Subacute sclerosing panencephalitis (SSPE) is a very rare type of encephalitis which can follow natural (wild) measles virus infection.

• ‘Subacute’ means a slow start and, usually, a gradual progression.
• ‘Sclerosing’ means a reaction which damages and scars the brain.
• ‘Pan-encephalitis’ means that all areas of the brain are affected.
• ‘Chronic Encephalitis’ means a type of encephalitis that has a slow time course.

Subacute sclerosing panencephalitis is a rare condition. It occurs in about 2 per 100,000 cases of natural measles. It occurs more often in children or young adults who were younger than two years old when they had the initial measles infection. Boys are affected more often than girls.

Symptoms and Stages of the Subacute sclerosing panencephalitis

The initial symptoms of subacute sclerosing panencephalitis can be very subtle and there are several stages. After the initial measles infection, the virus lies hidden in brain cells.

The symptoms of Subacute sclerosing panencephalitis usually start around 6-8 years after the measles infection and are related to destruction of the infected brain cells. At first, the problems noted are subtle and may be hard to spot as an illness. Usually, it begins with a change in personality and the ability to function at work, or for a child to cope with school, is altered. It may be a noticeable untidiness in handwriting, a difficulty in doing ordinary daily tasks, or a change in speech during conversation.

This can initially lead doctors to think that the child or young adult is suffering from psychological or psychiatric problems. Seizures or involuntary movements, such as jerks of the limbs (myoclonus) start, and it is often at this point that further investigations are initiated. The start of these abnormal movements forms the next phase of the illness.

Within a few months other movement problems start such as unwanted and uncontrolled movement of limbs which come and go, a gradual emergence of stiffness, and increased (spastic) muscle tone which can be more noticeable down one side of the body. As these signs emerge, there is progression of the brain deterioration, and it appears that the person is suffering from a type of dementia.  Vision, or recognizing what is seen, becomes affected by this stage.

The dementia and disability become severe, and the person affected becomes totally dependent on the family or carers for all their life. Finally, problems affecting feeding, swallowing and breathing contribute to the final stage of the illness. The patient may stay in this period for many months or even years. Death is usually caused by pneumonia. Very rarely subacute sclerosing panencephalitis comes on more quickly and progresses more rapidly, particularly if measles is caught by the infant around the time of birth. Subacute sclerosing panencephalitis can also be rapid if it appears in a mother during pregnancy.

Diagnosis

Doctors should consider subacute sclerosing panencephalitis in a child or young adult who presents with a dementia-like illness, especially if they develop seizures or their vision is affected. Brain scans may be normal in the early phase, but eventually some changes affecting certain parts of the brain (the cerebral cortex, deep nuclei and white matter) can be detected on magnetic resonance imaging (MRI) scans.

If the diagnosis is suspected, the level of specific measles antibodies (measles IgG) can be measured in the cerebrospinal fluid (CSF) and blood. A lumbar puncture is needed to obtain the spinal fluid. Parts of the measles virus (RNA) can also be detected in the CSF. The high levels of the measles IgG in the spinal fluid help to confirm the diagnosis.

In the early stages of the illness an electroencephalogram (EEG) may be performed. This looks at brain wave activity. The findings on an EEG can be suggestive of subacute sclerosing panencephalitis with characteristic patterns of wave forms being noted. These are not seizures in themselves but show a disturbance of the normal electrical activity in the brain caused by the disease process.

Allopathic treatment for subacute sclerosing panencephalitis

If treat with allopathy, most of those affected die within about five years of diagnosis. Allopathic antiviral agents and a medication called Interferon Alpha may alter the effects of the illness when given as a long-term treatment. Immunoglobulins (intra veins) and plasmapheresis (cleaning the blood of inflammatory chemicals) have also been reported to have some benefit.

There is interest in the problem of disturbed immunity and how it might be reversed but no clear treatment has yet emerged. Another approach considered is to inhibit or suppress the persisting measles virus by stopping the virus’ genetic material (RNA) building proteins needed for the virus to survive. Other allopathic medications have not been demonstrated to have any significant effects on the disease course and unfortunately, large scale trials cannot be undertaken due to the rarity of the disease. Despite initial improvements or a slowing in progression, the disease eventually resumes its course, and no cure has been reported up to this time with allopathic drugs. Sometimes patients can die as a result of complications related to the allopathic treatments themselves.

