The model maps the outcome to the underlying physiological mechanisms and agree with numerous evidence based medical observations. RESULTS AND CONCLUSIONS Progression of a cancer and the effect of treatments depend on the cancer size, the level of infection, and on the efficiency of the adaptive immune system. The model exhibits bi-stability, i.e., virtual patient trajectories gravitate towards one of two stable steady states: a dormant state or a full-blown cancer-infection disease state. An infectious threshold curve exists and if infection exceed this separatrix for sufficiently long time the cancer escapes. Thus, early treatment is vital for remission and severe infections may instigate cancer progression. CAR T-cell Immunotherapy may sufficiently control cancer progression back into a dormant state but the therapy significantly gains efficiency in combination with antibiotics or immunomodulation.
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Affiliation(s)
- Johnny T. Ottesen
- Center for Mathematical Modeling-Human Health and Disease (COMMAND), Roskilde University, 4000 Roskilde, Denmark;
- IMFUFA, Department of Science and Environment, Roskilde University, 4000 Roskilde, Denmark
| | - Morten Andersen
- Center for Mathematical Modeling-Human Health and Disease (COMMAND), Roskilde University, 4000 Roskilde, Denmark;
- IMFUFA, Department of Science and Environment, Roskilde University, 4000 Roskilde, Denmark
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26
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Simkhada N, Adhikari P, Pathak BD, Dhakal B, Mahat K. A Rare Case of Subacute Sclerosing Panencephalitis Presenting As Generalized Seizure. Cureus 2021; 13:e15100. [PMID: 34159008 PMCID: PMC8212923 DOI: 10.7759/cureus.15100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Subacute sclerosing panencephalitis (SSPE) is a late complication of childhood measles. It is characterized by a progressive decline in cognitive and motor functions, seizures, and eventually death. Although a combination of intrathecal interferon alpha (IFN-α) and daily oral isoprinosine has been reported to have a good outcome, there is no cure for this condition. We present a case of a 16-year-old male with SSPE who presented with progressive weakness, frequent loss of postural control, multiple episodes of generalized tonic-clonic seizures, and urinary incontinence. On exploration of his history, he had measles at the age of two months. Investigation showed increased serum measles antibody titer, high amplitude spikes in electroencephalogram (EEG), and high fluid-attenuated inversion recovery (FLAIR) signals on MRI of the brain consistent with probable SSPE. He was managed symptomatically until his condition got worse and he eventually passed away.
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Affiliation(s)
- Nabin Simkhada
- Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, NPL
| | - Prakash Adhikari
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
| | | | - Bishal Dhakal
- Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, NPL
| | - Krish Mahat
- Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, NPL
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27
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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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28
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Monie DD, Bhandarkar AR, Parney IF, Correia C, Sarkaria JN, Vile RG, Li H. Synthetic and systems biology principles in the design of programmable oncolytic virus immunotherapies for glioblastoma. Neurosurg Focus 2021; 50:E10. [PMID: 33524942 DOI: 10.3171/2020.12.focus20855] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/04/2020] [Indexed: 12/11/2022]
Abstract
Oncolytic viruses (OVs) are a class of immunotherapeutic agents with promising preclinical results for the treatment of glioblastoma (GBM) but have shown limited success in recent clinical trials. Advanced bioengineering principles from disciplines such as synthetic and systems biology are needed to overcome the current challenges faced in developing effective OV-based immunotherapies for GBMs, including off-target effects and poor clinical responses. Synthetic biology is an emerging field that focuses on the development of synthetic DNA constructs that encode networks of genes and proteins (synthetic genetic circuits) to perform novel functions, whereas systems biology is an analytical framework that enables the study of complex interactions between host pathways and these synthetic genetic circuits. In this review, the authors summarize synthetic and systems biology concepts for developing programmable, logic-based OVs to treat GBMs. Programmable OVs can increase selectivity for tumor cells and enhance the local immunological response using synthetic genetic circuits. The authors discuss key principles for developing programmable OV-based immunotherapies, including how to 1) select an appropriate chassis, a vector that carries a synthetic genetic circuit, and 2) design a synthetic genetic circuit that can be programmed to sense key signals in the GBM microenvironment and trigger release of a therapeutic payload. To illustrate these principles, some original laboratory data are included, highlighting the need for systems biology studies, as well as some preliminary network analyses in preparation for synthetic biology applications. Examples from the literature of state-of-the-art synthetic genetic circuits that can be packaged into leading candidate OV chassis are also surveyed and discussed.
