Earlier Onset of Subacute Sclerosing Panencephalitis in Bangladeshi Children: Insights from a Case Series

Abstract

Subacute sclerosing panencephalitis (SSPE) is a fatal neurodegenerative complication of measles, characterized by a progressive decline in neurological function. This case series described 42 children diagnosed with SSPE and received treatment at a tertiary neurology hospital in Dhaka, Bangladesh, from the year 2019 to 2021. The median age at onset of was 4 years (range: 2.5-11 years), with a mean latent period of 2.68 ± 0.97 (SD) years. While 30 cases (71.4%) were immunized, 23 of these children developed SSPE despite receiving immunization after 9 months of age. Additionally, a small proportion of cases (n = 7) had a history of measles infection prior to the scheduled age of vaccination. Males predominated (88.1%) in this cohort. Clinical presentation typically involved speech and motor regression alongside the myoclonic jerks. These findings point toward an earlier onset and shorter latency period of SSPE in this population which demands further evaluation.

Keywords

subacute sclerosing panencephalitis SSPE age at onset measles

Introduction

Subacute sclerosing panencephalitis (SSPE) is a rare but progressive and fatal neurodegenerative complication of measles, caused by persistent infection with the wild-type measles virus which inevitably leads to a vegetative state and death.¹ SSPE is clinically characterized by a gradual onset of behavioral disruptions, cognitive function deterioration, visual disturbances, and progressive motor dysfunction, ultimately leading to severe neurological impairment.² This disease typically manifests during childhood or early adolescence, with the age of onset commonly ranging from 6 to 13 years,³ following a latent period averaging around 4 to 10 years after an acute measles infection.^3,4

According to the World Health Organization (WHO), nearly 150 000 measles cases were reported globally in 2020, with the incidence of subacute sclerosing panencephalitis (SSPE) estimated at 4 to 11 cases per 100 000 infections.⁵ While mass immunization programs in the late 20th century successfully reduced SSPE incidence in developed nations, outbreaks persist in developing regions, including Bangladesh.^5,6 By 2015, Bangladesh achieved approximately 92% coverage for the first dose of the measles vaccine, however, the second dose coverage remained notably lower at approximately 80%, indicating a substantial number of susceptible children.⁷ Although recent data from 2023 indicates improvement- with coverage reaching 97% for first dose and 93% for second dose- measles transmission continues.⁸

Recent regional studies have reported an earlier onset and more rapid progression of subacute sclerosing panencephalitis in younger children, particularly those under 5 years.^9-13 Alongside, some adult onset cases also have been reported across the globe.^14-16 Despite being sporadic, these evidences challenge the current understanding of the pathogenesis and epidemiology of SSPE. It is crucial to determine whether these trends are consistent or isolated.

However, comprehensive data on SSPE in Bangladesh remains scarce. Understanding the population-based epidemiology of SSPE onset is essential for optimizing prevention and monitoring strategies. This case series presented a group of patients with subacute sclerosing panencephalitis attended at Pediatric Neurology department of a tertiary health care center situated in the capital of Bangladesh.

Methods

Case Selection and Diagnostic Criteria

This is a case series which included 42 children diagnosed with subacute sclerosing panencephalitis (SSPE) and treated at the Department of Pediatric Neurology, National Institute of Neuroscience and Hospital (NINS&H), Dhaka, Bangladesh, between 2019 and 2021. The diagnostic approach used in this study is based on the revised SSPE diagnostic criteria proposed in 2010^17-19 (Supplemental Table 1).

Study Procedure and Data Collection

For each case, detailed history was collected regarding demographic information, clinical and systemic examination findings, and relevant laboratory and imaging findings. Previous medical records were reviewed comprehensively. A semi-structured case record form was utilized for data collection.

