ABSTRACT

Subacute Sclerosing Panencephalitis (SSPE) is a progressive neurological disorder of children and young adults which commonly affects the central nervous system. Neurological disorders are diseases of the central and peripheral nervous systems. The brain and Spinal Cord are surrounded by tough membranes which are further enclosed in the skull and spinal vertebrae. It is a highly complex part of the body which coordinates the actions and sensory information and transmits its signals from one part to another part of the body. The nerves which transmit signals from the brain are known as Efferent nerves, which transfer the nerves to CNS (Central nervous system) are afferent nerves. There are two types of cells in the nervous system- Neurons and Glial cells. CNS (Central nervous system) is enclosed and protected by the meninges which is a three-layered system of membranes and the tough outer layer is Dura Mater. Nervous system is the main command centre which controls the movements, thoughts and automatic response. In this article, we are going to discuss its causes, symptoms and its ayurvedic aspect in detail.

INTRODUCTION

Subacute Sclerosing Panencephalitis (SSPE) is a rare complication due to an infection of Measles (Rubeola). It is a progressive Neurological disorder characterized by the inflammation of the brain (Encephalitis). It is commonly known as Dawson Disease which primarily affects children and it is estimated about 2 in 10,000 people with measles develop SSPE. It appears months or years later which causes mental deterioration, seizures and jerks of muscles. It usually develops 2-10 years after the initial viral attack. Measles remain endemic in many countries due to poor access to vaccinations. Subacute Sclerosing Panencephalitis is a single-stranded RNA virus of the Paramyxoviridae family which can be transmitted through aerosols and develops various complications, is a slow and persistent viral infection which are related mainly to measles.

PATHOPHYSIOLOGY

• The person who directly gets infected with measles causes SSPE, which has the strains of the tri-residue motif and has increased motility to spread.
• Measles has a tropism for lymphocytes in the lower respiratory tract and in epithelial cells of the upper respiratory tract.
• The virus infects the immune system cells within the respiratory tract which carry the infection to lymph nodes.
• The lymphatic system, various organs and tissue when infected through the fusion of cells causes the formation of Syncytium which is known as Warthin-Finkeldey Cells.  
• When the epithelial cells get destroyed via infections so the cells get sloughed off via cough and sneezing leading to allowing airborne transmission of the virus to another host.
• The typical immune response to infection usually starts with T-Helper 1 cells which release interferon alpha and IL-2.
• These Cytokines are helpful in eliminating viral infections from cells.
• It is due to the poor cellular response of immunity.
• The actual Mechanism is the Infection of CNS, where CD46 and Protein F play an important role in the entry of neurons.

HISTOPATHOLOGY

• Between 1933-1934 Dawson Investigated various cerebral lesions with several cellular inclusions.
• In 1960, electron microscopy the paramyxovirus was found within the lesions of SSPE patients.
• This disease includes the inflammation of both meninges and cerebral tissue with scattered demyelination neurons and support cells which contain various inclusion bodies and loss of neurons.
• The early stage shows the infection of the Central Nervous System which causes cellular swelling and damage to the genetic material
• Lipid Peroxidation causes demyelination in the early course which has an inflammatory phase in oligodendrocytes and neurons.
• Neurofibrillary Tangles have been found in the cases of SSPE (Subacute-Sclerosing panencephalitis).
• RNA from measles is isolated in various parts such as in Brain, Eyes, and spinal cord in patients with SSPE.

STAGES

• Stage 1- It includes personality/behavioral changes such as dementia, irritability and regression of speech. This stage lasts for 6 months. 
• Stage 2- It is made up of declination in motor functions which include symptoms- Dyskinesia, Dystonia and Myoclonus.
• Stage 3- It includes the progression to extrapyramidal symptoms which have symptoms of spasticity and Posturing. In this stage the complication starts which results in blindness or death.
• Stage 4- It develops due to a persistent vegetative state, akinetic mutism and autonomic failure. Occurs in the final stage during which breathing, heart rate and blood pressure are usually affected.

CAUSES

• Generally, the measles virus does not cause any damage to the brain.
• But due to the abnormal response of the immune system to the virus, it forms various mutant variations which further cause inflammation of the brain (irritation/ swelling) which usually lasts for many years.
• Single-stranded RNA Virus which is highly contagious is transmitted from one infected individual.

