Mid-Day Special: How measles can cause a fatal brain disease years after infection

A child recovers from measles The fever disappears the rash fades and the family believes the illness is over Years later however the child may begin forgetting lessons losing previously acquired skills or behaving differently School performance deteriorates Falls become frequent Then come sudden jerking movements seizures and progressive loss of movement speech and visionRead Also The measles that never really left How SSPE silently attacks the brain years laterIn severe cases the child can eventually lose the ability to walk swallow communicate or remain conscious This is Subacute Sclerosing Panencephalitis SSPE mdash a rare progressive and usually fatal neurological disease caused by persistent altered measles virus infection in the brainDr Fazal Nabi director of paediatrics at Jaslok Hospital in part seven of middayrsquos ninepart series on SSPE highlights how the disease is a stark reminder that measles is not simply a childhood infection that ends when the fever and rash disappear ldquoIn rare cases the virus can persist in the brain and years later lead to a devastating and progressive neurological illnessrdquo the expert saidSSPE generally appears several years after the original measles infection That long interval can make the connection difficult to recognise The disease usually begins insidiously with symptoms that may initially be mistaken for behavioural psychological or educational problems ldquoWhen a child develops unexplained behavioural or cognitive regression particularly when it is followed by myoclonic jerks or seizures SSPE should be considered especially if there is a history of measlesrdquo Dr Nabi saidEarly warning signsgtgt Falling school performancegtgt Forgetfulness and loss of learned skillsgtgt Personality or behavioural changesgtgt Irritability and withdrawalgtgt Speech deteriorationgtgt Progressive cognitive declinegtgt Unexplained falls or gait problemsgtgt Later development of myoclonic jerksgtgt Seizures and other movement abnormalitiesgtgt Visual impairmentRead Also MidDay Special Bombay HC to hear PIL seeking support for SSPE patientsFour stagesSSPE is commonly described clinically as a progressive fourstage disorder although the speed and exact pattern can vary between patientsStage I mdash The hidden beginningThe child may still appear physically well but parents and teachers notice that something has changedgtgt Personality and behavioural changesgtgt Declining academic performancegtgt Memory problems vIrritability or mood changesgtgt Loss of previously acquired abilitiesgtgt Early speech or cognitive difficultiesThis is often the stage at which diagnosis is most easily missedStage II mdash Jerks seizures and neurological declineNeurological abnormalities become unmistakablegtgt Characteristic myoclonic jerksgtgt Seizuresgtgt Worsening intellectual impairmentgtgt Speech deteriorationgtgt Gait disturbancegtgt Poor coordinationgtgt Abnormal movementsStage III mdash Severe neurological disabilityThe child progressively loses purposeful activitygtgt Rigidity and dystoniagtgt Severe motor impairmentgtgt Loss of independent movementgtgt Visual impairmentgtgt Increasing difficulty communicatinggtgt Progressive loss of interaction with the environmentRead Also Seven children seven SSPE battles families left with debt grief and unanswered questionsStage IV mdash Profound neurological failureIn the final stage the patient may developgtgt Akinetic or vegetative stategtgt Severe swallowing difficultygtgt Nutritional compromisegtgt Autonomic dysfunctiongtgt Recurrent aspirationgtgt Respiratory complicationsgtgt Loss of meaningful communicationgtgt Ultimately deathWhat happens inside the brainSSPE is not simply a second episode of ordinary measles Research indicates that the virus persists inside the central nervous system in an altered form Mutations in viral proteins particularly those involved in viral assembly and release allow the virus to persist and spread from cell to cell while limiting conventional release of infectious virus The process can produce chronic inflammation neuronal injury demyelination gliosis and progressive cerebral atrophy The important distinction is that SSPE is a delayed complication of a natural measles infection it is not transmitted between peopleWhat 2025 study revealedOne of the most important recent Indian datasets was published in 2025 by researchers from AIIMS New Delhi The study examined 144 patients with SSPE providing a contemporary picture of the disease in India It found substantial variation in clinical presentation and progression while confirming the severe functional and survival burden associated with the disease The study was hospitalbased and therefore should not be interpreted as a national incidence estimate for India Nevertheless it demonstrates that SSPE continues to impose a significant neurological burdenThe findings includedgtgt Mean patient age of about 167 yearsgtgt Myoclonus among the most characteristic neurological manifestationsgtgt Frequent cognitive deteriorationgtgt Characteristic periodic EEG abnormalities in many tested patients Among patients with available followup 48 per cent diedgtgt 233 achieved a good functional outcome based on modified Rankin Scale criteriaPrevention is crucialDr Fazal NabiDr Fazal Nabi told midday ldquoThere is currently no universally effective curative treatment for SSPE The objective is to slow progression where possible control seizures and other symptoms preserve function and provide comprehensive supportive care Ensuring that children receive their recommended measlescontaining vaccines is critical to reducing risk Prevention remains our strongest weapon By preventing measles infection in the first place we can prevent the devastating neurological legacy that SSPE can leave years laterrdquoRead Also Mumbai boy with rare SSPE left bedridden as family seeks government support and medical aid2026 reviewA 2026 systematic review examining the neuroimaging spectrum of SSPE analysed 461 reported casesNeuroimaging was available in 456 cases with MRI performed in 394 The review found among other things thatgtgt 935 had whitematter abnormalitiesgtgt Diffuse bilateral whitematter changes were commongtgt Cortical abnormalities were also frequentgtgt Cerebral atrophy was identified in a substantial proportiongtgt Deepgreymatter and brainstem abnormalities occurred less oftengtgt Imaging patterns could sometimes resemble other neurological diseasesThe findings are important because SSPE does not always produce one fixed MRI appearance Imaging abnormalities can change with disease progression and some patterns may mimic other disordersThe treatment challengeSubacute Sclerosing Panencephalitis is difficult to treat because the virus is persistently embedded within the brain and conventional antiviral strategies have limited evidence Some patients may receive combinations of antiviral and immunomodulatory therapy particularly during earlier stagesHowever there is no proven cure treatment responses are inconsistent evidence comes largely from small studies and observational experience large randomised controlled trials are lacking and advanced disease is particularly difficult to reverse Supportive treatment is therefore crucial and may include seizure control physiotherapy occupational therapy swallowing assessment nutritional support aspiration prevention respiratory care and palliative careMessage for parents doctorsThe disease is rare but its early symptoms can be deceptively ordinary A previously healthy child who develops progressive loss of cognitive or behavioural abilities followed by myoclonic jerks seizures movement problems or visual deterioration warrants neurological evaluation mdash particularly if there is a history of measlesRead Also lsquoI cannot leave Aahanrsquo Motherrsquos fiveyear battle caring for son with incurable SSPEThe key takeawaysgtgt Think SSPE when a child progressively regressesgtgt Ask about previous measles infectiongtgt Look for myoclonus and characteristic EEG abnormalitiesgtgt Use CSF measles antibodies to support diagnosisgtgt Do not dismiss SSPE because an early MRI is normalCurrent therapeutic approachesgtgt Isoprinosinegtgt Interferonalphagtgt Ribaviringtgt Antiseizure treatmentgtgt Rehabilitation and nutritional supportgtgt Palliative care