Detail demographic (age, sex, area of residence, socioeconomic status), clinical information (onset age, presenting features, duration, developmental history, measles infection history, and immunization status) were collected. The latency period of SSPE was calculated as the interval between measles infection and the onset of SSPE symptoms. Disease progression was assessed using the Jabbour staging system for SSPE. CSF anti-measles IgG levels > 200 mIU/ml were considered positive based on laboratory reference standards and in line with previously reported thresholds for intrathecal antibody synthesis in SSPE.²⁰ Electroencephalography (EEG) findings were reviewed with particular attention to the presence of characteristic periodic slow-wave complexes. Neuroimaging results from magnetic resonance imaging (MRI) were reviewed, noting any abnormalities consistent with SSPE.

Disease progression was assessed through clinical stage at last follow-up.¹⁸

The outcome was recorded as either death or survival at the last follow-up, with follow-up duration calculated for each patient.

Statistical Analysis

Data were analyzed using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to summarize participant characteristics. Categorical variables were expressed as frequencies and percentages, while continuous variables were presented as mean ± standard deviation or median (minimum–maximum) based on normality. Normality of data was tested by Shapiro-Wilk test. Characteristics were compared between participants aged < 5 years to ≥5 years. To determine the association between categorical variables, chi-square test was conducted. To compare continuous variables, independent Students t-test was conducted for normally distributed variables and Mann-Whitney U test was conducted for non-normally distributed for variables. A p-value < .05 was considered significant.

Ethical Consideration

This case series was conducted using deidentified patient data; therefore, ethical approval was obtained, which waived the requirement for informed consent due to the retrospective use of deidentified data. The study was conducted in accordance with the principles of the Declaration of Helsinki. This report was prepared following the CARE guidelines for case reporting.²¹

Results

This case series included 42 children diagnosed with SSPE, treated at the Department of Pediatric Neurology, NINS&H, Dhaka- over a 3-year period from 2019 to 2021.

The median age of onset of subacute sclerosing panencephalitis was 48 months with a range from 30 to 132 months. About 71.4% were immunized, with 66.6% receiving both doses of the measles vaccines. Among immunized children, the median age of onset was 48 months, while non-immunized cases also had a similar median onset age of 48 months (P = .89). The mean latent period was 29.2 ± 10.6 (SD) months in immunized cases and 36.87 ± 12.32 (SD) months in non-immunized cases (P = .15). A past history of measles infection was reported in 50% of cases- 7 cases were infected with measles before the age of scheduled measles vaccination. Among immunized cases, those with a prior measles history had a lower median onset age (48 months) compared to those without (54 months; P = .17). In non-immunized cases, those with a prior measles history had a higher median onset age (52 months) compared to those without (48 months; P = .86). (Figure 1).

Figure 1.

Age of onset of SSPE cases based on immunization and prior measles history (n = 42).

In this case series, 88.1% of SSPE cases were male, with 64.3% from poor socio-economic backgrounds. All cases were presented with speech regression followed by cognitive & motor regression (97.6% for each), generalized myoclonic jerks (85.7%) and generalized tonic-clonic seizures (24.4%). Upper motor neuron lesions were found in half of the cases. MRI showed non-specific white matter changes in 34.1%, and EEG revealed periodic complexes in 85.4%. CSF analysis showed a median anti-measles IgG was 753.6 mIU/ml. The mean latent period was 32.2 ± 11.64 (SD) months. At the last follow-up, 40.5% were in stage 2, 33.3% in stage 3, and 26.2% had died.

In the <5 years group, a higher incidence of generalized tonic-clonic seizures (37.5% vs 16%, P = .15) was observed, though without statistical significance. The mean latent period was also similar (31.13 ± 9.92 vs 35.8 ± 16.7 months, P = .45). A higher proportion of cases aged < 5 years had a prior history of measles (57.7% vs 37.5%, P = .204), but this was not statistically significant.

Regarding outcome, a higher proportion of cases in the ≤5 years group progressed to stage 3 (38.5% vs 25%, P = .08), and the mortality rate was also higher (34.6% vs 12.5%), though not statistically significant (Table 1).

Table 1.

Socio-Demographic Characteristics, Clinical Characteristics and Outcome of the Cases with SSPE (n = 42).