CLINICAL PRESENTATION

It is present with progressive Neuropsychological deterioration which consists of various personality changes such as Ataxia, myoclonus, seizures and coma.

• Early symptoms include- Poor performance in School, temper outbursts, Hallucinations and poor sleep.
• Various Unexpected Muscular jerks of the arms, head and body which finally cause Seizures together with Uncontrollable muscle movements. The speech and eyesight continue to deteriorate.
• When muscles become rigid and swallowing becomes difficult and further results in Pneumonia.
• In the final phases, the body temperature rises and there is abnormal pulse pressure.

DIAGNOSIS

• Brain Biopsy
• CSF Finding
• MRI (Magnetic resonance imaging)- shows decreased grey matter volume and Atrophy with ventriculomegaly.
• Magnetic Resonance Spectroscopy
• Spinal Tap
• Serum antibody titer
• EEG (Electroencephalogram)
• CT SCAN (Computed tomography)

TREATMENT

• Treatment factors include in reduction of symptoms, if the diagnosis is made during phase 1 it is possible to treat with Oral Isoprinosine (Inosiplex) and Intraventricular Interferon Alfa.
• Ribavirin (a nucleotide analogue)
• Antiepileptics used for controlling seizures

VACCINATIONS FOR MEASLES

1. It prevents SSPE from developing and the vaccination for measles is very safe and effective to prevent initial infections.
2. It should be separated into 2 doses, one dose at the age of 12-15 months and the second dose between 3-5 years of age.
3. It should not be immunosuppressed.

DIFFERENTIAL DIAGNOSIS

• Viral Encephalitis
• Autoimmune Encephalitis
• NMDA receptor encephalitis
• Atypical Multiple Sclerosis
• Neoplasms
• Paraneoplastic Syndrome

AYURVEDIC ASPECT

Ayurveda is one of the oldest forms of Holistic medicine which is used widely all over the world. Ayurveda focuses on the healing of the body which further states that it is a ‘Science of  Life’. In ayurveda, imbalances in the tridoshas are responsible for emotional, Mental and Physiological health. Mainly in SSPE (Subacute sclerosing Panencephalitis) mainly Vata doshas are affecting the various movements in the body and nervous system activities. Whenever there is an imbalance in Vata doshas, it results in various diseases. These doshas move in all the minute channels of the body and due to their nature gets aggravated along with Pitta and Kapha doshas which get displaced from their normal pathway and throw them at the abnormal path of the body and causes diseases. Mainly Avarana is a unique concept which is mainly seen in Vata disorders, as it encloses the doshas. This causes obstruction in Vata and disorders are known as Avaran Janya Vyadhi. In Vata-related disorders, Prana Vata is associated with the Head (brain).

HERBS USEFUL IN SSPE (SUBACUTE SCLEROSING PANENCEPHALITIS)

1. Ashwagandha

Ashwagandha (Withania somnifera) is a most potent ayurvedic herb which is helpful in the healing system. It is helpful in strengthening the immune system. Balances tridoshas of the body especially Kapha and Vata doshas. Improves the mass of the body and provides proper nourishment. Has anti-inflammatory properties and is well known for its nervine tonic which pacifies the nervous system and manages sleep disorders in many people.

2. Tagar

Tagar (Valeriana wallichii) is helpful in providing strength and promoting overall immunity. Is a great Vata, Kapha pacifier and is a great appetizer which is helpful in relaxing the muscles and calms the overall nervous system of the body. Reduces stress and anxiety which maintains overall neurological disorders. It is a good diuretic and improves various infertility conditions.

3. Brahmi

Brahmi (Bacopa monnieri) is helpful in balancing Vata and Kapha doshas. It is helpful in improving strength and immunity which are helpful in neurological disorders. It is used to influence the cells of the brain by promoting the regeneration of cells in the brain. Rejuvenates the mind and enhances memory. Is helpful in the digestive system which promotes proper digestion and prevents gastric ulceration.

4. Gandhak

Gandhak (Sulphur) is helpful in balancing tridoshas of the body and has various properties such as Anti-bacterial, Anti-viral. Has blood-purifying properties which reduce itching and improve the complexion of the skin. Possess the property of enhancing the immunity of the body and is beneficial in urinary tract disorders. Cures malabsorption syndrome and is an efficient wound healer and pain reliever.

