Measles – neurological complications of the disease. What do they look like and how often do they occur?

I usually like to start an article by introducing the reader to the topic by some clinical case. Maintaining medical secrecy and, of course, not revealing the so-called sensitive data that could allow the identification of the patient. I am talking about a situation in which I had the privilege of leading a patient with the disease in question. This allows me not only in practice, but also through education on the Internet, to use the knowledge extended thanks to patient care. I believe that this helps the recipients to stimulate empathy, better “empathize” with the patient’s ailments and understand the described disease. In addition, it is simply more pleasant to read then.

Due to the lack of the so-called lacquer, sometimes I start with a life story. After all, not every disease under the sun has happened to me in my work. It will also be such an article. In the case of measles, if the current trend in vaccine “freedom” continues, it could unfortunately change quickly.

A disease that was not supposed to be

In the video for the campaign of the Chief Sanitary Inspector #zaszszczieniBbezpieczni Dr. hab. Maria Pokorska-Śpiewak, MD, Ph.D. tells how presently students, when they come to classes, are happy to “see patients with measles”, seeing its rich symptomatology. I was one of those students who, as it says in this movie, “a few years ago” (in my case it is about 10 years) only studied measles, literally and figuratively, theoretically. And since all the lecturers told us that we would probably not see such a patient, I must admit that I did not pay much attention to remembering her symptoms, nor was I worried when, due to this ignorance, I got a point or two less on the test. After all, the clinic matters, right? Diseases that I will see and treat. You need to know these. As you can see, the concept of time is actually relative, because at least in the case of measles, time likes to go backwards. Whether they like it or not, doctors must educate themselves about diseases… which they were never meant to treat again.

Patients, on the other hand, most often have not heard of severe complications of these supposedly “mild childhood diseases”. Except for probably those whose families, unfortunately, it happened. Something is still breaking through to the media about flu complications, but measles? And it’s neurological? And probably everyone is aware that the mere clustering of the words “complications” and “neurological” does not sound good …

Also read: Measles is one of the most contagious diseases and there is no cure for it. “We are worried about the children the most”

So what can cause measles in the nervous system?

1. Acute encephalitis:

  1. may appear in the period of fading of the rash;
  2. occurs in about 1: 1000 patients;
  3. in about 1/4 it leaves permanent neurological defects;
  4. mortality 10-15%

2. Postinfection encephalitis (PIE):

  1. it is a diffuse encephalitis with multiple foci of perivascular inflammation and demyelination, that is, the destruction of the surrounding nerve fibers of the myelin;
  2. sometimes of the nature of hemorrhagic necrosis.

3. Measles-inclusion body encephalitis (MBIE).

4. Subacute sclerosing panencephalitis (SSPE): the most serious complication of measles, which is mainly discussed in this article.

Not that rare

Some textbooks today state that SSPE is rare – 1: 100. illnesses or even less frequently. Most sources now reduce this value to 1: 1700-3000 cases. However, as early as 2016, scientists from the University of California reported that among children who contracted SSPE before the age of 1, the disease is as high as 1: 600! Since children at this age are not yet vaccinated against measles, this is doubly alarming.

The average age of onset is 12 years, but it is recorded at the age of 3 and 30.

Also read: Record increase in measles incidence. Viruses reach Poland from beyond the eastern border

Not right away, nice not right away

The beginning of the SSPE is tricky. Usually, several to several years after contracting measles (but even a month or 27!), Sleep and memory disorders, difficulties with concentration, learning problems, depression, mood changes or headaches appear. Initially, they are easy to underestimate, to make a completely different diagnosis or to be overlooked. Then, the progressive dementia processes are joined by muscle jerks (myoclonus), convulsions and visual disturbances, including blindness. The next stage is increasing stiffness, movement and balance disorders. Sometimes, in the course of complications, the patient dies at this stage. The last stage is problems with breathing, heart function and maintaining normal blood pressure, coma and death of the patient.

It is true that the literature gives 5-10 percent. remission – whether spontaneous or after intrathecal (into the spinal canal) administration of inferferon-alpha in the first stage of the disease (treatment itself may cause neurological complications). However, in other cases SSPE will inevitably lead to death. Most often in 1-2 years. Sometimes the course is very quick (death within 3 months of diagnosis) and slower, when death occurs even after 10 years of the disease.

Diagnostics for diagnosis

Considering the current therapeutic possibilities (or rather the lack of them), diagnosis is made for the sake of diagnosis and an increasingly truer picture of statistical data. Subacute sclerosing encephalitis is mainly suspected in unvaccinated measles children and young adults with dementia and neuromuscular disorders. The cerebrospinal fluid shows an increased concentration of anti-measles antibodies, a rather characteristic EEG image, and MRI of the head most often shows cortical atrophy and / or changes in the subcortical white matter in the posterior poles of the hemispheres. In doubtful cases, a brain biopsy is sometimes performed. Cowdry A intranuclear inclusions can be found in the neurons and oligodendrocytes collected in this way, which is of diagnostic importance. The problem, however, is that they are not unique to the SSPE.

Save yourself who can

Currently, compulsory and free measles vaccination (in the form of MMR vaccine for measles, mumps and rubella) is given at 13-15 months of age and at 10 years of age as a booster dose. They are also recommended:

  1. adults unvaccinated in childhood;
  2. people who have only received 1 dose in the past;
  3. women of reproductive age (especially if they work with children, e.g. kindergarten teachers, teachers, doctors, nurses or registrars in health care institutions).

However, there is a large group of people who cannot get vaccinated:

  1. allergic to neomycin;
  2. allergic to gelatin;
  3. people after a severe anaphylactic reaction to the previous dose (allergic reactions are 1: 200 – 1 million doses administered);
  4. haematological patients (e.g. with leukemia or lymphoma);
  5. immunodeficient patients (including those treated with high doses of corticosteroids, e.g. after transplants);
  6. people after blood or plasma transfusion or administration of human immunoglobulin preparations (for 3-11 months);
  7. patients with an infection with high fever;
  8. pregnant women;
  9. children up to a minimum of 6 months of age, although the standard number in the vaccination schedule is 13 months.

Also read: 35 deaths from measles in Europe in the last 12 months. It could have been avoided

For our freedom and yours

Much is said about freedom in the context of vaccination. Unfortunately forgetting that, as Alexis de Tocqueville wrote, “human freedom ends where the freedom of another begins”. And the freedom of another person is also his right to stay healthy. By vaccinating ourselves or our children, we not only protect the vaccinated person, but by eliminating the circulation of the virus in society, those who do not have such “freedom”. My son is still waiting for his measles vaccination. Apart from vaccinating myself and the people who come into contact with him most often, there is nothing else I can do. It can only educate – hence this article.

Besides, not only he is unvaccinated. Recently, I talked to another young mother who envied me that in a few months I would be able to have my son vaccinated. Her Antek cannot receive part of the vaccinations, and the rest is delayed.

I realize that in these very rare cases of serious vaccine complications for the family it bears, it is a whole world and an unimaginable drama. However, is it due to the fact that in 0,5 percent car accidents happen to a car fire and seat belts can make it difficult to get out of a burning car, will we all stop wearing them?

In the case of infectious diseases, as a society, we play in one team. If it falls apart, the only thing left for little Antek is a lucky clover.

Please visit www.drdudziak.pl, where you can read, among others on early symptoms of brain tumors and where I post a series of articles on headaches, and to follow my profile http://www.instagram.com/drdudziak.

Source: doktorekradzi.pl

You haven’t been able to find the cause of your ailments for a long time? Do you want to tell us your story or draw attention to a common health problem? Write to the address [email protected] #Together we can do more

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