Variables	Total n = 42 n (%)	<5 years n = 26 n (%)	≥5 years n = 16 n (%)	P
Gender
Male	37 (88.1)	21 (80.8)	16 (100)	.06**
Female	5 (11.9)	5 (19.2)	0
Socio-economic status
Poor	27 (64.3)	17 (65.4)	10 (62.5)
Middle income group	14 (33.3)	9 (34.6)	5 (31.5)	>.999**
Affluent	1 (2.4)	0	1 (6.2)
Presenting symptoms
Speech regression	42 (100)	26 (100)	16 (100)	-
Cognitive decline	41 (97.6)	25 (96.2)	16 (100)	>.999*
Motor function regression	41 (97.6)	26 (100)	15 (93.8)	.4*
History of frequent fall	40 (95.2)	26 (100)	14 (87.5)	.06*
Myoclonic jerk
Generalized	36 (85.7)	23 (88.5)	13 (81.2)
Hemi myoclonus	3 (7.1)	1 (3.8)	2 (12.5)	.6*
Head nodding	3 (7.1)	2 (7.7)	1 (6.2)
History of generalized tonic-clonic seizures	10 (24.4)	4 (16)	6 (37.5)	.15*
Delayed development	2 (4.8)	1 (3.8)	1 (6.2)	>.999*
Neurological examination findings
Involvement of cranial nerve	2 (4.8)	1 (3.8)	1 (6.2)	>.999*
Upper motor neuron lesion	21 (50)	12 (46.2)	9 (56.2)	.5**
Eye involvement	3 (7.1)	2 (8)	1 (6.2)	.5*
Investigation findings
MRI
Non-specific white matter change	14 (34.1)	8 (32)	6 (37.5)	.7**
Unremarkable	27 (65.9)	17 (68)	10 (62.5)
EEG
Periodic complex	35 (85.4)	21 (84)	14 (87.5)	.75**
Generalized slowing	6 (14.6)	4 (16)	2 (12.5)
CSF cell^⸙(cells/µL)	2 (1-20)	2 (1-20)	2 (1-6)	.73^-
CSF protein^⸙(mg/dl)	33.5 (17.9-68)	30 (17.9-68)	34.5 (18-50)	.52^-
Anti-measles IgG^⸙(mIU/ml)	753.6 (204.6-1809)	729.95 (277.5-1809)	792 (204.6-1667.8)	.62^-
Past history of measles
No	21 (50)	11 (42.3)	10 (62.5)	.204**
Yes	21 (50)	15 (57.7)	6 (37.5)
Duration of latent period^⸙⸙	32.2 ± 11.64	31.13 ± 9.92	35.8 ± 16.7	.45⁻⁻
History of immunization
Not immunized	12 (28.6)	8 (30.8)	4 (25)	.74
Immunized	30 (71.4)	18 (69.2)	12 (75)
Outcome at last follow-up
Stage 2	17 (40.5)	7 (26.9)	10 (62.5)
Stage 3	14 (33.3)	10 (38.5)	4 (25)	.08*
Death	11 (26.2)	9 (34.6)	2 (12.5)

Variables are expressed as frequency (percentage) unless otherwise specified. Variables are presented as median (minimum–maximum)^⸙ and mean ± standard deviation^⸙⸙. p values were determined using Fisher’s Exact Test*, Chi-Square Test**, Mann-Whitney U Test^⁃ and independent Student’s t-test⁻⁻ as appropriate.

Geographically, the majority of patients were from Sylhet division (56.6%), followed by Dhaka (17.1%), Barishal (12.2%), and Chittagong (7.3%). The remaining patients were from Khulna, Rajshahi, and Mymensingh, with each region contributing 2.4% of the cases, along with other regions of Bangladesh. (Figure 2).

Figure 2.

Geographical distribution of cases with SSPE of this series (n = 42).

Among the patients who died during the follow-up, the mean duration between the onset of symptoms and death was 3.77 ± 1.67 (SD) months (Supplemental Table 3).

