Reply to ?Trial of intraventricular ribavirin therapy for subacute sclerosing panencephalitis in Japan$rdquo;

Abstract

Thank you for sending us your comment on our trial of intraventricular ribavirin therapy for subacute sclerosing panencephalitis (SSPE) in Japan. As you mentioned, the efficacy of ribavirin to this miserable disease is still controversial and we have not argued or discussed this point in our report [1]. In short, our findings in this study do not necessarily imply that intraventricular ribavirin therapy for SSPE is effective, but from the viewpoint of clinical safety and possible clinical effectiveness in some patients, ribavirin therapy would be worth considering for treatment of patients with SSPE, especially those who are non-responsive to interferon (IFN-α) or inosiplex. In fact, Hara et al. [2] reported the ineffectiveness in one of our patients on both clinical symptoms (the neurological disability) and measles virus RNA levels in the CSF by quantitative PCR assay. However, 7 of 10 patients who received a combination of intraventricular IFN and ribavirin improved clinically or showed decreased measles antibody titers in the CSF. Of course, further studies should be performed to establish a long-term treatment protocol by careful evaluation of effects and side effects in patients with SSPE. For the ethical reason, I think the therapeutic trial of this devastating disease should not be performed in a blinded fashion.