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Seizures in a boy with subacute sclerosing panencephalitis during high-dose intrathecal interferon-alpha therapy
Hüseyin Caksen1, Dursun Odabaş, Bülent Ataş
1Department of Pediatrics, Yüzüncü Yil University Faculty of Medicine, Van, Turkey.
Insights
High-dose intrathecal interferon-alpha may trigger seizures in children with subacute sclerosing panencephalitis. Reducing the dose resolved the seizures, suggesting caution with high interferon levels in pediatric cases.
Area of Science:
- Neurology
- Pediatrics
- Virology
Background:
- Subacute sclerosing panencephalitis (SSPE) is a rare, progressive neurological disorder caused by persistent measles virus infection.
- SSPE management often involves immunomodulatory therapies, including interferon-alpha.
- Intrathecal interferon-alpha administration is a recognized treatment modality for SSPE.
Observation:
- A 27-month-old boy with SSPE experienced generalized tonic-clonic seizures and high fever after receiving a high dose (6 million units/week) of intrathecal interferon-alpha.
- The seizures occurred shortly after the second administration of the escalated dose.
- EEG did not reveal epileptic discharges, and seizures ceased upon dose reduction.
Findings:
- The patient developed seizures following an increase in intrathecal interferon-alpha dosage.
- Seizures resolved completely after returning to the standard, lower interferon-alpha dose regimen.
- This case suggests a potential link between high-dose intrathecal interferon-alpha and seizure induction in pediatric SSPE.
Implications:
- High-dose intrathecal interferon-alpha may pose a risk of seizures in young children with SSPE.
- Careful dose titration and monitoring are crucial when administering intrathecal interferon-alpha to pediatric patients.
- This finding highlights the importance of individualized treatment protocols and cautious dose escalation in managing SSPE.
Abstract:
A 27-month-old boy was admitted with speech abnormality, inability to walk, and involuntary movements. He was diagnosed with subacute sclerosing panencephalitis based on clinical and laboratory findings. Inosiplex (100 mg/kg/day orally) plus intrathecal interferon-alpha (3 million units/dose twice per week) in a standard regime were given. After four doses of interferon it was prescribed as 6 million units/dose/week because he had been admitted from a remote district. One day after giving the second dose of 6 million units of interferon, two generalized tonic-clonic seizures that occurred within an hour, associated with high fever, which lasted approximately 5 minutes were observed. An antiepileptic agent was not administered because electroencephalogram results did not indicate epileptic discharges. After this condition we returned to the first treatment protocol of interferon (3 million units/dose twice per week). At the current time, he is in the fifth month of follow-up and remains convulsion-free. To the best of our knowledge, seizures as a result of high-dose intrathecal interferon in subacute sclerosing panencephalitis has not been reported in the literature. Our patient demonstrated that it is reasonable to avoid the use of high-dose intrathecal interferon-alpha in childhood.