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Affiliation(s)
- Dileep D Monie
- Departments of1Immunology.,6Mayo Clinic Alix School of Medicine.,7Mayo Clinic Graduate School of Biomedical Sciences; and Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | | | | | - Cristina Correia
- 5Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic
| | | | | | - Hu Li
- 5Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic
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29
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Dey PK, Ghosh A. Atypical Presentation of Fulminating Subacute Sclerosing Panencephalitis: A Case Series. Neuropediatrics 2021; 52:52-55. [PMID: 33065753 DOI: 10.1055/s-0040-1715623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Subacute sclerosing panencephalitis (SSPE) is a rare and progressive inflammatory disease of central nervous system due to aberrant measles virus with an outcome that is nearly always fatal. In acute fulminant SSPE, the disease rapidly evolves leading to death within 3 months of the diagnosis. We report here four cases of fulminant SSPE with atypical presentations, two of them presented at very early age with history of congenital measles infection in first case and gait abnormality as initial symptom in second case; acute disseminated encephalomyelitis (ADEM) with refractory seizures in third case, unilateral myoclonus with hemiparesis in fourth case at the onset of disease, respectively. The typical periodic electroencephalographic (EEG) complexes, elevated cerebrospinal fluid (CSF), and serum antimeasles antibodies in our patients led to the diagnosis of SSPE. A high index of clinical suspicion in fulminant type with awareness of atypical features, EEG, and CSF studies are of paramount importance in establishing its diagnosis.
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Affiliation(s)
- Pranab K Dey
- Department of Paediatrics, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Arindam Ghosh
- Department of Paediatrics, Midnapore Medical College, Midnapore, West Bengal, India
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30
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Yentür SP, Demirbilek V, Gurses C, Baris S, Kuru U, Ayta S, Yapici Z, Adin-Cinar S, Uysal S, Celik Yilmaz G, Onal E, Cokar O, Saruhan-Direskeneli G. Immune alterations in subacute sclerosing panencephalitis reflect an incompetent response to eliminate the measles virus. PLoS One 2021; 16:e0245077. [PMID: 33411786 PMCID: PMC7790413 DOI: 10.1371/journal.pone.0245077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/21/2020] [Indexed: 11/19/2022] Open
Abstract
In subacute sclerosing panencephalitis (SSPE) the persistence of measles virus (MeV) may be related to the altered immune response. In this study, cytokine responses of lymphocytes and monocytes were evaluated in SSPE compared to controls with non-inflammatory (NICON) and inflammatory (ICON) diseases. Patients with SSPE (n = 120), 78 patients with ICON and 63 patients with NICON were included in this study. Phenotypes of peripheral blood mononuclear cells (PBMC) have been analyzed by flow cytometry. CD3 and CD28, and S. aureus Cowan strain I (SAC) stimulated and unstimulated cells were cultured and IL-2, IL-10, IFN-γ, IL-12p40, IL-12p70 and IL-23 were detected in supernatants by ELISA. MeV peptides were used for MeV-specific stimulation and IFN-γ secretion of PBMC was measured by ELISPOT. Spontaneous and stimulated secretions of IL-10 were lower in SSPE compared to both control groups. T cell stimulation induced lower IFN-γ production than ICON group, but higher IL-2 than NICON group in SSPE. Stimulated PBMC produced lower IL-12p70 in SSPE and had decreased CD46 on the cell surface, suggesting the interaction with the virus. IFN-γ responses against MeV peptides were not prominent and similar to NICON patients. The immune response did not reveal an inflammatory activity to eliminate the virus in SSPE patients. Even IL-10 production was diminished implicating that the response is self-limited in controlling the disease.
