Nonconvulsive status epilepticus and decreased frontal glucose metabolism in a case with SSPE

Abstract

We report a 9-year-old boy with atypical presentation of subacute sclerosing panencephalitis (SSPE). He was admitted due to staring spells and cognitive deterioration. Electroencephalography (EEG) demonstrated bilaterally symmetrical, synchronous, frontal sharp-and-slow wave discharges in 80% of the record. Diazepam or midazolam administration during EEG recording attenuated the sharp-and-wave discharges, but revealed no periodic complexes. Magnetic resonance imaging delineated bilateral frontal T2-weighted hyperintense foci. Fluorodeoxyglucose-positron emission tomography imaging indicated bilaterally decreased glucose metabolism in frontal cortex. The other laboratory tests including measles antibody in cerebrospinal fluid and serum suggested no specific etiology. Interestingly, a month later, the previously detected sharp-and-slow wave discharges disappeared, and periodic slow-wave paroxysms appeared on EEG recording. Measles antibody titers showed seroconversion and confirmed the diagnosis of SSPE. The present case suggests that clinicians be cautious while excluding SSPE.

Keywords

SSPE - nonconvulsive status epilepticus - PET