HERBAL REMEDIES FOR SSPE (SUBACUTE SCLEROSING PANENCEPHALITIS) BY PLANET AYURVEDA

Planet Ayurveda is a trustworthy herbal pharmaceutical brand whose products are used by people in various parts of the world and not only in India. The products which are prepared and formulated here are pure, herbal and vegetarian which are free from any preservatives, chemicals, dyes and fillers. The products which are manufactured are under the Supervision of M.D Ayurvedic doctors which are as formulated as per Ayurvedic Principles. Numerous Acute and Chronic diseases are treated by herbal remedies of Planet ayurveda which are prescribed by our Ayurvedic Doctors. For Subacute Sclerosing Panencephalitis, Planet Ayurveda provides a combination of medicines which helps the natural management of the disease and prevents its further progression.

PRODUCTS LIST

1. Tab. Gandhak Rasayan
2. Neurogenie Capsules
3. Cap. Boswellia Curcumin
4. Cap. Gotu Kola
5. Cap. Indian Valeriana

Herbal Remedies For SSPE (Subacute Sclerosing Panencephalitis)

PRODUCTS DESCRIPTION

1. Gandhak Rasayan

Gandhak Rasayan are herbal tablets which are made by planet ayurveda using Shuddh Gandhak (Sulphur). It acts as a natural blood purifier and manages skin disorders. Has antibacterial properties which prevent burning sensation and skin redness. Improves the overall health of the body and supports various kidney and stomach issues. Increase the immunity of the body and is helpful in fighting against infections.

Dosage- 2 tablets twice daily after meals with plain water.

2. NeuroGenie

NeuroGenie are polyherbal Capsules which are formulated by planet Ayurveda using Brahmi (Bacopa monnieri) and Ashwagandha (Withania Somnifera). It is helpful in the treatment of Insomnia and improves memory and mental power. Has anti-diarrheal properties which aid digestion and improve absorption. Controls the Vata doshas which nourishes the neurons and organs to function properly.

Dosage- 2 capsules twice daily after meals with plain water.

3. Boswellia-Curcumin

Boswellia curcumin are polyherbal Capsules which are made by planet ayurveda using Shallaki (Boswellia serrata) and Curcumin (Curcuma longa). It is helpful in maintaining overall health and well-being. Supports healthy joints and relieves morning stiffness. Rich in antioxidants and has Neuroprotective activity which supports the movement of joints.

Dosage- 1 capsule twice daily after meals with plain water.

4. Gotu Kola Capsules

Gotu Kola is a single herbal Capsule which is manufactured by planet Ayurveda using a Standardized extract of Gotu Kola (Centella Asiatica). It is helpful in the treatment of all neurological disorders which calms the mind and has bacterial and Viral Infections. Helpful in the healing of wounds and burns. Supports healthy mental functioning and acts as an anti-anxiety agent.

Dosage- 2 Capsules twice daily after meals with plain water.

5. Indian Valeriana

Indian Valeriana is a single herbal Capsule which is made by planet ayurveda using a standardized extract of Tagar (Valeriana Wallichii). It is helpful in calming the mind and body which provides relief from stress and anxiety. Manages the blood pressure and relaxes the central nervous system. Manages muscle pain and has antispasmodic and analgesic properties.

Dosage- 1 capsule twice daily after meals with plain water.

CONCLUSION

Subacute Sclerosing Panencephalitis (SSPE) is a progressive neurological disorder of children and young adults which commonly affects the central nervous system. The nerves which transmit signals from the brain are known as Efferent nerves, which transfer the nerves to CNS (Central nervous system) are afferent nerves. Subacute Sclerosing Panencephalitis (SSPE) is a rare complication due to an infection of Measles (Rubeola). It is a progressive Neurological disorder characterised by the inflammation of the brain (Encephalitis). Mainly in SSPE (Subacute sclerosing Panencephalitis) mainly Vata doshas are affecting the various movements in the body and nervous system activities. Prana Vata is associated with the Head (brain). This causes obstruction in Vata and disorders are known as Avaran Janya Vyadhi. Further, we will discuss herbal supplements from Planet Ayurveda for SSPE (Subacute sclerosing panencephalitis) which are helpful in this without causing any side effects.