A 27-year-old man presented to the outpatient clinic to establish routine neurologic care. He has a history of measles infection at age 4 months with full clinical resolution. At age 9, he developed encephalitis which manifested with frequent seizures, imbalance, left hemiparesis, and falls. His neurologic exam deteriorated rapidly over 6 months. He exhibited severe cognitive and language impairment, and was completely wheelchair-dependent due to left hemiplegia. Laboratory testing revealed a 1:16 CSF and 1:256 serum measles titer with a positive measles IgG index. A diagnosis of SSPE was made and he was initiated on combination therapy with daily oral isoprinosine and intrathecal interferon-α every two weeks.
The patient demonstrated marked clinical improvement throughout the first 4 years and has since plateaued. He has residual mild cognitive and language impairment, but is independent in activities of daily living. He has persistent mild left hemiparesis but does not require any gait assistance. His epilepsy is well-controlled on lacosamide and medical cannabis in addition to vagal nerve stimulation.