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Affiliation(s)
- Sibel P. Yentür
- Department of Physiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Veysi Demirbilek
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Candan Gurses
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Safa Baris
- Department of Pediatrics, Marmara Medical Faculty, Marmara University, Istanbul, Turkey
| | - Umit Kuru
- Department of Pediatrics, Bayrampasa State Hospital, Istanbul, Turkey
| | - Semih Ayta
- Department of Neurology, Haseki State Hospital, Istanbul, Turkey
| | - Zuhal Yapici
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Suzan Adin-Cinar
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Serap Uysal
- Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Gulden Celik Yilmaz
- Department of Microbiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Emel Onal
- Department of Public Health, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ozlem Cokar
- Department of Neurology, Haseki State Hospital, Istanbul, Turkey
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31
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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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Gupta A, Agarwal A, Sathish P, Salunkhe M, Garg A, Rajan R, Vishnu V, Bhatia R, Singh M, Padma Srivastava MV. Atypical subacute sclerosing panencephalitis (SSPE): All postpartum altered behavior isn't CVT! Ann Indian Acad Neurol 2021; 24:1002-1004. [PMID: 35359544 PMCID: PMC8965926 DOI: 10.4103/aian.aian_1313_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: 12/30/2020] [Revised: 01/02/2021] [Accepted: 01/06/2021] [Indexed: 11/05/2022] Open
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Oncel I, Sancar M, Konuskan B, Arioz F, Tezcan S, Arman-Kandirmaz E, Parlak S, Gumeler E, Anlar B. Aprepitant in the Treatment of Subacute Sclerosing Panencephalitis: A Randomized, Double-Blind, Placebo-Controlled Study. Pediatr Neurol 2020; 110:59-63. [PMID: 32718528 DOI: 10.1016/j.pediatrneurol.2020.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aprepitant is a neurokinin-1 receptor antagonist approved for the treatment of chemotherapy-induced nausea. We aimed to investigate the safety and efficacy of aprepitant in patients with subacute sclerosing panencephalitis. METHODS A randomized, double-blind, placebo-controlled study was conducted in patients with subacute sclerosing panencephalitis assigned to receive two courses of aprepitant 250 mg/day orally or placebo for 15 days with an interval of two months between courses. Primary end points were safety and tolerability, and secondary end point was clinical improvement or stabilization assessed by subacute sclerosing panencephalitis scoring system. Electroencephalography (EEG), brain magnetic resonance imaging, and cerebrospinal fluid measles-specific immunoglobulin G index were evaluated before and after treatment. RESULTS Sixty-two patients with subacute sclerosing panencephalitis were allocated to aprepitant (n = 31, median age 18 years) or placebo (n = 31, median age 22 years) group. Fifteen patients left the study within the first six months and 12 patients left between six and 12 months. Aprepitant was well tolerated and treatment-associated adverse events were similar to those described in the treatment of nausea. Clinical status at six and 12 months' follow-up did not differ between aprepitant and placebo groups. Post-treatment EEG scores at 12 months were better in the aprepitant group (P = 0.015). Cerebral atrophy on magnetic resonance imaging increased in both groups, whereas measles-specific immunoglobulin G index decreased in the placebo group. CONCLUSIONS In this first clinical trial of aprepitant treatment in patients with subacute sclerosing panencephalitis, the drug was safe and well tolerated. No clinical effect was observed. A modest improvement in EEG findings might justify trials for longer periods because EEG changes can precede clinical findings in subacute sclerosing panencephalitis.
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Affiliation(s)
- Ibrahim Oncel
- Department of Pediatric Neurology, Hacettepe University, Ankara, Turkey.
| | - Mesut Sancar
- Faculty of Pharmacy, Marmara University, Istanbul, Turkey
| | - Bahadir Konuskan
- Department of Pediatric Neurology, Hacettepe University, Ankara, Turkey; Pediatric Neurology Clinic, Ministry of Health Mardin Public Hospital, Mardin, Turkey
| | | | - Songul Tezcan
- Faculty of Pharmacy, Marmara University, Istanbul, Turkey
| | | | - Safak Parlak
- Department of Radiology, Hacettepe University, Ankara, Turkey
| | - Ekim Gumeler
- Department of Radiology, Hacettepe University, Ankara, Turkey
| | - Banu Anlar
- Department of Pediatric Neurology, Hacettepe University, Ankara, Turkey
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34
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Stemberger Marić L, Đaković Rode O, Višković K, Hećimović H, Lambaša S, Lepur D. Atypical adult-onset subacute sclerosing panencephalitis. Acta Clin Croat 2020; 59:543-548. [PMID: 34177067 PMCID: PMC8212648 DOI: 10.20471/acc.2020.59.03.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Although subacute sclerosing panencephalitis is almost exclusively a childhood disease, it can occur in adults as well. We present an atypical case of adult-onset subacute sclerosing panencephalitis. The disease was characterized by prolonged insidious course followed by accelerated and aggressive phase, atypical EEG findings, and absence of myoclonic jerks. The diagnostic and treatment-related pitfalls are discussed.
