Comprehensive Case Study Report: Subacute Sclerosing Panencephalitis (SSPE)

Comprehensive Case Study Report: Subacute Sclerosing Panencephalitis (SSPE) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Comprehensive Case Study Report: Subacute Sclerosing Panencephalitis (SSPE) Reema Danish This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8608592/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Subacute Sclerosing Panencephalitis (SSPE) is a progressive and fatal neurodegenerative disease. It can be caused by persistent measles virus infection in the central nervous system or not receive treatment of measles at early years (Campbell et al., 2020). Case Presentation: A 5-year-old girl, who was previously stable physically, and her motor capabilities were intact. She presents with an episode of seizures in clinic, which was taken normal and Anti-Epileptic prescribed by Neuro-Medicine. After a week, she presented with an initial rash, which was initially mistaken for mosquito bites. Later, she developed tonic-clonic seizures, requiring immediate medical intervention. Over the following months, her condition worsened, with frequent seizure episodes despite medication. Further diagnostic tests confirmed SSPE. Her parents reported regression in her ability to perform daily activities, indicating a rapid neurological decline. This case underscores the importance of early diagnosis and intervention in managing SSPE. Management: Medical management of SSPE primarily involves symptomatic treatment aimed at controlling seizures, modulating immune responses, and slowing disease progression. Relieving the patient from seizures is very important as it can weaken the patient physically and cognitively. Furthermore, Antiviral therapies such as interferon-alpha and ribavirin have been used, though their efficacy remains limited (Rima & Duprex, 2018). Immunotherapy, including intravenous immunoglobulin (IVIG), has been explored to modulate immune responses and potentially slow disease progression (Johnson et al., 2022). Supportive care, including nutritional support, respiratory monitoring, and physiotherapy, palliative care is crucial in improving the patient's quality of life. Educating and supporting families through caregiver training programs and psychological counselling enhances patient outcomes. Conclusion: SSPE is a rare yet devastating complication of measles, emphasizing the importance of vaccination. While no definitive cure exists, early diagnosis and supportive management can improve patient outcomes and quality of life. A multidisciplinary approach involving neurology, infectious disease specialists, rehabilitation therapists, and supportive care teams, which may include nutritionists, respiratory therapists, and social workers, is crucial in managing SSPE effectively (Griffin & Lin, 2021). Continuous research and advancements in immunotherapy offer hope for better future outcomes. Immunology Vaccine Development Neurology Physical Medicine & Rehab Epileptic Neurological Subacute Sclerosing Panencephalitis (SSPE) neurodegenerative Measles rehabilitation IgGE Introduction Subacute Sclerosing Panencephalitis (SSPE) is a progressive and fatal neurodegenerative disease. It can be caused by persistent measles virus infection in the central nervous system or not receive treatment of measles at early years (Campbell et al., 2020). SSPE originates after months or years after an initial measles infection, leading to progressive cognitive decline, motor dysfunction, seizures, and, ultimately, death (Griffin & Lin, 2021). Uptil now Despite advances in medical research, SSPE remains a formidable disease to manage, with no definitive cure. This case study shows the clinical description of patient with SSPE who 5 years old girl is, SSPE differential diagnosis, nursing management, Medical treatment of SSPE. Moreover, we will discuss the in-depth discussion on evidence-based nursing practices and a multidisciplinary approach to care. Case Scenario Early recognition of symptoms is crucial in the case of SSPE. A 5-year-old girl, who was previously stable physically, and her motor capabilities were intact. On January, She presents with an episode of seizures in clinic, which was taken normal and Anti-Epileptic prescribed by Neuro-Medicine. presented with an initial rash in January, which was initially mistaken for mosquito bites. In February, she developed tonic-clonic seizures, requiring immediate medical intervention. Over the following months, her condition worsened, with frequent seizure episodes despite medication. Further diagnostic tests confirmed SSPE. Her parents reported regression in her ability to perform daily activities, indicating a rapid neurological decline. This case underscores the importance of early diagnosis and intervention in managing SSPE. Case History The patient is a 5-year-old female who presented with recurrent seizures and cognitive decline. The history of the present illness began in January when a rash appeared, which was presumed to be a mosquito bite. In February, she experienced her first tonic-clonic seizure, prompting medical evaluation. Over