On the other hand, the cases who survived till last follow-up, the median survival was 9 months (range: 1.5-25 months; Supplemental Table 4).

All patients received symptomatic treatment aimed at controlling myoclonus, dystonia, and spasticity. Sodium valproate and clonazepam were the most frequently used medications for myoclonic jerks. Tizanidine and trihexyphenidyl were used for management of spasticity and dystonia. Despite symptomatic therapy, all cases showed progressive neurological deterioration during follow-up. Disease-modifying therapies such as inosine pranobex and interferon-alpha were not administered in any case due to unavailability in the treatment setting.

Discussion

This case series presents 42 cases of subacute sclerosing panencephalitis over a 3-year period, all treated at the National Institute of Neurosciences and Hospital (NINS) in Dhaka, Bangladesh. SSPE is a rare, progressive and fatal condition and there is no specific effective treatment. In Bangladesh, data on the incidence, clinical course, and outcomes of SSPE remain scarce, and no national guidelines or recommendations for its management have been established.

In this series, over two-thirds of SSPE cases had received measles vaccination and notably 7 of them reported prior history of measles infection, occurring before the scheduled age for vaccination. It is possible that SSPE in vaccinated patients is attributed to infection prior to immunization, or due to vaccine failure.^3,22 As of 2023, in Bangladesh, the coverage of the first dose of measles vaccine is 97%, and of the second dose is 93%. Despite high vaccination coverage, 247 measles cases have been reported in Bangladesh as of April 2024.²³ These facts raise concerns regarding the ongoing risk of measles transmission in regional context of Bangladesh. Infantile measles exposure before vaccination or vaccination schedule increases the risk of SSPE.^22,24,25

Though subacute sclerosing panencephalitis SSPE cases have been reported to occur at any point of life between 4 months and 56 years of age, it is typically occurs in children with an average age of onset ranging from 6 to 13 years.³ This series reported a comparatively earlier age of onset with a median of 4 years than the previous studies.^24,26-28 Additionally, the average latent period of SSPE cases was notably shorter than the latent period typically reported in the literature.^3,4 However, similar to our cases, there are few reports which have documented comparatively earlier onset of SSPE.^9,10,29,30 The earlier age at onset and shorter latency observed in this series may be related to early-life measles infection and immature host immune responses at the time of primary infection, which have been associated with ineffective viral clearance and persistence of measles virus within the central nervous system. Variability in latency and disease onset is therefore more likely to reflect differences in host–virus interaction rather than differences in the speed of immune response. While vaccination failure could be another possible concern. This phenomenon may be due to factors such as incomplete vaccination, the specific strain of measles virus, individual immune responses or some underlying reasons yet to be revealed.

The clinical features reported in these cases were largely consistent with the classic presentation of SSPE, with myoclonic jerks, frequent falls, speech regression, cognitive decline, and motor dysfunction observed in most patients.³¹ EEG findings also corresponded, with periodic complexes observed in the majority of the cases.³² However, MRI findings were nonspecific in most of the cases.

In this study, a comparison between the age groups of ≤5 years and >5 years has been conducted as SSPE generally presents after this age range. The immunization status and history of measles did not show a significant difference between the 2 age groups. Both immunized and non-immunized children, as well as those with or without a previous history of measles, presented similar clinical patterns and latent period which indicates to the fact there could be more pathology behind earlier onset rather than immunization and prior measles infection.

Management in these cases was primarily symptomatic as disease-modifying therapies such as inosine pranobex and interferon-alpha are not routinely available in Bangladesh, reflecting a significant therapeutic gap in SSPE management. All patients showed progressive neurological deterioration despite symptomatic management with poor clinical outcome. Over a quarter of patients died by the last follow-up, while the mean interval from symptom onset to death was 3.77 months. Among the rest, 40.5% were in stage 2 and 33.3% in stage 3 at last follow-up with the median survival period of 9 months (range: 1.5-25 months) from symptom onset to last follow-up. The comparatively short survival observed in this cohort is lower than that reported in other studies.^33,34 However, variability in survival among SSPE patients is well documented, with a small subset demonstrating prolonged survival, particularly in those receiving disease-modifying therapies such as interferon-α and inosine pranobex. In contrast, all patients in this series received only symptomatic treatment, as disease-modifying therapies were not available in the study setting, which may have contributed to more rapid neurological deterioration. Previous studies have suggested that immunomodulatory regimens may slow disease progression and improve survival in selected patients, although responses remain variable. Additionally, loss to follow-up in a proportion of surviving patients may have led to underestimation of true survival duration, thereby contributing to an apparently shorter longevity in this cohort.