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Affiliation(s)
| | - Oktavija Đaković Rode
- 1School of Dental Medicine, University of Zagreb, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Department of Microbiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 3Department of Radiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 4Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 6School of Dental Medicine, University of Zagreb, Department of Intensive Care Medicine and Neuroinfectology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Klaudija Višković
- 1School of Dental Medicine, University of Zagreb, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Department of Microbiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 3Department of Radiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 4Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 6School of Dental Medicine, University of Zagreb, Department of Intensive Care Medicine and Neuroinfectology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Hrvoje Hećimović
- 1School of Dental Medicine, University of Zagreb, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Department of Microbiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 3Department of Radiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 4Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 6School of Dental Medicine, University of Zagreb, Department of Intensive Care Medicine and Neuroinfectology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Smiljka Lambaša
- 1School of Dental Medicine, University of Zagreb, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Department of Microbiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 3Department of Radiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 4Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 6School of Dental Medicine, University of Zagreb, Department of Intensive Care Medicine and Neuroinfectology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Dragan Lepur
- 1School of Dental Medicine, University of Zagreb, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Department of Microbiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 3Department of Radiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 4Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 6School of Dental Medicine, University of Zagreb, Department of Intensive Care Medicine and Neuroinfectology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia
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35
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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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36
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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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37
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Holmes BB, Conell-Price J, Kreple CJ, Ashraf D, Betjemann J, Rosendale N. Adult-Onset Subacute Sclerosing Panencephalitis With a 30-Year Latent Period. Neurohospitalist 2020; 10:127-132. [PMID: 32373277 DOI: 10.1177/1941874419869713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Subacute sclerosing panencephalitis (SSPE) is a rare progressive neuroinfectious disease due to a late complication of the measles virus. The hallmark clinical features of this disease include behavioral changes, myoclonus, dementia, visual disturbances, and pyramidal and extrapyramidal signs. The presence of characteristic high-amplitude periodic complexes on electroencephalography and raised antibody titers against measles in the cerebrospinal fluid help solidify the diagnosis. We present a case of a 40-year-old patient with SSPE who initially developed ophthalmologic manifestations 30 years after the primary measles infection. This case highlights both typical and atypical features of SSPE and provides a diagnostic framework for evaluating cases that fall outside of the standard scope of this disease.
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Affiliation(s)
- Brandon B Holmes
- Department of Neurology, University of California, San Francisco, CA, USA
| | | | - Collin J Kreple
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Davin Ashraf
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - John Betjemann
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Nicole Rosendale
- Department of Neurology, University of California, San Francisco, CA, USA
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Yagcioglu Yassa O, Kenangil G, Yalcin AD. Adult-onset subacute sclerosing panencephalitis presenting with tonic motor seizures. Int J Neurosci 2020; 131:914-918. [PMID: 32370641 DOI: 10.1080/00207454.2020.1759584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE/AIM OF THE STUDY Subacute sclerosing panencephalitis (SSPE) is a degenerative disease of the brain caused by a persistent measles virus infection occurring mostly in childhood or early adolescence. The spectrum of epileptic phenomena associated with SSPE is wide, varying from partial or generalized tonic-clonic seizures and atypical absences to myoclonic-atonic attacks. Tonic seizures are very rare in SSPE. MATERIALS AND METHODS Herein, we discuss a case of 25 years old male that presented with adult-onset SSPE with tonic seizures accompanying myoclonic seizures. RESULTS Patient was treated with clonazepam 5 mg/day and an isoprinosine regimen with a dose of 70 mg/kg/day. This is the fourth case of SSPE presenting with myoclonic and tonic seizures and the first case of SSPE with myoclonic and tonic seizures reported in an adult-onset case in the English literature. CONCLUSIONS Adult-onset SSPE with tonic seizures is rare and may be confusing, thus, it is important to recognize the presence of this type of tonic motor seizures in SSPE patients.