the next several months, from March to June, she exhibited progressive cognitive impairment, myoclonic jerks, and a loss of motor function. Eventually, her condition deteriorated to the point where hospital admission was necessary due to an escalation in seizure activity and unresponsiveness to treatment. The patient had no prior significant illnesses and no documented history of measles vaccination. Her family history revealed no neurological disorders. In representations of social history, the child had achieved typical developmental milestones prior to the onset of her illness, making the progression of symptoms particularly alarming. Physical Examination Upon inspection and examination, the patient seemed very thin, underweight, and drowsy. Her GCS was 8/15, Eyes opening 2, Verbal 3, and Motor 5 at the time of admission. Furthermore, she was showing a severe representation of respiratory arrest, abdominal breath, and 43 breaths per minute. For 3 months, she displayed progressively declining cognitive function. She was not hemodynamically stable at the time of admission and taken on intubation, including heart rate was 165bpm, blood pressure 95/55mmHg, and temperature was 36.3 but initially got a fever spike at home. However, a detailed neurological assessment revealed hyperreflexia, myoclonic jerks, impaired coordination, and declining verbal and motor responses. She also exhibited periodic bursts of abnormal movements, further supporting a neurological disorder. A skin examination showed that the rash had resolved, and no other systemic abnormalities were identified. Despite typical vital signs, the progressive neurological deterioration indicated an underlying pathological process affecting the central nervous system. Differential Diagnosis Several conditions were considered in the differential diagnosis. At first, seizures taken as pathologically effect of fever as patient had a fever spike, too which was not taken as serious in clinic by doctors and no investigation suggested. Epileptic encephalopathy was a primary consideration due to the recurrent seizures and progressive neurological impairment as with time patient’s motor activity diminished day by day. Autoimmune encephalitis was another possibility, given its potential to cause brain inflammation, leading to similar symptoms. Mitochondrial disorders were also considered, as they can present with progressive neurological dysfunction. Other potential diagnoses included neurodegenerative diseases, which share characteristics of cognitive decline and motor impairment, and viral encephalitis, which can cause neurological symptoms due to viral infection of the brain. Lastly, Progressive Myoclonic Epilepsy was included in the differential diagnosis due to the presence of myoclonic jerks and cognitive regression. Laboratory and Diagnostic Findings Following Table. 1 the findings Complete Blood Count (CBC ) is mentioned which was taken from hospital system with the permission of family and staff. In CBC report the WBC count is raised which indicated the traces of infection which is related to neurologically as dropped in GCS as well. Table 1 Complete Blood Count Findings. Parameter Result Normal Range WBC 20,680 4,000 - 11,000 /uL RBC 5.12M 4.5 - 6.5 M/uL Hemoglobin 13.8 g/dL 13.0 - 18.0 g/dL Hematocrit (HCT) 41.2% 40 - 54% Platelet Count 263,000 150,000 - 400,000 /uL In Table 2 Lumbar Puncture results is mentioned which showing the CSF Analysis to rule out the causative agent which affecting the Brain and motor functions. If we concentrate on the findings, we can see there are elevations of measle specific IgE in patient’s CSF which indicate that a strong parasitic CNS infection taken over to the CSF and not treated. As level of IgE mostly seen in blood and mucus but it’s elevation in CSF indicates that it’s a rare kind of disease which is progressive and fatal too. Table 2 Lumbar Puncture Findings. Parameter Result Normal Range CSF IgE Elevated Absent Glucose 56.9 mg/dL 60 - 80 mg/dL Protein 79.3 mg/dL 40 - 120 mg/dL In Table. 3 following are the results of Electrolyte Levels which slightly altered due to the unmet requirement nutritional needs. Table 3 Electrolyte Levels. Parameter Result Normal Range Sodium 134 mEq/L 136 - 145 mEq/L Potassium 3.3 mEq/L 3.5 - 5.1 mEq/L Imaging and EEG Findings In a patient diagnosed with Subacute Sclerosing Panencephalitis (SSPE), diagnostic evaluations reveal significant findings. Magnetic Resonance Imaging (MRI) demonstrates diffuse cortical atrophy accompanied by white matter changes, indicative of disease progression affecting both cortical and subcortical regions. Electroencephalography (EEG) exhibits periodic high-voltage discharges, a hallmark characteristic of SSPE, along with a burst-suppression pattern, reflecting severe impairment of neuronal activity. Additionally, blood cultures show no bacterial growth, effectively ruling out bacterial infections as a contributing factor to the patient's neurological decline. Medical Management Medical management of SSPE primarily involves symptomatic treatment aimed at controlling seizures, modulating immune responses, and slowing