Teresa Binstock
Researcher in Developmental & Behavioral Neuroanatomy
March 05, 2009
[Diligent readers are encouraged to read two important MMR papers
(cites 13-14).]
During the last 10 years or so, various researchers have considered
that some cases of MMR-related autism may be an atypical variant of
SSPE, otherwise known as subacute sclerosing panencephalitis (1).
Evidence consistent with this possibility is increasing.
A recently published study described atypical SSPE in a child with
Acute Disseminated Encephalomyelitis (2; ADEM). Importantly, ADEM can
be induced by the MMR, as admitted by the Vaccine Court in regard to a
child who developed PDD, one of the Autism-Spectrum Disorders (3). The
new SSPE finding (2) is not the only report of ADEM being linked with
SSPE and with demyelination (eg, 4-11). If an infant or toddler has
hyper-inflammatory alleles (12) or impaired immunity, increased risk
towards ADEM, atypical SSPE, and an ASD seems biologically plausible.
References
1. SSPE overview
http://en.wikipedia.org/wiki/Subacute_sclerosing_panencephalitis
2. Subacute Sclerosing Panencephalitis (SSPE) Presenting as Acute
Disseminated Encephalomyelitis in a Child.
Goraya JS et al. J Child Neurol. 2009 Feb 9. [Epub ahead of
print] PMID: 19204320
Subacute sclerosing panencephalitis (SSPE) typically presents with
progressive mental deterioration, behavioral changes, and myoclonic
jerks. Atypical presentations are not unknown and may result in
diagnostic delays. A 9-year-old girl presented with poor balance and
ataxia following an episode of upper respiratory tract infection.
Neurological examination revealed mild hemiparesis and ataxia. Brain
magnetic resonance imaging revealed scattered areas of T2 and
fluid-attenuated inversion recovery hyperintensities in the white
matter consistent with acute disseminated encephalomyelitis.... Later
during the course of her illness, subacute sclerosing panencephalitis
was suspected from the appearance of burst-suppression pattern on
electroencephalogram, and the diagnosis confirmed by elevated titers of
measles antibodies in cerebrospinal fluid. Physicians taking care of
children need to be aware of atypical presentations of subacute
sclerosing panencephalitis and must have a high index of suspicion to
prevent diagnostic delays and avoid unnecessary diagnostic and
therapeutic interventions.
3. ADEM --> PDD/ASD
Another ruling in the US vaccine court
Melanie Phillips, The Spectator
http://www.spectator.co.uk/melaniephillips/3395891/another-ruling-in-the-us-vaccine-court.thtml
4. PubMed Search:
Acute AND Disseminated AND Encephalomyelitis AND sspe
5: Involvement of morbilliviruses in the pathogenesis of demyelinating
disease.
Rev Med Virol. 2007 Jul-Aug;17(4):223-44. PMID: 17410634
6: Subacute sclerosing panencephalitis presenting as acute disseminated
encephalomyelitis.
Indian J Pediatr. 2006 Dec;73(12):1119-21. PMID: 17202644
7: Subacute sclerosing panencephalitis presenting as acute disseminated
encephalomyelitis: a case report.
J Neurol Sci. 1997 Feb 27;146(1):13-8. PMID: 9077490
8: Immune responses during measles virus infection.
Griffin DE. Curr Top Microbiol Immunol. 1995;191:117-34. PMID: 7789155
The characteristic disease features of measles--fever and rash--are
associated with the immune response to infection and are coincident
with virus clearance. MV-specific antibody and CD4 and CD8 T cell
responses are generated and contribute to virus clearance and
protection from reinfection. During this same phase of immune
activation immunologic abnormalities are also apparent. There is a
generalized suppression of cellular immune responses that may
contribute to increased susceptibility to other infections. Autoimmune
disease may appear in the form of acute disseminated encephalomyelitis.
If virus-specific immune responses are inadequate infection may
progress with pulmonary or CNS manifestations, but without a rash. The
pathogenesis of the rare disease SSPE, that occurs many years after
primary infection is not clear, but immune responses show increased
antibody to measles and cellular immune responses similar to those seen
after uncomplicated infection.
9: Delayed acute measles inclusion body encephalitis in a 9-year-old
girl: ultrastructural, immunohistochemical, and in situ hybridization
studies.
Mod Pathol. 1992 May;5(3):348-52. PMID: 1353879
10: Magnetic resonance imaging of inflammatory and demyelinating
white-matter diseases of childhood.
Dev Med Child Neurol. 1990 Feb;32(2):97-107. PMID: 2338183
11: Measles and the central nervous system.
Lancet. 1983 Dec 17;2(8364):1406-10. PMID: 6140503
12. Vaccination policy lags behind vaccine science
Teresa Binstock, Dec 2007
http://ravenintellections.typepad.com/from_the_desk_of_teresa_b/2007/12/vaccination-pol.html
13. Measles, mumps, rubella vaccine: through a glass,
darkly.
Wakefield AJ, Montgomery SM.
Adverse Drug React Toxicol Rev. 2000 Dec;19(4):265-83; discussion
284-92.
14. The Seat of the
Soul; The Origins of the Autism Epidemic
Andrew Wakefield
Presented at Carnegie Mellon University, 11-17-05
http://www.whale.to/v/wakefield.pdf
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