24 August,2026 09:55 AM IST | Mumbai | Vinod Kumar Menon
SSPE remains difficult to treat because the virus is persistently embedded within the brain. Representation Pic/iStock
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 vision.
Read Also: The measles that never really left: How SSPE silently attacks the brain years later
In severe cases, the child can eventually lose the ability to walk, swallow, communicate or remain conscious. This is Subacute Sclerosing Panencephalitis (SSPE) - a rare, progressive and usually fatal neurological disease caused by persistent, altered measles virus infection in the brain.
Dr Fazal Nabi, director of paediatrics at Jaslok Hospital, in part seven of mid-day's nine-part 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. "In rare cases, the virus can persist in the brain and, years later, lead to a devastating and progressive neurological illness," the expert said.
SSPE 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. "When 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 measles," Dr Nabi said.
>> Falling school performance
>> Forgetfulness and loss of learned skills
>> Personality or behavioural changes
>> Irritability and withdrawal
>> Speech deterioration
>> Progressive cognitive decline
>> Unexplained falls or gait problems
>> Later development of myoclonic jerks
>> Seizures and other movement abnormalities
>> Visual impairment
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SSPE is commonly described clinically as a progressive four-stage disorder, although the speed and exact pattern can vary between patients.
The child may still appear physically well, but parents and teachers notice that something has changed.
>> Personality and behavioural changes
>> Declining academic performance
>> Memory problems vIrritability or mood changes
>> Loss of previously acquired abilities
>> Early speech or cognitive difficulties
This is often the stage at which diagnosis is most easily missed.
Neurological abnormalities become unmistakable.
>> Characteristic myoclonic jerks
>> Seizures
>> Worsening intellectual impairment
>> Speech deterioration
>> Gait disturbance
>> Poor coordination
>> Abnormal movements
The child progressively loses purposeful activity.
>> Rigidity and dystonia
>> Severe motor impairment
>> Loss of independent movement
>> Visual impairment
>> Increasing difficulty communicating
>> Progressive loss of interaction with the environment
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In the final stage, the patient may develop:
>> Akinetic or vegetative state
>> Severe swallowing difficulty
>> Nutritional compromise
>> Autonomic dysfunction
>> Recurrent aspiration
>> Respiratory complications
>> Loss of meaningful communication
>> Ultimately, death
SSPE 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 people.
One 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 hospital-based and therefore should not be interpreted as a national incidence estimate for India. Nevertheless, it demonstrates that SSPE continues to impose a significant neurological burden.
The findings included:
>> Mean patient age of about 16.7 years
>> Myoclonus among the most characteristic neurological manifestations
>> Frequent cognitive deterioration
>> Characteristic periodic EEG abnormalities in many tested patients. Among patients with available follow-up, 48 per cent died
>> 23.3% achieved a good functional outcome based on modified Rankin Scale criteria
Dr Fazal Nabi
Dr Fazal Nabi told mid-day, "There 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 measles-containing 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 later."
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A 2026 systematic review examining the neuroimaging spectrum of SSPE analysed 461 reported cases.
Neuroimaging was available in 456 cases, with MRI performed in 394. The review found, among other things, that:
>> 93.5% had white-matter abnormalities
>> Diffuse bilateral white-matter changes were common
>> Cortical abnormalities were also frequent
>> Cerebral atrophy was identified in a substantial proportion
>> Deep-grey-matter and brainstem abnormalities occurred less often
>> Imaging patterns could sometimes resemble other neurological diseases
The 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 disorders.
Subacute 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 stages.
However 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 care.
The 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 - particularly if there is a history of measles.
Read Also: âI cannot leave Aahan'; Mother's five-year battle caring for son with incurable SSPE
The key takeaways
>> Think SSPE when a child progressively regresses.
>> Ask about previous measles infection.
>> Look for myoclonus and characteristic EEG abnormalities.
>> Use CSF measles antibodies to support diagnosis.
>> Do not dismiss SSPE because an early MRI is normal.
>> Isoprinosine
>> Interferon-alpha
>> Ribavirin
>> Antiseizure treatment
>> Rehabilitation and nutritional support
>> Palliative care