disease progression. This medical treatment relieves the patient from the seizures which is result from the disease. Additionally, antiseizure medications, including valproic acid, lamotrigine, and clonazepam, are administered to manage seizure episodes (Bellini et al., 2019). Relieving the patient from seizures is very important as it can weaken the patient physically and cognitively. Furthermore, Antiviral therapies such as interferon-alpha and ribavirin have been used, though their efficacy remains limited (Rima & Duprex, 2018). Immunotherapy, including intravenous immunoglobulin (IVIG), has been explored to modulate immune responses and potentially slow disease progression (Johnson et al., 2022). Supportive care, including nutritional support, respiratory monitoring, and physiotherapy, palliative care is crucial in improving the patient's quality of life. Lifestyle Modifications Lifestyle modifications are essential in managing SSPE symptoms and alleviate the patient's comfort and reduce the risk of complications. A safe environment with a better understanding to improve patient’s remaining days pain free. It is also crucial to prevent injuries from seizures, necessitating the removal of sharp objects, installation of padded bed railings, and constant supervision. Additionally, a high-caloric diet is recommended to meet the increased metabolic demands of neurological disorders. As patients are unable to swallow in stage two of these diseases then it is important to educate the parent about the feeding through NG and different blendarized diet which fulfill patient’s need. Rehabilitation at home Rehabilitation in which Physiotherapy is an integral component of maintaining muscle tone and preventing contractures, helping to retain some mobility for as long as possible. Moreover, providing psychosocial support to both the patient and family is vital, as caregivers face emotional distress in managing a progressively deteriorating condition. Counselling sessions and caregiver education significantly enhance coping mechanisms. Preventive Measures Against SSPE The most effective preventive measure against SSPE is measles vaccination, which significantly reduces the risk of measles infection and prevents SSPE development (WHO, 2021). Public health campaigns should focus on increasing awareness of measles vaccination and its critical role in preventing complications. This highlights the potential for prevention and offers hope in the fight against SSPE. Early diagnosis and surveillance of high-risk populations can facilitate timely intervention, slowing disease progression. Additionally, implementing global immunization programs, particularly in underdeveloped regions, can drastically reduce SSPE incidence. Nursing Management Using Evidence-Based Practice Nursing management of SSPE requires a multidisciplinary approach involving neurologists, infectious disease specialists, and rehabilitation therapists. Nurses play a pivotal role in patient care by ensuring adherence to treatment regimens, monitoring seizure activity, and preventing complications. This collaborative approach ensures comprehensive care and enhances patient outcomes. Implementing evidence-based interventions such as airway management, fall prevention, and skin integrity maintenance is essential in managing SSPE effectively. Educating and supporting families through caregiver training programs and psychological counselling enhances patient outcomes. Following updated clinical guidelines for SSPE management ensures that nursing interventions remain relevant and effective in providing holistic care. Conclusion SSPE is a rare yet devastating complication of measles, emphasizing the importance of vaccination. While no definitive cure exists, early diagnosis and supportive management can improve patient outcomes and quality of life. A multidisciplinary approach involving neurology, infectious disease specialists, rehabilitation therapists, and supportive care teams, which may include nutritionists, respiratory therapists, and social workers, is crucial in managing SSPE effectively (Griffin & Lin, 2021 ). Continuous research and advancements in immunotherapy offer hope for better future outcomes. Declarations I confirm that written informed consent was obtained from the legal guardian, who agreed to the publication of the case report containing the minor’s clinical data. Ethics Approval is not relevant to my manuscript. References Bellini, W. J., et al. (2019). Measles virus pathogenesis and persistence in the CNS. Journal of Neurology . Campbell, H., et al. (2020). Neurological complications of measles infection: A review. Pediatric Neurology . Griffin, D. E., & Lin, W. H. (2021). Subacute sclerosing panencephalitis: Pathogenesis and immunity. Nature Reviews Neurology . Johnson, R. T., et al. (2022). CSF IgE as a biomarker for SSPE. The Lancet Neurology . Rima, B. K., & Duprex, W. P. (2018). Molecular mechanisms of measles virus persistence. Virology Journal . World Health Organization. (2021). Measles vaccination and SSPE prevention. World Health Organization