Seizures can be very troublesome and don’t respond well to any allopathic treatment. In Allopathic treatment, it’s only possible to control the symptom to somehow improve patient’s quality of life. Anticonvulsant (medication to stop fits) drugs can be helpful for controlling seizures. Other medications can be used to relax stiff muscles. Patients will ultimately require feeding via a nasogastric tube or a gastrostomy (tube directly into the stomach from the abdominal).

The main part of allopathic management is a coordinated approach to care, by the allopathic health professionals, once the condition is recognized. With a multidisciplinary approach much can be done to relieve discomfort, support nutrition and daily care. In this situation, patients, and their family will need emotional and practical support. It is recommended that early referral to a psychologist, social worker, palliative care team and hospice is offered.

Homeopathic treatment for the Subacute Sclerosing Panencephalitis

Homeopathically there are a number of remedies that can cure central nervous system infections, measles and subacute sclerosing panencephalitis in any stage and in any age, here are few of those medicines:

Helleborus Niger

Sensorial depression. Sees, hears, tastes imperfectly. General muscular weakness, which may go on to complete paralysis, accompanied by dropsical effusions. Low states of vitality and serious disease. Sinking sensation. State of effusion in hydrocephalus. Mania of a melancholy type. Slow in answering. Thoughtless; staring. Involuntary sighing. Complete unconsciousness. Picks lips and clothes.

Head: Forehead wrinkled in folds. Stupefying headache. Rolls head day and night; moaning, sudden screams. Bores head into pillow; beats it with hands. Dull pain in occiput, with sensation of water swashing inside. Headache culminates in vomiting. Eyeballs turn upwards, squinting, vacant look. Pupils dilated. Eyes wide open, sunken. Night blindness.

Face Wrinkled. Neuralgia on left side; parts so tender he cannot chew.  Automatic motion of one arm and leg. Parkinson’s disease. Limbs heavy and painful. Stretching of limbs. Sudden screams in sleep. Sporous sleep. Cri encephalique. Cannot be fully aroused.

Morbillinum

Catarrh. Coryza. Cough. Ear affections. Eye affections. Measles. Skin affections. The well-known symptoms which characterize an attack of measles may all be taken as guides for its homoeopathic use. Its chief use hitherto has been as a prophylactic against infection, and to clear up aftereffects of an attack.

My own use of it has been confined to the 200th and higher. As a prophylactic given to those who are, or may be, exposed to infection, a dose of the 200th twice or thrice daily. For an attack of the disease, I find nothing better than Morbillinium-200, eight or ten globules in six ounces of water, a dessertspoonful every two hours.

The effect of this is heightened by giving alternately Belladona 200 in the same way. These two medicines will be sufficient to carry through any uncomplicated case.

Belladonna

Belladonna acts upon every part of the nervous system, it has a marked action on the vascular system, skin and glands. Belladonna always is associated with hot, red skin, flushed face, glaring eyes, throbbing carotids, excited mental state, hyperesthesia of all senses, delirium, restless sleep, convulsive movements, dryness of mouth and throat with aversion to water, neuralgic pains that come and go suddenly. Heat, redness, throbbing and burning.

Great children’s remedy. Epileptic spasms followed by nausea and vomiting. Measles. Scarlet fever and also prophylactic. Exophthalmic goiter. Corresponds to the symptoms of “airsickness” in aviators. Give as preventive. Sleeplessness, with drowsiness.

Eyes feel swollen and protruding, staring, brilliant; conjunctiva red; dry, burn; photophobia; shooting in eyes. Tearing pain in middle and external ear. Humming noises. Membrana tympani bulges and injected. Parotid gland swollen. Sensitive to loud tones. Hearing very acute. Otitis media. Pain causes delirium. Barking cough, whooping cough, with pain in stomach. A high feverish state with comparative absence of toxemia. Burning, pungent, steaming, heat. Feet icy cold. Superficial blood-vessels, distended. Perspiration dries only on head. No thirst with fever.

