ORAL RIBAVIRIN THERAPY OF SUBACUTE SCLEROSING PANENCEPHALITIS (SSPE)

Abstract

SSPE is a persistent fatal measles virus infection of the central nervous system. Because ribavirin is active in vitro against measles and reportedly efficacious in naturally occurring measles, we treated 2 patients with SSPE with oral ribavirin. The patients were an 11 year old girl and an 18 year old boy ill for 2 and 8 years, respectively. The dose was 10 mg/kg tid for 3 days, then bid daily for 6 and 14 weeks, respectively. Serum and cerebrospinal fluid (CSF) ribavirin concentrations (courtesy of J. Connor, Univ. of Calif. San Diego) and measles antibody titers (Courtesy of V. Berardi, Mass. State Dept. of Health) were measured serially. Clinical response was evaluated by neurological examination and EEG, and toxicity was monitored by blood count, electrolytes, urinalysis, liver and renal function tests. Ribavirin Concentration (uM) Patient #1 (Patient #2 pending) Neurological examination and EEGs were essentially unchanged during therapy. There was no decrease in antibody titers. Ribavirin was well tolerated except for mild hemolytic anemia in patient #1. CSF ribavirin levels were 75% of serum at 7 days, and remained above 66% for 6 weeks. Future therapeutic trials should consider prolonged treatment or higher doses of oral ribavirin early in the course of SSPE.