Seizure spectrum in children with subacute sclerosing panencephalitis: a cross-sectional study from a tertiary care center

Naveed Anjum; Faisal Zafar; Muhammad Tariq Aziz; Arif Zulqarnain; Aysha Fayyaz; Amir Hanif

doi:10.56310/pjns.v21i01.478

Naveed Anjum The Children’s Hospital & Institute of Child Health, Multan https://orcid.org/0000-0001-6145-8144
Faisal Zafar The Children’s Hospital & Institute of Child Health, Multan
Muhammad Tariq Aziz The Children’s Hospital & Institute of Child Health, Multan
Arif Zulqarnain The Children’s Hospital & Institute of Child Health, Multan
Aysha Fayyaz The Children’s Hospital & Institute of Child Health, Multan
Amir Hanif The Children’s Hospital & Institute of Child Health, Multan

DOI: https://doi.org/10.56310/pjns.v21i01.478

Keywords: Electroencephalography, Myoclonic seizures, Seizure spectrum

Abstract

Background and Objective:

Subacute sclerosing panencephalitis (SSPE) is a progressive and fatal neurodegenerative disorder caused by persistent infection of the central nervous system with a mutated measles virus. The objective of this study was to describe the spectrum and electroclinical characteristics of seizure types in children with SSPE.

Methods:

This retrospective observational study was conducted at a tertiary-care pediatric neurology center in Pakistan from January 2020 to December 2025. Children aged 2–14 years fulfilling modified Dyken’s criteria for SSPE were included. Clinical records, electroencephalography (EEG), and laboratory data were reviewed. Seizure semiology and electroclinical features were analyzed, and seizures were classified according to the International League Against Epilepsy 2017 criteria.

Results:

A total of 125 children were analyzed (male: female ratio 3:1; mean age 7.1 ± 2.8 years). Myoclonic seizures were most frequent (52.8%), followed by movement disorder–associated paroxysmal events in the form of dystonia (21.6%), generalized tonic–clonic seizures (13.6%), atonic seizures (5.6%), and focal seizures (4.0%). EEG showed no focal or lateralized epileptiform activity; rather, all patients exhibited generalized periodic high-amplitude slow-wave complexes, frequently time-locked with myoclonic jerks. Seizures were frequent and pharmacoresistant, with sustained seizure control achieved in only 6.4% of patients. Severe postictal impairment was observed in 65.6% of cases.

Conclusion:

Children with SSPE exhibit a distinctive epileptic phenotype dominated by myoclonic and dystonic posturing with characteristic EEG correlates. Early recognition of these patterns aids diagnosis, while effective measles immunization remains the only proven preventive strategy.