Calcarea Carbonica

Forgetful, confused, low-spirited. Anxiety with palpitation. Obstinacy: slight mental effort produces hot head. Averse to work or exertion. Sense of weight on top of head. Subacute Sclerosing Panencephalitis. Headache, with cold hands and feet. Vertigo on ascending, and when turning head. Headache from overlifting, from mental exertion, with nausea. Head feels hot and heavy, with pale face. Icy coldness in, and on the head, especially right side. Open fontanelles: head enlarged; much perspiration, wets the pillow. Itching of the scalp. Scratches head on waking. Photophobia. Farsightedness. Dilation of pupils. Tinnitus and/or cracking sounds in ears. Deafness.

Ignatia Amara

Subacute Sclerosing Panencephalitis. Changeable mood; introspective; silently brooding. Melancholic, sad, tearful. Not communicative. Sighing and sobbing. After shocks, grief, disappointment. Head feels hollow, heavy; worse, stooping. Headache as if a nail were driven. Cramp-like pain over root of nose. Congestive headaches following anger or grief. Asthenopia, with spasms of lids and neuralgic pain about eyes. Flickering zigzags. Twitching of muscles of face and lips (myoclonus). Changes color when at rest.

Thuja Occidentalis

Fixed ideas, as if a strange person were at his side; as if soul and body were separated; as if something alive in abdomen. Emotional sensitiveness; music causes weeping and trembling. Headache as if pierced by a nail. Neuralgia from tea. Ciliary neuralgia; iritis. Subacute Sclerosing Panencephalitis. Eyelids agglutinated; dry, scaly. Styes and tarsal tumors. Acute and subacute inflammation of sclera. Sclera raised in patches, and looks bluish red. Large, flat phlyctenules; indolent. Recurring episcleritis. Chronic scleritis. Chronic otitis. Creaking when swallowing. Polypi.

Chronic catarrh; thick, green mucus; blood and pus. On blowing nose, pain in teeth. Ulceration within the nostrils. Dryness of nasal cavities. Painful pressure at root. Tip of tongue very painful. White blisters on side close to root. Teeth decay next to gums; very sensitive; gums retract. Drinks fall audibly into stomach. Ranula; varicose veins on tongue and mouth. Pyorrhea alveolaris.

Vareliolinum

Delirium with the initial fever. Vertigo. Syncope in attempting to rise. Forehead very hot, face red and bloated, carotids pulsating violently. Headache – all over head; particularly in forehead; severe in vertex; severe lancinating, throbbing. Intolerable pain in occiput. Subacute Sclerosing Panencephalitis. Crazy feeling through brain. Keratitis, with small-pox and after vaccination. Chronic ophthalmia with loss of sight. Pupils contracted.

Deafness. Skin of face and neck deep dark-purple hue. Jaw falling when asleep, with trembling when aroused. Teeth covered with thick brown slime. Thick, dirty yellow coating on tongue. When asleep tongue protruded, black coating, when raised it is with difficulty drawn back; looks like a mass of putrid flesh. Throat very sore, redness of faucets. Pharynx and faucets deep purplish crimson, with gangrenous appearance; breath horribly offensive. Painful deglutition. Diphtheria with horrible fetor orris.

Aurum Metallicum

Melancholy, with inquietude and desire to die. Irresistible impulse to weep. Hopeless. Suicidal; desperate. Excessive scruples of conscience. Despair of oneself, and of others. Ill-humor and aversion to conversation. Grumbling, quarrelsome humor. Alternate peevishness and cheerfulness. Anger and passion. Alternation of gaiety, or of irritability with melancholy. Hypochondriacal humor. Weakness of the intellectual faculties. Weakness of the memory. Subacute Sclerosing Panencephalitis.