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Affiliation(s)
- Ozge Yagcioglu Yassa
- Department of Neurology, Medical Park Goztepe Hospital, Bahcesehir University, Istanbul, Turkey
| | - Gulay Kenangil
- Department of Neurology, Medical Park Goztepe Hospital, Bahcesehir University, Istanbul, Turkey
| | - Ayse Destina Yalcin
- Department of Neurology, Umraniye Training and Research Hospital, Health Sciences University, Istanbul, Turkey
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39
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Kumari M, Shah I, Shetty NS, Kulkarni S. Subacute Sclerosing Panencephalitis (SSPE) in HIV Infected Child. Indian J Pediatr 2020; 87:241. [PMID: 31933132 DOI: 10.1007/s12098-019-03172-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/24/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Manju Kumari
- Pediatric HIV Clinic, Department of Pediatrics, B J Wadia Hospital for Children, Mumbai, India
| | - Ira Shah
- Pediatric HIV Clinic, Department of Pediatrics, B J Wadia Hospital for Children, Mumbai, India
| | - Naman S Shetty
- Pediatric HIV Clinic, Department of Pediatrics, B J Wadia Hospital for Children, Mumbai, India.
| | - Shilpa Kulkarni
- Pediatric Neurology Clinic, Department of Pediatrics, B J Wadia Hospital for Children, Mumbai, India
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Kornbluh R, Davis R. Global trends in measles publications. Pan Afr Med J 2020; 35:14. [PMID: 32373265 PMCID: PMC7195917 DOI: 10.11604/pamj.supp.2020.35.1.18508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 01/20/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Beginning with the 1960s, this review analyzes trends in publications on measles indexed by the National Library of Medicine from January 1960 to mid-2018. It notes both the growth in numbers of published papers, and the increasing number and proportion of publications, in the current century, of articles on such items as costing, measles elimination, and determinants of coverage. METHODS A two-person team extracted from the National Library of Medicine (NLM) homepage all citations on measles beginning in 1960 and continuing through mid-2018. These were then classified both by overall number and by subject matter, with tabular summaries of both by decade and by subject matter. The tabular presentation forms the basis for a discussion of the ten most frequently cited subjects, and publication trends, with a special emphasis on the current century. RESULTS As in the past, the most often currently published items have been on coverage and its determinants, measles elimination, outbreak reports, SSPE, and SIAs. The putative relationship between vaccination and autism saw a spurt of articles in the 1990s, rapidly declining after the IOM report rejecting the causative hypothesis. CONCLUSION There is a discussion on the sequencing of polio and measles eradication, the former unlikely before 2022, and an examination of likely research priorities as the world moves from measles control to measles eradication. There is a key role for social science in combatting vaccination reticence. The role of technical innovations, such as micropatch vaccination, is discussed.
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Misin A, Antonello RM, Di Bella S, Campisciano G, Zanotta N, Giacobbe DR, Comar M, Luzzati R. Measles: An Overview of a Re-Emerging Disease in Children and Immunocompromised Patients. Microorganisms 2020; 8:E276. [PMID: 32085446 PMCID: PMC7074809 DOI: 10.3390/microorganisms8020276] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/15/2020] [Accepted: 02/16/2020] [Indexed: 12/15/2022] Open
Abstract
Despite the availability of a safe and effective vaccine, in 2018, around 350,000 measles cases were reported worldwide, which resulted in an estimate of 142,300 deaths from measles. Additionally, in 2017, global measles cases spiked, causing the death of 110,000 people, mostly children under the age of 5 years and immunocompromised adults. The increase in measles incidence is caused by the ongoing reduction of vaccination coverage. This event has triggered public and scientific interest. For this reason, we reviewed the pathophysiology of measles infection, focusing on mechanisms by which the virus spreads systemically through the host organism. By reaching the lymphocytes from the airways through a "trojan horse" strategy, measles induces an immunosuppression status. H and F glycoproteins, both expressed in the envelope, ensure attachment of the virus to host cells and spreading from one cell to another by binding to several receptors, as described in detail. The severity of the disease depends both on the age and underlying conditions of patients as well as the social and health context in which epidemics spread, and is often burdened by sequelae and complications that may occur several years after infection. Particular attention was paid to special groups that are more susceptible to severe or atypical measles. An overview of microbiology, symptoms, diagnosis, prevention, and treatment completes and enriches the review.