Guidelines Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8608592","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":574991685,"identity":"39cde696-d77b-4005-a4e1-55ae60baa76e","order_by":0,"name":"Reema 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Panencephalitis (SSPE) is a progressive and fatal neurodegenerative disease. It can be caused by persistent measles virus infection in the central nervous system or not receive treatment of measles at early years (Campbell et al., 2020). SSPE originates after months or years after an initial measles infection, leading to progressive cognitive decline, motor dysfunction, seizures, and, ultimately, death (Griffin \u0026amp; Lin, 2021). Uptil now Despite advances in medical research, SSPE remains a formidable disease to manage, with no definitive cure. This case study shows the clinical description of patient with SSPE who 5 years old girl is, SSPE differential diagnosis, nursing management, Medical treatment of SSPE. Moreover, we will discuss the in-depth discussion on evidence-based nursing practices and a multidisciplinary approach to care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Scenario\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEarly recognition of symptoms is crucial in the case of SSPE. A 5-year-old girl, who was previously stable physically, and her motor capabilities were intact. On January, She presents with an episode of seizures in clinic, which was taken normal and Anti-Epileptic prescribed by Neuro-Medicine. presented with an initial rash in January, which was initially mistaken for mosquito bites. In February, she developed tonic-clonic seizures, requiring immediate medical intervention. Over the following months, her condition worsened, with frequent seizure episodes despite medication. Further diagnostic tests confirmed SSPE. Her parents reported regression in her ability to perform daily activities, indicating a rapid neurological decline. This case underscores the importance of early diagnosis and intervention in managing SSPE.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase History\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient is a 5-year-old female who presented with recurrent seizures and cognitive decline. The history of the present illness began in January when a rash appeared, which was presumed to be a mosquito bite. In February, she experienced her first tonic-clonic seizure, prompting medical evaluation. Over the next several months, from March to June, she exhibited progressive cognitive impairment, myoclonic jerks, and a loss of motor function. Eventually, her condition deteriorated to the point where hospital admission was necessary due to an escalation in seizure activity and unresponsiveness to treatment.\u003c/p\u003e\n\u003cp\u003eThe patient had no prior significant illnesses and no documented history of measles vaccination. Her family history revealed no neurological disorders. In representations of social history, the child had achieved typical developmental milestones prior to the onset of her illness, making the progression of symptoms particularly alarming.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhysical Examination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUpon inspection and examination, the patient seemed very thin, underweight, and drowsy. Her GCS was 8/15, Eyes opening 2, Verbal 3, and Motor 5 at the time of admission. Furthermore, she was showing a severe representation of respiratory arrest, abdominal breath, and 43 breaths per minute. For 3 months, she displayed progressively declining cognitive function. She was not hemodynamically stable at the time of admission and taken on intubation, including heart rate was 165bpm, blood pressure 95/55mmHg, and temperature was 36.3 but initially got a fever spike at home. However, a detailed neurological assessment revealed hyperreflexia, myoclonic jerks, impaired coordination, and declining verbal and motor responses. She also exhibited periodic bursts of abnormal movements, further supporting a neurological disorder.\u003c/p\u003e\n\u003cp\u003eA skin examination showed that the rash had resolved, and no other systemic abnormalities were identified. Despite typical vital signs, the progressive neurological deterioration indicated an underlying pathological process affecting the central nervous system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDifferential Diagnosis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeveral conditions were considered in the differential diagnosis. At first, seizures taken as pathologically effect of fever as patient had a fever spike, too which was not taken as serious in clinic by doctors and no investigation suggested. Epileptic encephalopathy was a primary consideration due to the recurrent seizures and progressive neurological impairment as with time patient\u0026rsquo;s motor activity diminished day by day. Autoimmune encephalitis was another possibility, given its potential to cause brain inflammation, leading to similar symptoms. Mitochondrial disorders were also considered, as they can present with progressive neurological dysfunction.