Vertigo: when stooping, on rising, when walking in open air. Fatigue from intellectual labor. Sudden stupefaction, with loss of sense. Pain in the brain and sometimes inducing confusion of ideas. Congestion of blood to the head. Congestions to and heat in the head, sparks before the eyes, and glossy bloatedness of the face. Buzzing in the head. Pain in the bones of the cranium. Pain in the eyes aggravated by touch. Tension in the eyes, with diminution of sight. Black spots before the eyes. Flames and sparks before the eyes. Vertical half-sight. Hemiopia. Objects seem smaller and more distant.

Hearing too sensitive. Caries of the mastoid process. Oversensitive to noises. Hardness of hearing. Embarrassed speech. Humming/tinnitus in the ears. Roaring in the ears. Inflammation of the bones of the face. Parotids swollen and painful. Traction in the jaws. Tongue swollen; with scirrhous-like hardness; after biting tongue in sleep.

Tuberculinium

Mania and melancholia, insomnia and sopor. Irritable, especially when awakening. Depressed, melancholy. Fear of dogs. Animals especially. Desire to use foul language, curse and swear.

Deep brain headaches and intense neuralgias. Everything seems strange. Meningitis. Nocturnal hallucinations, awakes frightened. Plica polonica. Persistent, offensive otorrhea. Perforation in membrana tympani, with ragged edges.

Phosphorus

Produces a picture of destructive metabolism. Irritation, inflammation and degeneration of mucous membranes, irritates and inflames spinal cord and nerves (paralysis), destroyed bones, especially the lower jaw and tibia; vascular inflammation, causing fatty degeneration in blood vessels and every tissue and organ of the body. Hemorrhages and hematogenous jaundice. Subacute Sclerosing Panencephalitis.

Lowness of spirits. Easily vexed. Fearfulness, hallucination. Clairvoyant state. Great tendency to start. Over-sensitive to external impressions. Loss of memory. Low memory. Paralysis of the insane. Ecstasy. Dread of death when alone. Brain feels tired. Insanity, with an exaggerated idea of one’s own importance. Excitable, produces heat all over. Restless, fidgety. Hypo-sensitive, indifferent.

Vertigo of the aged, after rising, faintness. Heat comes from spine. Neuralgia: parts must be kept warm. Burning pains. Chronic congestion of head. Brain-fag, with coldness of occiput. Cataract. Black points seem to float before the eyes. Patient sees better by shading eyes with hand. Fatigue of eyes and head. Green halo about the light. Letters appear red. Atrophy of optic nerve. Partial loss of vision from abuse of tobacco. Pain in orbital bones. Paresis of extrinsic muscles. Diplopia, due to deviation of the visual axis. Amaurosis from sexual excess. Glaucoma. Thrombosis of retinal vessels and degenerative changes in retinal cells. Degenerative changes where soreness and curved lines are seen in old people. Retinal trouble with lights and hallucination of vision.

Hearing difficult, especially to human voice. Re-echoing of sounds. Over-sensitive smell. Foul imaginary odors. Blue rings under eyes. Hippocratic countenance.

Hepar Sulphuricum

Ulcers on cornea. Iritis, with pus in anterior chamber; purulent conjunctivitis, with marked chemosis, profuse discharge. Otitis media, discharge of fetid pus from the ears. Whizzing and throbbing in the ears, with hardness of hearing. Deafness after measles and/or scarlet fever. Pustules in auditory canal and auricle. Mastoiditis. Subacute Sclerosing Panencephalitis.

Putrid ulcers, surrounded by little pimples. Smallpox. Measles. Herpes circinate. Constant offensive exhalation from the body.

Anguish in the evening and night, with thoughts of suicide. The slightest cause irritates. Dejected and sad. Ferocious. Hasty speech. Vertigo and headache, when shaking the head or riding – boring pain. Objects appear red and too large. Vision obscured by reading; field reduced one-half. Bright circles before eyes. Hypopyon.

Neuralgia of right side of face, extending in streak into temple, ear, alae, and lip. Pains in bones of face, especially when being touched.

Mercurius Corrosive

Delirium, stupor. Frontal pain, congestion of head with burning in cheeks. Drawing pain in periosteum of skull. Excessive photophobia. Face swollen., red, puffy. Lips black, swollen. Sores. Facial neuralgia. Aphonia.

