Sub-Acute Sclerosing Panencephalitis Manifesting as Psychiatric Illness: A Case Report

Abstract

Subacute sclerosing panencephalitis (SSPE) is a chronic progressive inflammatory central nervous system disorder manifesting as a rare complication of measles viral infection in childhood resulting in fatality in all cases. It is likely to have possibility of subclinical or undiagnosed measles in early childhood in absence of prior overt measles infection. Measles vaccine has a protective effect against SSPE and high vaccination gap is associated with higher incidence of SSPE. Children residing in areas with poor vaccination coverage are at increased risk of developing the disease. It is characterised by progressive intellectual deterioration, seizures, myoclonus, ataxia and visual disturbances. The onset of SSPE is insidious and can manifest as significant psychiatric ailments. A 17 years old girl with history of progressive scholastic deterioration for a year presented with focal seizures, myoclonic jerks and psychiatric manifestations like emotional outburst followed by progressive unresponsiveness, altered sensorium and memory lapses since two weeks. A diagnosis of Subacute sclerosing panencephalitis (SSPE) was made on the basis of clinical symptoms, typical EEG changes and presence of anti-measles antibody in cerebrospinal fluid. Patient received treatment for myoclonic jerks, spasticity along with supportive care. SSPE is often a chronic inflammatory and life threatening disease of central nervous system with no cure despite development of antiviral and immunomodulator drugs. There is urgent need to advocate policies to enhance vaccination coverage and for extensive research in field for potential therapies for treatment of such patients to improve clinical outcomes.