To evaluate the clinical profile and therapeutic response to a novel 4-drug combination protocol in paediatric SSPE patients from a low-resource setting.
Background:
SSPE is a rare but progressive, and universally fatal, complication of measles that is poorly responsive to treatment with antiviral and immunomodulatory therapies. In view of the recent outbreaks of measles and SSPE in some continents (including North America), there is an urgent requirement for new treatment strategies. In our unit, we developed a combined treatment protocol based on insights from pre-existing literature.
Design/Methods:
This is a retrospective case series including six children diagnosed with SSPE between 2021 and 2024 based on Dyken's criteria. All of them received monthly doses of intrathecal interferon alpha-2B (1.2 million IU), along with daily oral ribavirin (15 mg/kg), isoprinosine (50 mg/kg), and levamisole (2.5 mg/kg). Neurological status was monitored using Jabbour staging, EEG, MRI, and Neurological Disability Index scores.
Results:
All 6 Patients (mean age 7.7 years) presented at Stage II or higher. While all patients demonstrated transient improvement in myoclonus and cognition by the 2nd-3rd dose there was uniform deterioration thereafter. All of them eventually succumbed to the disease within a year either due to aspiration pneumonia or sepsis. Notably all fundoscopic abnormalities were noted and a steady progression was noted in all.
Conclusions:
Combination therapy offered only transient benefit and failed to alter the trajectory of the disease. Our findings highlight the urgency of early diagnosis and reinforce the fact that measles vaccination is the only effective preventive strategy against SSPE.
10.1212/WNL.0000000000215548
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