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Affiliation(s)
- Andrea Misin
- Department of Infectious Diseases, Azienda Sanitaria Universitaria Giuliano Isontina (ASU GI), Via G.L. Gatteri 25/1, 34125 Trieste, Italy; (S.D.B.); (R.L.)
| | - Roberta Maria Antonello
- Faculty of Medicine and Surgery, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Stefano Di Bella
- Department of Infectious Diseases, Azienda Sanitaria Universitaria Giuliano Isontina (ASU GI), Via G.L. Gatteri 25/1, 34125 Trieste, Italy; (S.D.B.); (R.L.)
| | - Giuseppina Campisciano
- SSD of Advanced Microbiology Diagnosis and Translational Research, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Via dell’Istria 65/1, 34137 Trieste, Italy; (G.C.); (N.Z.); (M.C.)
| | - Nunzia Zanotta
- SSD of Advanced Microbiology Diagnosis and Translational Research, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Via dell’Istria 65/1, 34137 Trieste, Italy; (G.C.); (N.Z.); (M.C.)
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino—IRCCS, L.go R. Benzi 10, 16132 Genoa, Italy;
- Department of Health Sciences (DISSAL), University of Genoa, Via A. Pastore 1, 16132 Genoa, Italy
| | - Manola Comar
- SSD of Advanced Microbiology Diagnosis and Translational Research, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, Via dell’Istria 65/1, 34137 Trieste, Italy; (G.C.); (N.Z.); (M.C.)
- Department of Medical Sciences, University of Trieste, Piazzale Europa 1, 34127 Trieste, Italy
| | - Roberto Luzzati
- Department of Infectious Diseases, Azienda Sanitaria Universitaria Giuliano Isontina (ASU GI), Via G.L. Gatteri 25/1, 34125 Trieste, Italy; (S.D.B.); (R.L.)
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42
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Xerri T, Darmanin N, Zammit MA, Fsadni C. Complications of measles: a case series. BMJ Case Rep 2020; 13:13/2/e232408. [PMID: 32066574 DOI: 10.1136/bcr-2019-232408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Measles, which was once thought to be a disappearing viral infection due to effective vaccination, has been re-emerging globally, with increasing cases in adolescents and adults. This has been attributed to anti-vaccination campaigning in the early 21st century, which has resulted in a drop in overall herd immunity. In this case series we report three patients with complications secondary to measles who presented to a hospital in Malta in 2019. Through this series, we discuss the range of possible complications caused by the measles virus, ranging from mild viraemic symptoms to multiorgan involvement which could possibly lead to high-dependency care and may even be fatal. We also highlight recent global statistics which reflect the exponential increase in the incidence of measles, with a special focus on Europe. It is emphasised that vaccine education and compliance with the two-dose measles vaccine should be implemented worldwide.
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Affiliation(s)
- Thelma Xerri
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | | | | | - Claudia Fsadni
- Department of Infectious Disease, Mater Dei Hospital, Msida, Malta
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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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44
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Reyes AJ, Ramcharan K, Perot S, Giddings SL, Rampersad F, Gobin R. Subacute Sclerosing Panencephalitis Causing Rapidly Progressive Dementia and Myoclonic Jerks in a Sexagenarian Woman. Tremor Other Hyperkinet Mov (N Y) 2019; 9:tre-09-680. [PMID: 31660255 PMCID: PMC6777289 DOI: 10.7916/tohm.v0.680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/30/2019] [Indexed: 11/14/2022] Open
Abstract
Background Subacute sclerosing panencephalitis (SSPE) is a disease of childhood and adolescence, but can affect adults. Rapidly progressive cognitive decline, seizures including myoclonic jerks, spasticity, ataxia, visual disturbances, and incontinence are typical manifestations. Case report A 62-year-old woman who presented with rapidly progressive dementia and myoclonus was diagnosed with SSPE. There was resolution of the movement disorder with clonazepam and valproic acid treatment and some amelioration of cognitive decline after 3 months of therapy with interferon alfa and isoprinosine. Discussion With the recent rise in measles cases worldwide, any increased incidence of SSPE would require vigilance for early interventions.
