Dr. Upendra Kumar Shah
Neurology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am the father of a 5-year-old daughter. She is a very energetic, lively, talkative, and intelligent girl. Two months back, we noticed she frequently falls while running and having a minor issue with her studies. We consulted a pediatrician, and he suggested some vitamins. However, the frequency of falling increased, so we went to a pediatric neurologist. It was on the 15th of that month, and she had little jerks, problems while sitting straight, little forgetfulness, and some memory issues.
The neurologist did EEG and found some abnormalities in that. He further asked for MRI and CSF test by lumbar puncture.
All reports came (attached reports for your reference). He started some medicine as below
1) Valparin 7ml morning and evening.
2) Nootropil 3ml morning and evening.
3) Isoprinosine 500 MG morning and evening.
4) Ribavirin 200 once a day.
5) Clonotril 0.5 1/4 at night.
Apart from this, she is also having homeopathic treatment. However, her condition keeps on worsening, and right now, she cannot stand or sit, cannot talk, and has problems swallowing food and drinking water.
Could you please look at these reports and share your valuable opinion on the cause of such conditions.
Hi,
Welcome to icliniq.com.
By inspecting the reports (attachments removed to protect patient's identity), it seems this is a case of SSPE (subacute sclerosing panencephalitis) due to measles, a kind of virus that is slowly growing in the brain causing all these symptoms. Unfortunately, there is no specific therapy to stop the progression of the disease. It can be delayed to some extent with medications, which are already going on but can never return to normal. Antiepileptics are already going on to control the seizure episodes. These antiepileptics can be increased if seizures or jerks are not controlled.
I feel very sorry when little children get this kind of disease, and we cannot do anything to stop the infection. I am sorry.
Did she have a measles vaccination in the first year of life?
Please get back if you have further queries.
Patient's Query
Hi doctor,
Thank you.
She got pneumonia when she was eight months old and had red rashes for two to three days. Measles was suspected but ruled out by doctors. Later at 9 and 15 months, I gave MMR vaccination.
What is the role of Isoprinosine and Ribavirin as it seems these are making an impact on her? We started antiepileptic on the nineteenth of that month and these drugs on the second of the following month. After that, her condition is worsening rapidly.
Cannot there be any other cause for these symptoms? Is there no chance for her to be normal? Will giving measle vaccine now help in this situation?Please guide me.
Hello,
Welcome back to icliniq.com.
Since there is a history of measles-like illness in infancy, CSF (cerebrospinal fluid) measles antibodies are strongly positive. Furthermore, EEG (electroencephalogram) picture and clinical features are all in favor of SSPE. Therefore, I do not think of any other possibility. Moreover, many investigations have already been done to rule out the other possible causes, and they came negative.
Isoprinosine and Ribavirin are antiviral medications. They are supposed to halt the viral replication. There could be some side effects for current deterioration. However, it cannot rule out disease progression by itself. Please consult a local Pediatrician or Pediatric Neurologist to adjust the medications. Treatment is purely symptomatic and supportive. Disease progression is expected, which can be rapid or slow. It varies from person to person.
Sorry to say, but I have never seen a recovery in this condition. Unfortunately, the measles vaccine will not help now.
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Neurology
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