RISING SURGE OF SUBACUTE SCLEROSING PANENCEPHALITIS IN PANDEMIC ERA

OBJECTIVE: Subacute sclerosing panencephalitis(SSPE) is a rare neurodegenerative disorder with annual incidence of 4.3/million in below 20 years age.We noted an alarming rise in cases of SSPE during COVID-19 pandemic so this study was conducted to study and note the reasons for the sudden surge.

METHODOLOGY: This is a cross sectional,retrospective,analytical study.Records of patients diagnosed with SSPE from 2017-21 at tertiary care centre from India,were studied.Demographic,clinical, radiological,EEG features were noted.Temporal relationships with Covid-19 exposure/infections and MR vaccination were analysed.

RESULTS: Sixty-five children presented with SSPE over 4 years,with mean age of presentation 6.8 years(2-14 years).11 children presented in pre-pandemic and 49 were during the pandemic period.Prior history of measles was noted in 9 patients with a median latency period 3.5 years(0.5-8 years).Measles immunization history was in 70% and 46% of them had received extra MR vaccination. During the covid-pandemic 30% cases showed Covid positivity(antigen or antibody).Common presenting features were cognitive decline(poor scholastic performance,difficulty in activity of daily living) in 60% followed by behavioral issues(excessive aggression) in 50% cases.All had epilepsy with myoclonic jerks/head drops.EEG finding was periodic-superimposable-delta burst appearance in 40%.Neuroimaging was normal in 65% followed by peri-ventricular abnormalities in 30%.The progression of disease was fast in patients presenting during covid-pandemic without definite association of covid.

CONCLUSION: There was definite surge of SSPE patients during the covid-pandemic with a rapid course as compared to pre-pandemic patients.
Keywords: post measles complication, progressive myoclonic epilepsy, head drops, neurodegenerative disorder