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Affiliation(s)
- Antonio Jose Reyes
- Infectious Disease Unit, San Fernando Teaching Hospital,
The University of the West Indies, San Fernando, TT,Department of Medicine, San Fernando Teaching Hospital, The
University of the West Indies, San Fernando, TT
| | - Kanterpersad Ramcharan
- Department of Medicine, Surgi-Med Clinic, The University of
the West Indies, San Fernando, TT,To whom correspondence should be addressed.
E-mail:
| | - Sean Perot
- Department of Medicine, San Fernando Teaching Hospital, The
University of the West Indies, San Fernando, TT
| | - Stanley Lawrence Giddings
- Infectious Disease Unit, San Fernando Teaching Hospital,
The University of the West Indies, San Fernando, TT,Department of Medicine, San Fernando Teaching Hospital, The
University of the West Indies, San Fernando, TT
| | - Fidel Rampersad
- Radiology Department, The University of the West Indies,
St. Augustine, TT
| | - Reanna Gobin
- Infectious Disease Unit, San Fernando Teaching Hospital,
The University of the West Indies, San Fernando, TT,Department of Medicine, San Fernando Teaching Hospital, The
University of the West Indies, San Fernando, TT
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45
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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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46
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Garg RK, Mahadevan A, Malhotra HS, Rizvi I, Kumar N, Uniyal R. Subacute sclerosing panencephalitis. Rev Med Virol 2019; 29:e2058. [PMID: 31237061 DOI: 10.1002/rmv.2058] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/05/2019] [Accepted: 05/07/2019] [Indexed: 12/12/2022]
Abstract
Subacute sclerosing panencephalitis (SSPE) is a slowly progressive brain disorder caused by mutant measles virus. SSPE affects younger age groups. SSPE incidence is proportional to that of measles. High-income countries have seen substantial decline in SSPE incidence following universal vaccination against measles. SSPE virus differs from wild measles virus. Measles virus genome recovered from the autopsied brain tissues demonstrates clustered mutations in virus genome particularly in the M gene. These mutations destroy the structure and functioning of the encoded proteins. Complete infectious virus particle has rarely been recovered from the brain. Human neurons lack required receptor for entry of measles virus inside the neurons. Recent in vitro studies suggest that mutations in F protein confer hyperfusogenic properties to measles virus facilitating transneuronal viral spread. The inflammatory response in the brain leads to extensive tissue damage. Clinically, SSPE is characterized by florid panencephalitis. Clinically, SSPE is characterized by cognitive decline, periodic myoclonus, gait abnormalities, vision loss, and ultimately to a vegetative state. Chorioretinitis is a common ocular abnormality. Electroencephalography (EEG) shows characteristic periodic discharges. Neuroimaging demonstrates periventricular white matter signal abnormalities. In advanced stages, there is marked cerebral atrophy. Definitive diagnosis requires demonstration of elevated measles antibody titers in cerebrospinal fluid (CSF). Many drugs have been used to stabilize the course of the disease but without evidence from randomized clinical trials. Six percent of patients may experience prolonged spontaneous remission. Fusion inhibitor peptide may, in the future, be exploited to treat SSPE. A universal vaccination against measles is the only proven way to tackle this menace currently.