Sulphur

A best anti-viral. Its action is centrifugal-from within outward. Subacute Sclerosing Panencephalitis. Very forgetful. Difficult thinking. Delusions: thinks rag beautiful things-that he is immensely wealthy. Busy all the time. Childish peevishness in grown people. Irritable. Affections vitiated; very selfish, no regard for others. Religious melancholy. Averse to business; loafs-too lazy to arouse himself. Imagining giving wrong things to people, causing their death. Always irritable, depressed, thin and weak, even with good appetite.

Beating headache; worse, stooping, and with vertigo. Tinea capitis. Halo around light. Heat and burning in eyes. Black motes before eyes. Whizzing in ears. Oversensitive to odors. Deafness, preceded by exceedingly sensitive hearing, catarrhal deafness. Imaginary foul smells. Jerks through teeth. Swelling of gums; throbbing pain. Trembling of hands. Drawing and tearing in arms and hands. Stiffness of knees and ankles. Cannot walk erect; stoop shouldered.

Lycopodium Clavatum

Melancholy; afraid to be alone. Little things annoy, extremely sensitive. Averse to undertaking new things. Head strong and haughty when sick. Loss of self-confidence. Hurried when eating. Subacute Sclerosing Panencephalitis. Constant fear of breaking down under stress. Apprehensive. Weak memory, confused thoughts; spells or writes wrong words and syllables. Failing brainpower. Cannot bear to see anything new. Cannot read what he writes. Sadness in morning on awaking.

Shakes head without apparent cause. Twists face and mouth. Pressing headache on vertex. Vertigo in morning on rising. Day-blindness. Night-blindness. Gaz palsy – sees only one-half of an object. Otorrhea and deafness with or without tinnitus; after scarlatina. Humming and roaring with hardness of hearing; every noise causes peculiar echo in ear.

Sense of smell very acute. Grayish-yellow color of face, with blue circles around eyes. Withered, shriveled, and emaciated; copper-colored eruption. Dropping of lower jaw. Heaviness of arms. Tearing in shoulder and elbow joints. Limbs go to sleep. Twitching and jerking.

Graphite

Great tendency to start. Timid. Unable to decide. Want of disposition to work. Fidgety while sitting at work. Music makes weep. Apprehensive, despondency, indecision.

Headache in morning on waking, mostly on one side, with inclination to vomit. Sensation of cobweb on forehead and/or on face. Feels numb and pithy. Rheumatic pains on one side of head, extending to teeth and neck. Burning on vertex. Cataleptic condition. Ophthalmia, with intolerance of artificial light. Hears better in noise. Hardness of hearing. Hissing in the ears. Detonation in ear like report of a gun. Smell abnormally acute; cannot tolerate flowers. Subacute Sclerosing Panencephalitis. Pain in nape of neck, shoulders and back and limbs. Spinal pains. Pain in small of back with great weakness. Excoriation between thighs. Left hand numb; arms feel asleep; finger-nails thick, black, and rough, matrix inflamed.

Aconitum Napellus

A state of fear, anxiety; anguish of mind and body. Physical and mental restlessness, fright, is the most characteristic manifestation of Aconite. Acute, sudden, and violent invasion, with fever. Does not want to be touched. Sudden and great sinking of strength. Inflammations. Inflammatory fevers. Serous membranes and muscular tissues affected. Burning in internal parts; tingling, coldness and numbness. Tension of arteries (inflammation); emotional and physical mental tension explain many symptoms.

Pulsatilla Pratensis

Weeps easily. Timid, irresolute. Fears in evening to be alone, dark, ghost. Likes sympathy. Children like fuss and caresses. Easily discouraged. Morbid dread of the opposite sex. Religious melancholy. Given to extremes of pleasure and pain. Highly emotional. Wandering stitches about head; pains extend to face and teeth; vertigo; better in open air. Headache from overwork. Hearing difficult. Otorrhea. Subacute Sclerosing Panencephalitis.