Most patients in this study were from Sylhet, suggesting possible regional variations in SSPE incidence also. Hence, this study was based on findings from a single-center, which may not fully represent the national epidemiological trends of SSPE in Bangladesh. But this geographic clustering aligns with regional reports from the Bangladesh Expanded Program on Immunization (EPI), which have historically identified Sylhet as a region with comparatively higher vaccine dropout rates and lower coverage for the second dose of the measles vaccine.³⁵ These regional disparities, often attributed to hard-to-reach terrain and mobile populations, likely created localized pockets of susceptibility. The high prevalence of SSPE in children from this region suggests that localized immunity gaps may allow for sustained wild-type measles virus transmission, even when national administrative coverage figures appear high.

This case series points to a pressing need for increased awareness and surveillance for measles infection and SSPE. The comparatively earlier age of onset and shorter latent period in this SSPE cohort raises concern for effectiveness of vaccination, epidemiological shift of disease presentation and moreover- a potential resurgence of SSPE in the coming years. The events of early measles infection prior to scheduled vaccination needs to evaluate and may be a revision of current immunization strategies should be considered based on the evaluation report.

Conclusion

This case series observed a significant shift toward an earlier age of onset and a shorter latent period of SSPE among Bangladeshi children compared to traditional global patterns. While Bangladesh has achieved high national vaccination coverage, the occurrence of SSPE in both immunized children and those infected prior to their scheduled vaccination time points toward an immunity gaps and early-life viral exposure as critical risks. The rapid clinical progression and high mortality rate observed in this cohort- exacerbated by the unavailability of disease-modifying therapies highlight an urgent need for enhanced measles surveillance, particularly in regions like Sylhet. A potential re-evaluation of national immunization strategies is also must need to protect infants from early-life exposure. Further large-scale epidemiological studies are warranted to better understand the host and viral factors driving these emerging trends in Bangladesh.

Supplemental Material

sj-docx-1-gph-10.1177_30502225261453521 – Supplemental material for Earlier Onset of Subacute Sclerosing Panencephalitis in Bangladeshi Children: Insights from a Case Series

Supplemental material, sj-docx-1-gph-10.1177_30502225261453521 for Earlier Onset of Subacute Sclerosing Panencephalitis in Bangladeshi Children: Insights from a Case Series by Sarah Alam, Yamin Shahriar Chowdhury, Narayan Saha, Samsun Nahar Sumi, Sufia Khatun Sumi and Tamanna Tabassum in Sage Open Pediatrics

Footnotes

Acknowledgements

The authors must thank the entire team of the Pi Research & Development Center () for their critical help for this case.

Abbreviations

SSPE–Subacute Sclerosing Panencephalitis

WHO–World Health Organization

NINS&H–National Institute of Neuroscience and Hospital

CSF–Cerebrospinal fluid

EEG – Electroencephalography

MRI–Magnetic Resonance Imaging

ORCID iD

Tamanna Tabassum

Ethical Considerations

This case series was conducted using deidentified patient data. Ethical approval was obtained from Ethical Review Committee of the Public Health Foundation (PHF) [Approval No.: PHFBD-ERC-SFP-R-001/2025]. All steps of this study were taken in accordance with the ethical standards of the institutional research committee and the principles of the Declaration of Helsinki.

Informed Consent

The requirement of informed consent was waived by the Ethical Review Committee of PHF because the study utilized deidentified patient data and posed minimal risk to study participants.