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Affiliation(s)
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Hardeep Singh Malhotra
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Imran Rizvi
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Neeraj Kumar
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ravi Uniyal
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
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47
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Cakmak Genc G, Dursun A, Karakas Celik S, Calik M, Kokturk F, Piskin IE. IL28B, IL29 and micro-RNA 548 in subacute sclerosing panencephalitis as a rare disease. Gene 2018; 678:73-78. [PMID: 30077763 DOI: 10.1016/j.gene.2018.07.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/18/2018] [Accepted: 07/24/2018] [Indexed: 12/18/2022]
Abstract
Subacute sclerosing panencephalitis (SSPE) is a progressive neurodegenerative disease which affects children and young adults, caused by a persistent infection of defective measles virus. IFN-λs (IL-28A, IL-28B and IL-29) are a group of cytokines mediating antiviral responses. It has been shown that IL-29 levels are significantly higher in infected cells with defective measles virus. IL-29 expression is thought to be regulated at post-transcriptional level and miRNA-548 family targets the 3'UTR of the IFNL1 gene. Impaired immune system has an important role as well as viral factors in SSPE. The aim of our study investigates whether IL-28B, IL-29 levels and gene polymorphisms contribute to the damaged immune response leading to the development of SSPE. Also possible association of miR-548 family with IL-29 and SSPE is explored. Frequencies of rs12979860, rs8099917, rs30461, serum levels of IL-28B, IL-29 and expression levels of miR-548b, miR-548c, miR-548i are determined at 64 SSPE patients and 68 healthy controls. Serum IL-29 levels are statistically significant higher in SSPE patients. Allele frequencies of rs8099917 are statistically significant higher in SSPE patients and resulted G allele is found to increase 2.183-fold risk of SSPE. The expression levels of miR-548b-5p, miR-548c-5p and miR-548i are found to be statistically significant higher in SSPE patients. Dramatically increased level of IL-29 seen in patient group indicates that the elevated miR-548 expression is compensatory result of the over-activated immune system response. Further studies referred to IL28, IL29 and related miRNA's will be enlightened the pathogenesis of SSPE.
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Affiliation(s)
- Gunes Cakmak Genc
- Faculty of Medicine, Department of Medical Genetics, Bulent Ecevit University, Zonguldak, Turkey.
| | - Ahmet Dursun
- Faculty of Medicine, Department of Medical Genetics, Bulent Ecevit University, Zonguldak, Turkey
| | - Sevim Karakas Celik
- Faculty of Sciences and Arts, Department of Molecular Biology and Genetics, Bulent Ecevit University, Zonguldak, Turkey
| | - Mustafa Calik
- Faculty of Medicine, Department of Pediatric Neurology, Harran University, Sanlıurfa, Turkey
| | - Furuzan Kokturk
- Faculty of Medicine, Department of Biostatistics, Bulent Ecevit University, Zonguldak, Turkey
| | - Ibrahim Etem Piskin
- Faculty of Medicine, Department of Pediatrics, Bulent Ecevit University, Zonguldak, Turkey
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48
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Reddy B, Das S, Guruprasad S. Primary Psychiatric Manifestations of Subacute Sclerosing Panencephalitis: A Case Report and Literature Review. PSYCHOSOMATICS 2018; 59:408-412. [DOI: 10.1016/j.psym.2017.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/17/2017] [Accepted: 12/18/2017] [Indexed: 11/16/2022]
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49
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Bhattacharyya R, Mukherjee B, Bhattacharyya S. A Case of Early Onset Subacute Sclerosing Panencephalitis Presented as Juvenile Myoclonic Epilepsy. Indian J Psychol Med 2017; 39:803-807. [PMID: 29284817 PMCID: PMC5733434 DOI: 10.4103/0253-7176.219642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
A 7.5 years girl presented with myoclonic jerks with prolonged duration coming progressively at shorter intervals for last six moinths. There was declining academic performances. The dystonic, dyskinetic movements and ataxia were there for last three months. The stages were progressing too rapidly. IgG antibody titre to measles virus was found to be positive with EEG changes which confirms diagnosis. SSPE at so early age with atypical presentation is unique in this indexed case.
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Affiliation(s)
- Ranjan Bhattacharyya
- Department of Psychiatry, Murshidabad Medical College and Hospital, Berhampore, West Bengal, India
| | - Bhaskar Mukherjee
- Department of Psychiatry, Malda Medical College and Hospital, Malda, West Bengal, India
| | - Sumita Bhattacharyya
- Department of Dermatology, Lalbagh Sub Divisional Hospital, Murshidabad, West Bengal, India
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50
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Andersen O. MS and infections-Abandoned and surviving hypotheses. Acta Neurol Scand 2017; 136 Suppl 201:4-9. [PMID: 29068491 DOI: 10.1111/ane.12846] [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: 08/31/2017] [Indexed: 11/29/2022]
Abstract
In this introduction, we follow the ups and downs of infections in MS pathogenesis. Our arguments focus on specific agents and events, not referring to general MS epidemiology. The historical approach continues on to contemporary data and a critical analysis.
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Affiliation(s)
- O. Andersen
- Institution of Neuroscience and Physiology; University of Gothenburg Neurology; Sahlgrenska University Hospital; Göteborg Sweden
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