Background: Subacute sclerosing PANENCEPHALITIS is a progressive neurological disease of children due to measles virus. Dementia, ataxia, myoclonus and focal neurological signs with a fatal outcome are seen in this disease. Anti-measles vaccination programs have substantially decreased the incidence of subacute sclerosing PANENCEPHALITIS. Materials and Methods: Over a period of 14 years, between 1988 to 2002, thirty patients who had presented with neurological signs, were confirmed to have subacute sclerosing PANENCEPHALITIS. The diagnosis was based on neurological signs, EEG findings as well as high titers of anti-measles antibody in the cerebrospinal fluid using ELISA. Results: The age range of the patients was 3-15 years with a mean of 7±1 years. Nineteen patients were male and 11 were female with a male 11 female ratio of 1.7. Myoclonus (24), convulsion (18), hemiparesis (10), ataxia and coma were the most common signs in order of frequency followed by cranial nerve involvement, athetosis and delirium. Conclusion: Cases of subacute sclerosing PANENCEPHALITIS are being diagnosed in spite of anti-measles vaccination. This may be due to incomplete measles vaccination in our region.

Objective: Sub acute Sclerosing Pan Encephalitis (SSPE), a progressive neurological disorder characterized by inflammation of the brain (encephalitis), is the result of an inappropriate immune response to the measles virus or measles vaccination. SSPE usually develops 2 to 10 years after the original viral attack. Some of the major signs and symptoms are mental deterioration, jerky movements, and seizures specially myoclonic type, involuntary movements, and/or behavioral changes, difficulty in walking, speech, and loss of cognition, respiratory distress and death.Materials and Methods: During the ten years, from July 1991 to July 2001, we admitted 45 cases of (SSPE), at different stages of the disorder. Regard less of their stage of disease, for intervention, randomly, we used one of three drugs; Amantadin, Interferon alfa and Isoprinosine, administered to the patients, for between one month to one year. Fourteen cases received Amantadin, 15Alfa interferon, and 16 were given Isoprinosine.Results: While the results show all three drugs to be relatively effective, Isoprinosine showed four times more effectiveness than Amantadin and twice as much as Interferon.Conclusion: The results showed Isoprinosine to be much more effective than Amantadin and Alfa interferon in treating the condition.

During a period of 7 years (1997-2003) we were received pairs of serum and CSF of 27 suspicious clinically cases from neurology department of several hospitals in Tehran. Among them 7 were serologically positive for progressive rubella PANENCEPHALITIS (PRPE) and 2 were positive for sub acute sclerosing PANENCEPHALITIS (SSPE). Rubella virus was isolated from 4 of 7 serologically positive cases of PRPE using three different cell culture systems.    

Lumbar puncture (LP) plays a critical role in both pediatric medical diagnosis and treatment today. An accurate physical neurologic assessment will be a vital part in the medical decision making process about whether an LP should be performed. LP is used to obtain a sample of cerebro-spinal fluid (CSF) to aid in the diagnosis of infectious, inflammatory, oncologic, and metabolic processes. Therapeutic indications include the delivery of chemotherapy, antibiotics, and anesthetic agents. Increased intracranial pressure (ICP) with pseudotumor cerebri and after hemorrhage or meningitis can be effectively treated with repeated LP without shunting in some children. Diagnostic LP indications include suspicion of meningitis, in a child younger than 12 months with febrile convulsion, for measurements of antibody titers in subacute sclerosing PANENCEPHALITIS, measles, rubella, and progressive rubella PANENCEPHALITIS, suspected subarachnoid hemorrhage, pseudotumor cerebre, lead encephalopathy, diagnosis of CNS neoplasia, and some neurologic conditions (eg, normal pressure hydrocephalus, Guillain-Barre syndrome). Contraindications to LP can be absolute or relative. Increased ICP is an absolute contraindication. For patients with a bleeding diathesis or cardiopulmonary instability, the contraindications are relative to the importance of CSF results for immediate management decisions. Normal CT scan brain does not mean it is safe to do LP. Clinical signs, not a CT scan brain, are the best indicators of when to or when not to do LP. The most common complication of LP is headache. Other complications are backache or spasms in the lower back or thighs, transient voiding problems, seizures, slight rise in temperature, bleeding, shock, infection, transtentorial or cisternal herniation ("coning"), spinal/epidural abscess, epidermoid tumor, herniation of nerve roots and cerebral herniation (the most serious complication). Knowledge of the contraindications, the pertinent anatomy, and the methods to minimize the risk of complications are necessary for the safe and efficient performance of the procedure. Risks, although rare, can be substantial and even potentially life-threatening.