Loss of smell. Right-sided facial neuralgia, with profuse lachrymation. Swelling of lower lip, which is cracked in middle. Prosoplasia towards evening till midnight; chilly, with pain. Drawing, tensive pain in thighs and legs, with restlessness, sleeplessness and chilliness. Pain in limbs, shifting rapidly; tensive pain, letting up with a snap. Numbness around elbow. Hip-joint painful. Knees swollen, with tearing, drawing pains. Boring pain in heels toward evening; suffering worse from letting the affected limb hang down.

Bryonia Alba

Children dislike being carried or raised. Physical weakness, all-pervading apathy. Complaints apt to develop slowly. Exceedingly irritable; everything puts him out of humor. Delirium; wants to go home; talks of business. Vertigo, nausea, faintness on rising, confusion. Bursting, splitting headache. Drawing in bones towards zygoma. Headache; worse on motion, even of eyeballs. Frontal headache, frontal sinuses involved.

Painful stiffness in nape of neck. Stitches and stiffness in small of back. Constant motion of left arm and leg.

Arsenicum Album

Subacute Sclerosing Panencephalitis. Great anguish and restlessness. Changes place continually. Fears, of death, of being left alone. Great fear, with cold sweat. Thinks it useless to take medicine. Suicidal. Hallucinations of smell and sight. Despair drives him from place to place. Miserly, malicious, selfish, lacks courage. General sensibility increased. Sensitive to disorder and confusion.

Hemicrania, with icy feeling of scalp and great weakness. Sensitive head in open air. Delirium tremens; cursing and raving; vicious. Head is in constant motion. Parkinson’s disease. Intense photophobia; better external warmth. Ciliary neuralgia, with fine burning pain. Roaring in ears, during a paroxysm of pain. Weakness in small of back. Drawing in of shoulders. Pain and burning in back.

Extremities trembling, twitching, spasms, weakness, heaviness, uneasiness. Cramps in calves. Swelling of feet. Sciatica. Burning pains. Peripheral neuritis. Diabetic gangrene. Paralysis of lower limbs with atrophy.

Apis Mellifica

Apathy, indifference, and unconsciousness. Awkward; drops things readily. Stupor, with sudden sharp cries and starting. Subacute Sclerosing Panencephalitis. Stupor alternating with erotic mania. Sensation of dying. Listless; cannot think clearly. Jealous, fidgety, hard to please. Sudden shrill, piercing screams. Whining. Tearfulness. Jealously, fright, rage, vexation, grief. Cannot concentrate mind when attempting to read or study.

Whole brain feels very tired. Vertigo with sneezing, worse on lying or closing eyes. Heat, throbbing, distensile pains, better on pressure, and worse on motion. Sudden stabbing pains. Dull, heavy sensation in occiput, accompanied with sexual excitement. Bores head into pillow and screams out. Conjunctiva bright red, puffy. Lachrymation hot. Photophobia. Sudden piercing eye pains. Pain around orbits. Numbness of hands and tips of fingers. Hives with intolerable itching.

Rhus Toxicodendron

Listless, sad. Thoughts of suicide. Extreme restlessness, with continued change of position. Delirium, with fear of being poisoned. Sensorium becomes cloudy. Great apprehension at night, cannot remain in bed. Vertigo when rising. Heavy head. Brain feels loose and as if struck against skull on walking or rising. Scalp sensitive; worse on side lain on. Jaws crack when chewing. Easy dislocation of jaw. Swollen face, erysipelas. Cheek bones sensitive to touch. Parotitis. Facial neuralgia, with chilliness.

Hot, painful swelling of joints. Pains tearing in tendons, ligaments, and fasciae. Limbs stiff paralyzed. Pain along ulnar nerve. Sciatica. Numbness and formication. Paralysis; trembling after exertion. Tenderness about knee joint. Loss of power in forearm and fingers; crawling sensation in the tips of fingers. Tingling in feet. Adynamic; restless, trembling.

P. S: This article is only for doctors having good knowledge about Homeopathy and allopathy, for learning purpose(s).

For proper consultation and treatment, please visit our clinic.

None of above-mentioned medicine(s) is/are the full/complete treatment, but just hints for treatment; every patient has his/her own constitutional medicine.

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Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.

  Senior research officer at Dnepropetrovsk state medical academy Ukraine.

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