\u003c/p\u003e\n\u003cp\u003eOther potential diagnoses included neurodegenerative diseases, which share characteristics of cognitive decline and motor impairment, and viral encephalitis, which can cause neurological symptoms due to viral infection of the brain. Lastly, Progressive Myoclonic Epilepsy was included in the differential diagnosis due to the presence of myoclonic jerks and cognitive regression.\u003c/p\u003e"},{"header":"Laboratory and Diagnostic Findings","content":"\u003cp\u003eFollowing \u003cstrong\u003eTable. 1\u003c/strong\u003e the findings Complete Blood Count (CBC\u003cstrong\u003e)\u0026nbsp;\u003c/strong\u003eis mentioned which was taken from hospital system with the permission of family and staff. In CBC report the WBC count is raised which indicated the traces of infection which is related to neurologically as dropped in GCS as well.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003e\u003cem\u003eComplete Blood Count Findings.\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal Range\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eWBC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e20,680\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e4,000 - 11,000 /uL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eRBC\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e5.12M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e4.5 - 6.5 M/uL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eHemoglobin\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e13.8 g/dL\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e13.0 - 18.0 g/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eHematocrit (HCT)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e41.2%\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;40 - 54%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003ePlatelet Count\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e263,000\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e150,000 - 400,000 /uL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIn Table 2 Lumbar Puncture results is mentioned which showing the CSF Analysis to rule out the causative agent which affecting the Brain and motor functions. If we concentrate on the findings, we can see there are elevations of measle specific IgE in patient\u0026rsquo;s CSF which indicate that a strong parasitic CNS infection taken over to the CSF and not treated. As level of IgE mostly seen in blood and mucus but it\u0026rsquo;s elevation in CSF indicates that it\u0026rsquo;s a rare kind of disease which is progressive and fatal too.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003e\u003cem\u003eLumbar Puncture Findings.\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal Range\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eCSF IgE\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;Elevated\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;Absent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eGlucose\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e56.9 mg/dL\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e60 - 80 mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eProtein\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e79.3 mg/dL\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;40 - 120 mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIn Table. 3 following are the results of Electrolyte Levels which slightly altered due to the unmet requirement nutritional needs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u0026nbsp;\u003c/strong\u003e\u003cem\u003eElectrolyte Levels.\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal Range\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eSodium\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e134 mEq/L\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e136 - 145 mEq/L\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003ePotassium\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;3.3 mEq/L\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e3.5 - 5.1 mEq/L\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Imaging and EEG Findings","content":"\u003cp\u003eIn a patient diagnosed with Subacute Sclerosing Panencephalitis (SSPE), diagnostic evaluations reveal significant findings. Magnetic Resonance Imaging (MRI) demonstrates diffuse cortical atrophy accompanied by white matter changes, indicative of disease progression affecting both cortical and subcortical regions. Electroencephalography (EEG) exhibits periodic high-voltage discharges, a hallmark characteristic of SSPE, along with a burst-suppression pattern, reflecting severe impairment of neuronal activity. Additionally, blood cultures show no bacterial growth, effectively ruling out bacterial infections as a contributing factor to the patient\u0026apos;s neurological decline.