Author Contributions

Conceptualization, SA, and TT formal analysis, SA, NS, and TT investigation, SA, YSC, NS, SNS, SKS, and TT methodology, SA, YSC and SKS resources, SA, and TT supervision SA, SNS writing – original draft, SA, YSC, NS, SNS, SKS and TT writing – review & editing, SA, YSC and TT All authors have read and agreed to the published version of the manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

Data and materials pertaining to individual patients can be accessed upon request from the corresponding author.*

Supplemental Material

Supplemental material for this article is available online.

References

Garg

Mahadevan

Malhotra

Rizvi

Kumar

Uniyal

. Subacute sclerosing panencephalitis. Rev Med Virol. 2019;29(5):1-13.

Garg

Pandey

. Subacute sclerosing panencephalitis: recent advances in pathogenesis, diagnosis, and treatment. Ann Indian Acad Neurol. 2025;28(2):159-168.

Campbell

Andrews

Brown

Miller

. Review of the effect of measles vaccination on the epidemiology of SSPE. Int J Epidemiol. 2007;36(6):1334-1348.

Cece

Tokay

Yildiz

Karakas

Iscan

. Epidemiological findings and clinical and magnetic resonance presentations in subacute sclerosing panencephalitis. J Int Med Res. 2011;39(2):594-602.

Memon

Afzal

Tukruna

Khan

Tebha

Zaidi

. Trends and treatment of sub-acute sclerosing panencephalitis: an updated review. Glob Pediatr Health. 2021;8:22-23.

Tabassum

Hassan Hafeez

Naeem

Bibi

Akilimali

Sharma

. The challenges and main recommendations to fight measles in India: a mini review. New Microbes New Infect. 2024;60-61:60.

Khanal

Bohara

Chacko

, et al. Progress toward measles elimination — Bangladesh, 2000–2016. Relev Epidemiol Hebd. 2017;66(28):753-757.

World Health Organization, UNICEF. Bangladesh: WHO and UNICEF estimates of immunization coverage: 2023 revision [Internet]. 2024. [cited 2026 Apr 18]. https://cdn.who.int/media/docs/default-source/country-profiles/immunization/2024-country-profiles/immunization-2024-bgd.pdf

Kasinathan

Sharawat

Kesavan

Suthar

Sankhyan

. Early-onset subacute sclerosing panencephalitis: report of two cases and review of literature. Ann Indian Acad Neurol. 2019;22(3):361-363.

10.

Lam

Ranjan

Newark

, et al. A recent surge of fulminant and early onset subacute sclerosing panencephalitis (SSPE) in the United Kingdom: an emergence in a time of measles. Eur J Paediatr Neurol. 2021;34:43-49.

11.

Srivastava

Agarwal

Rajadhyaksha

. Resurgence of subacute sclerosing panencephalitis: case series and global epidemiological trends. J Pediatr Neurol. 2022;20(03):182-187.

12.

Aulakh

Tiwari

. Subacute sclerosing panencephalitis in a toddler: changing epidemiological trends. Case Rep Pediatr. 2013;2013:1-4.

13.

Liao

Zhong

Zou

Jiang

. Seizures as onset symptoms and rapid course in preschool children with subacute sclerosing panencephalitis. Brain Behav. 2021;11(4):e02051.

14.

Shaligram

Garud

Jadhav

Chalipat

Mane

. A rare case of subacute sclerosing panencephalitis in an immunized patient. Cureus. 2024;16(6):e63258.

15.

Prashanth

Taly

Ravi

Sinha

Arunodaya

. Adult onset subacute sclerosing panencephalitis: clinical profile of 39 patients from a tertiary care centre. J Neurol Neurosurg Psychiatry. 2006;77(5):630-633.

16.

Garg

Sharma

Kumar

Pandey

. Subacute sclerosing panencephalitis in older adulthood. Tremor Other Hyperkinet Mov (N Y). 2019;9(0):9.

17.

