Rationale:Subacute sclerosing panencephalitis(SSPE)is a progressive neurological disorder caused by persistent measles virus infection.SSPE predominantly affects children and adolescents.The symptoms usually develop 6...Rationale:Subacute sclerosing panencephalitis(SSPE)is a progressive neurological disorder caused by persistent measles virus infection.SSPE predominantly affects children and adolescents.The symptoms usually develop 6-15 years after measles infection and ultimately leading to death in many cases.Patient concerns:Patient 1 presented with cognitive decline and myoclonus and the Patient 2 presented with diminution of vision with myoclonic jerks.Diagnosis:Based on the clinical features with a characteristic electroencephalogram pattern and the presence of a high titer of anti-measles IgG in serum and cerebrospinal fluid,these patients were diagnosed as SSPE.Interventions:Antiepileptics were started for controlling myoclonus along with supportive treatment.Outcomes:Both patients were discharged on antiepileptics and supportive care.Lessons:Whenever there are unusual clinical manifestations with unknown vaccination status,SSPE can be suspected and the cerebrospinal fluid should be examined for anti-measles antibodies.Our case study also highlights the importance of universal coverage of measles vaccination.To reduce the incidence of measles and associated deaths,it is important to maintain a high level of immunization coverage for the measles vaccine and to strengthen all the integral components of the national immunization program.展开更多
Background: EEG could be normal or atypical in spite of suggestive clinical features and positive measles Ab of SSPE cases which could have typical EEG pattern after Benzodiazepine. Objectives: The purpose of the pres...Background: EEG could be normal or atypical in spite of suggestive clinical features and positive measles Ab of SSPE cases which could have typical EEG pattern after Benzodiazepine. Objectives: The purpose of the present study was to find out the necessity of administration of benzodiazepine during EEG recording of SSPE cases as well as to compare the efficacy of diazepam and midazolam in eliciting EEG pattern. Methodology: This double blind, parallel, single centered, non-randomized clinical trial was conducted in the Department of Pediatric Neurology at National Institute of Neurosciences, Dhaka, Bangladesh from July 2014 to June 2015 for a period of 1 (one) year. All the clinical and investigational suspected cases of sub-acute Sclerosing Panencephalitis (SSPE) children in both sexes were included as study population. Others neurodegenerative diseases including Wilson’s disease were excluded from this study. Patients were divided into two groups named as group A who were given diazepam and the other group B was given midazolam in IV during EEG recording. The clinical outcomes were measured and were recorded in a pre-designed data sheet. Result: The characteristic typical periodic slow wave complex (PSWC) was found only in 8 (30.8%) patients among the 26 (100.0%) before intervention with benzodiazepines. The remaining 18 (69.2%) had non-typical PSWC of which 10 (38.5%) were normal, 3 (11.5%) with atypical PSWC and 5 (19.2%) were with other EEG findings. After intervention with benzodiazepines, 23 (88.5%) had shown typical PSWC and only 3 (11.5%) had non-typical PSWC. Among the typical PSWC cases after intervention, 8 (30.8%) had normal EEG initially, 5 (19.2%) had other EEG finding, 2 (7.7%) had non-typical PSWC and 8 (30.8%) had typical PSWC from the beginning. Of the 3 (11.5%) of the non-typical PSWC of intervention group, 2 (7.7%) had shown no changes in EEG from the beginning and 1 (3.8%) had shown other EEG finding. The difference between before and after intervention was actually statistically extremely significant (p 0.05). Conclusion: The role of benzodiazepine is very obvious in eliciting the typical EEG pattern in SSPE patients which has shown the characteristic PSWC in EEG in most cases.展开更多
文摘Rationale:Subacute sclerosing panencephalitis(SSPE)is a progressive neurological disorder caused by persistent measles virus infection.SSPE predominantly affects children and adolescents.The symptoms usually develop 6-15 years after measles infection and ultimately leading to death in many cases.Patient concerns:Patient 1 presented with cognitive decline and myoclonus and the Patient 2 presented with diminution of vision with myoclonic jerks.Diagnosis:Based on the clinical features with a characteristic electroencephalogram pattern and the presence of a high titer of anti-measles IgG in serum and cerebrospinal fluid,these patients were diagnosed as SSPE.Interventions:Antiepileptics were started for controlling myoclonus along with supportive treatment.Outcomes:Both patients were discharged on antiepileptics and supportive care.Lessons:Whenever there are unusual clinical manifestations with unknown vaccination status,SSPE can be suspected and the cerebrospinal fluid should be examined for anti-measles antibodies.Our case study also highlights the importance of universal coverage of measles vaccination.To reduce the incidence of measles and associated deaths,it is important to maintain a high level of immunization coverage for the measles vaccine and to strengthen all the integral components of the national immunization program.
文摘Background: EEG could be normal or atypical in spite of suggestive clinical features and positive measles Ab of SSPE cases which could have typical EEG pattern after Benzodiazepine. Objectives: The purpose of the present study was to find out the necessity of administration of benzodiazepine during EEG recording of SSPE cases as well as to compare the efficacy of diazepam and midazolam in eliciting EEG pattern. Methodology: This double blind, parallel, single centered, non-randomized clinical trial was conducted in the Department of Pediatric Neurology at National Institute of Neurosciences, Dhaka, Bangladesh from July 2014 to June 2015 for a period of 1 (one) year. All the clinical and investigational suspected cases of sub-acute Sclerosing Panencephalitis (SSPE) children in both sexes were included as study population. Others neurodegenerative diseases including Wilson’s disease were excluded from this study. Patients were divided into two groups named as group A who were given diazepam and the other group B was given midazolam in IV during EEG recording. The clinical outcomes were measured and were recorded in a pre-designed data sheet. Result: The characteristic typical periodic slow wave complex (PSWC) was found only in 8 (30.8%) patients among the 26 (100.0%) before intervention with benzodiazepines. The remaining 18 (69.2%) had non-typical PSWC of which 10 (38.5%) were normal, 3 (11.5%) with atypical PSWC and 5 (19.2%) were with other EEG findings. After intervention with benzodiazepines, 23 (88.5%) had shown typical PSWC and only 3 (11.5%) had non-typical PSWC. Among the typical PSWC cases after intervention, 8 (30.8%) had normal EEG initially, 5 (19.2%) had other EEG finding, 2 (7.7%) had non-typical PSWC and 8 (30.8%) had typical PSWC from the beginning. Of the 3 (11.5%) of the non-typical PSWC of intervention group, 2 (7.7%) had shown no changes in EEG from the beginning and 1 (3.8%) had shown other EEG finding. The difference between before and after intervention was actually statistically extremely significant (p 0.05). Conclusion: The role of benzodiazepine is very obvious in eliciting the typical EEG pattern in SSPE patients which has shown the characteristic PSWC in EEG in most cases.