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMedical Management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMedical management of SSPE primarily involves symptomatic treatment aimed at controlling seizures, modulating immune responses, and slowing disease progression. This medical treatment relieves the patient from the seizures which is result from the disease. Additionally, antiseizure medications, including valproic acid, lamotrigine, and clonazepam, are administered to manage seizure episodes (Bellini et al., 2019). Relieving the patient from seizures is very important as it can weaken the patient physically and cognitively. Furthermore, Antiviral therapies such as interferon-alpha and ribavirin have been used, though their efficacy remains limited (Rima \u0026amp; Duprex, 2018).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eImmunotherapy, including intravenous immunoglobulin (IVIG), has been explored to modulate immune responses and potentially slow disease progression (Johnson et al., 2022). Supportive care, including nutritional support, respiratory monitoring, and physiotherapy, palliative care is crucial in improving the patient\u0026apos;s quality of life.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLifestyle Modifications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLifestyle modifications are essential in managing SSPE symptoms and alleviate the patient\u0026apos;s comfort and reduce the risk of complications. A safe environment with a better understanding to improve patient\u0026rsquo;s remaining days pain free. It is also crucial to prevent injuries from seizures, necessitating the removal of sharp objects, installation of padded bed railings, and constant supervision. Additionally, a high-caloric diet is recommended to meet the increased metabolic demands of neurological disorders. As patients are unable to swallow in stage two of these diseases then it is important to educate the parent about the feeding through NG and different blendarized diet which fulfill patient\u0026rsquo;s need.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRehabilitation at home\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRehabilitation in which Physiotherapy is an integral component of maintaining muscle tone and preventing contractures, helping to retain some mobility for as long as possible.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMoreover, providing psychosocial support to both the patient and family is vital, as caregivers face emotional distress in managing a progressively deteriorating condition. Counselling sessions and caregiver education significantly enhance coping mechanisms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePreventive Measures Against SSPE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe most effective preventive measure against SSPE is measles vaccination, which significantly reduces the risk of measles infection and prevents SSPE development (WHO, 2021). Public health campaigns should focus on increasing awareness of measles vaccination and its critical role in preventing complications. This highlights the potential for prevention and offers hope in the fight against SSPE.\u003c/p\u003e\n\u003cp\u003eEarly diagnosis and surveillance of high-risk populations can facilitate timely intervention, slowing disease progression. Additionally, implementing global immunization programs, particularly in underdeveloped regions, can drastically reduce SSPE incidence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNursing Management Using Evidence-Based Practice\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNursing management of SSPE requires a multidisciplinary approach involving neurologists, infectious disease specialists, and rehabilitation therapists. Nurses play a pivotal role in patient care by ensuring adherence to treatment regimens, monitoring seizure activity, and preventing complications. This collaborative approach ensures comprehensive care and enhances patient outcomes. Implementing evidence-based interventions such as airway management, fall prevention, and skin integrity maintenance is essential in managing SSPE effectively.\u003c/p\u003e\n\u003cp\u003eEducating and supporting families through caregiver training programs and psychological counselling enhances patient outcomes. Following updated clinical guidelines for SSPE management ensures that nursing interventions remain relevant and effective in providing holistic care.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSSPE is a rare yet devastating complication of measles, emphasizing the importance of vaccination. While no definitive cure exists, early diagnosis and supportive management can improve patient outcomes and quality of life. A multidisciplinary approach involving neurology, infectious disease specialists, rehabilitation therapists, and supportive care teams, which may include nutritionists, respiratory therapists, and social workers, is crucial in managing SSPE effectively (Griffin \u0026amp; Lin, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Continuous research and advancements in immunotherapy offer hope for better future outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cspan\u003eI confirm that written informed consent was obtained from the legal guardian, who agreed to the publication of the case report containing the minor\u0026rsquo;s clinical data.