Gascon

. Randomized Treatment Study of inosiplex versus combined inosiplex and intraventricular interferon-α in subacute sclerosing panencephalitis (SSPE): international multicenter study. J Child Neurol. 2003;18(12):819-827.

18.

Rocke

Belyayeva

. Subacute sclerosing panencephalitis. In: StatPearls. StatPearls Publishing; 2025. https://www.ncbi.nlm.nih.gov/books/NBK560673/

19.

Kume

Hashimoto

Iida

, et al. Diagnostic reference value of antibody levels measured using enzyme immunoassay for subacute sclerosing panencephalitis. Microbiol Immunol. 2022;66(9):418-425.

20.

Rahman

Syed

Morshed

Chowdhury

. Subacute sclerosing panencephalitis with disorganized behavior: a case report from psychiatry ward. Bangladesh J Psychiatry. 2024;37(2):49-51.

21.

Gagnier

Kienle

Altman

Moher

Sox

Riley

. The CARE guidelines: consensus-based clinical case report guideline development. J Clin Epidemiol. 2014;67(1):46-51.

22.

Miller

Andrews

Rush

Munro

Jin

Miller

. The epidemiology of subacute sclerosing panencephalitis in England and Wales 1990-2002. Arch Dis Child. 2004;89(12):1145-1148.

23.

World Health Organization (WHO). Immunization dashboard: Bangladesh. 2025 [cited 2025 May 4]. https://immunizationdata.who.int/dashboard/regions/south-east-asia-region/BGD

24.

Schönberger

Ludwig

Wildner

Weissbrich

. Epidemiology of subacute sclerosing panencephalitis (SSPE) in Germany from 2003 to 2009: a risk estimation. PLoS One. 2013;8(7):e68909.

25.

Wendorf

Winter

Zipprich

, et al. Subacute sclerosing panencephalitis: the devastating measles complication that might be more common than previously estimated. Clin Infect Dis. 2017;65(2):226-232.

26.

Akram

Naz

Malik

Hamid

. Clinical profile of subacute sclerosing panencephalitis. J Coll Physicians Surg Pak. 2008;18(8):485-488.

27.

Jagtap

Nair

Kambale

. Subacute sclerosing panencephalitis: a clinical appraisal. Ann Indian Acad Neurol. 2013;16(4):631-633.

28.

Sonia

Lalit

Shobha

, et al. Subacute sclerosing panencephalitis in a tertiary care centre in post measles vaccination era. J Commun Dis. 2009;41:161-167.

29.

Suryawanshi

Kalrao

Asad

Tiwary

Attarde

. Early-onset subacute sclerosing panencephalitis and its rapid clinical course of progression to vegetative state: an atypical presentation. Indian Journal of Case Reports. 2024;10(11):342-347.

30.

Kapoor

Kakkar

Narayana

Garg

Mukherjee

. Subacute sclerosing panencephalitis in Indian children under 5 years during the COVID pandemic: a paradigm shift in the clinical profile. Indian Pediatr Case Reports. 2022;2(3):139-144.

31.

Gutierrez

Issacson

Koppel

. Subacute sclerosing panencephalitis: an update. Dev Med Child Neurol. 2010; 52(10):901-907.

32.

Ali

Kumar

Ullah

Haq

MAU

Gul

Kumar

. Electroencephalography patterns of subacute sclerosing panencephalitis. Cureus. 2021;13(6):10-15.

33.

Makharia

Agarwal

Garg

Srivastava

Garg

. Prolonged survival in subacute sclerosing panencephalitis: case series with a review of literature on “long survivors. Ann Indian Acad Neurol. 2025;28(2):268-272.

34.

Garg

Sharma

. Disease-modifying therapy in subacute sclerosing panencephalitis: an area of darkness. Ann Indian Acad Neurol. 2023;26(1):3-9.

35.

Uddin

Adhikary

Ali

, et al. Evaluation of impact of measles rubella campaign on vaccination coverage and routine immunization services in Bangladesh. BMC Infect Dis. 2016;16:411.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.02 MB

0.00 MB