SCIENTIFIC LETTER TO THE EDITOR Subacute Sclerosing Panencephalitis in a Toddler Mahesh Kamate & Ashwin Y. Belludi & S. N. Madhusudana Received: 24 September 2011 /Accepted: 1 December 2011 /Published online: 15 December 2011 # Dr. K C Chaudhuri Foundation 2011 Sir, Differential diagnoses in a clinical scenario are based mostly on the age at onset of symptoms, progression of symptoms, examination findings and the results of pre- liminary investigations. Certain diagnoses can be missed if they are not considered in the differential diagnoses. This highlights the importance of knowing the atypical presentations or rare presentations of common diseases. We here present a toddler with subacute-sclerosing- panencephalitis (SSPE) where in the early age of onset had deterred the clinicians from considering SSPE as a possibility. A developmentally normal, two-and-half year old boy, third child born to non-consanguineously married couple, started having sudden jerking of limbs involving both upper and lower limbs. There was no preceding fever or trauma. Initially the jerks were 2–4/d and then gradually increased over the next 4 mo to 2–4/h. Gradually he developed imbalance, stopped speaking and reduced interaction with parents. There was no response to full dose of valparin and clobazam. Examination revealed choreoa- thetosis and hyperreflexia in all limbs. There was no history suggestive of measles in the past and the ante- natal/peri and postnatal period were uneventful except for non-specific fever for few days in the last trimester. Electroencephalogram done 2 mo after the onset of jerks showed evidence of pseudo-periodic generalized epilep- tiform discharges. Computed tomography scan of brain was normal. In view of the clinical picture of progres- sive jerks, dementia and rapid progression, cerebrospinal fluid was sent for anti-measles antibody estimation. The cerebrospinal fluid anti-measles antibody titre of 1:625 confirmed the diagnosis of SSPE. Prognosis was explained and the child was put on anticonvulsants. Parents did not get their child for follow-up but telephonic conversation with the family physician of the patient revealed that the child died after 6 mo of diagnosis because of uncontrolled jerks and aspiration pneumonia. SSPE is a rare subacute infection of the nervous system caused by measles virus [1]. Most patients with SSPE have a history of primary measles infection at an early age (<2 y), which is followed, after a latent period of 6–8 y, by the onset of progressive neurolog- ical disorder [2]. Hence SSPE is usually considered in children who are above 5 y. SSPE that occurs before 3 y of age is rare but reported [3, 4]. Most of these children had primary measles infection at an early age either as perinatal infection or infection in the neonatal period [4]. These patients exhibit an early-onset of SSPE and rapid progressive course of the disease. Though parents of our patient did not give definite history of measles, the child might have had measles in infancy that could have been missed. Hence, in developing countries like India where measles is en- demic and SSPE cases are still reported, SSPE should be considered in the setting of progressive myoclonic epilepsy irrespective of the age. M. Kamate (*) Division of Pediatric Neurology and Child Development, Department of Pediatrics, KLE University’ s J N Medical College, Belgaum, Karnataka, India e-mail: drmaheshkamate@gmail.com A. Y. Belludi : S. N. Madhusudana Department of Neurovirology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India Indian J Pediatr (October 2012) 79(10):1384–1385 DOI 10.1007/s12098-011-0654-z