\u003c/span\u003e\u003c/p\u003e\u003cp\u003eEthics Approval is not relevant to my manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBellini, W. J., et al. (2019). Measles virus pathogenesis and persistence in the CNS. \u003cem\u003eJournal of Neurology\u003c/em\u003e.\u003c/li\u003e\n \u003cli\u003eCampbell, H., et al. (2020). Neurological complications of measles infection: A review. \u003cem\u003ePediatric Neurology\u003c/em\u003e.\u003c/li\u003e\n \u003cli\u003eGriffin, D. E., \u0026amp; Lin, W. H. (2021). Subacute sclerosing panencephalitis: Pathogenesis and immunity. \u003cem\u003eNature Reviews Neurology\u003c/em\u003e.\u003c/li\u003e\n \u003cli\u003eJohnson, R. T., et al. (2022). CSF IgE as a biomarker for SSPE. \u003cem\u003eThe Lancet Neurology\u003c/em\u003e.\u003c/li\u003e\n \u003cli\u003eRima, B. K., \u0026amp; Duprex, W. P. (2018). Molecular mechanisms of measles virus persistence. \u003cem\u003eVirology Journal\u003c/em\u003e.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. (2021). Measles vaccination and SSPE prevention. \u003cem\u003eWorld Health Organization Guidelines\u003c/em\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Shifa International Hospital","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Epileptic, Neurological, Subacute Sclerosing Panencephalitis (SSPE), neurodegenerative, Measles, rehabilitation, IgGE","lastPublishedDoi":"10.21203/rs.3.rs-8608592/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8608592/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubacute Sclerosing Panencephalitis (SSPE) is a progressive and fatal neurodegenerative disease. It can be caused by persistent measles virus infection in the central nervous system or not receive treatment of measles at early years (Campbell et al., 2020).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Presentation:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 5-year-old girl, who was previously stable physically, and her motor capabilities were intact. She presents with an episode of seizures in clinic, which was taken normal and Anti-Epileptic prescribed by Neuro-Medicine. After a week, she presented with an initial rash, which was initially mistaken for mosquito bites. Later, she developed tonic-clonic seizures, requiring immediate medical intervention. Over the following months, her condition worsened, with frequent seizure episodes despite medication. Further diagnostic tests confirmed SSPE. Her parents reported regression in her ability to perform daily activities, indicating a rapid neurological decline. This case underscores the importance of early diagnosis and intervention in managing SSPE.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eManagement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMedical management of SSPE primarily involves symptomatic treatment aimed at controlling seizures, modulating immune responses, and slowing disease progression. Relieving the patient from seizures is very important as it can weaken the patient physically and cognitively. Furthermore, Antiviral therapies such as interferon-alpha and ribavirin have been used, though their efficacy remains limited (Rima \u0026amp; Duprex, 2018).\u003c/p\u003e\n\u003cp\u003eImmunotherapy, including intravenous immunoglobulin (IVIG), has been explored to modulate immune responses and potentially slow disease progression (Johnson et al., 2022). Supportive care, including nutritional support, respiratory monitoring, and physiotherapy, palliative care is crucial in improving the patient's quality of life. Educating and supporting families through caregiver training programs and psychological counselling enhances patient outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSSPE is a rare yet devastating complication of measles, emphasizing the importance of vaccination. While no definitive cure exists, early diagnosis and supportive management can improve patient outcomes and quality of life. A multidisciplinary approach involving neurology, infectious disease specialists, rehabilitation therapists, and supportive care teams, which may include nutritionists, respiratory therapists, and social workers, is crucial in managing SSPE effectively (Griffin \u0026amp; Lin, 2021). Continuous research and advancements in immunotherapy offer hope for better future outcomes.\u003c/p\u003e","manuscriptTitle":"Comprehensive Case Study Report: Subacute Sclerosing Panencephalitis (SSPE)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-19 09:00:27","doi":"10.21203/rs.3.rs-8608592/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8bdf48b9-66ac-42b6-8a5b-7f2fc9bbb542","owner":[],"postedDate":"January 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":61179936,"name":"Immunology"},{"id":61179937,"name":"Vaccine Development"},{"id":61179938,"name":"Neurology"},{"id":61179939,"name":"Physical Medicine \u0026 Rehab"}],"tags":[],"updatedAt":"2026-01-19T09:00:27+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-19 09:00:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8608592","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8608592","identity":"rs-8608592","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}