Epilepsia Partialis Continua as a Sequelae of Measles Infection in Children With Hematolymphoid Malignancies

Abstract

PURPOSE To share our clinical experience with the diagnosis and management of children with hematolymphoid malignancies presenting with epilepsia partialis continua (EPC) as a sequelae of measles infection. MATERIALS AND METHODS In December 2022, a series of children in our hemato-oncology unit presented with focal status epilepticus with no conclusive evidence pointing toward any underlying etiology. One such child had a typical measles rash a few weeks before the onset of this focal status epilepticus. After a series of cases with a similar presentation, a clinical pattern suspicious for measles became evident. cerebrospinal fluid polymerase chain reaction was positive for measles virus with measles immunoglobin M detected in the serum. This led to the diagnosis of measles inclusion-body encephalitis in a series of children who presented with EPC over a period of 3 months. EPC is a rare manifestation of measles that is seen only in immunocompromised patients. RESULTS Among the 18 children reported in this series, only 10 had a history of rashes. The rash was mostly transient and elicited only on retrospective history taking. Five of the 18 children who did not lose consciousness during the prolonged seizure episode survived the disease but had residual neurologic sequelae. Among the 18 children, two were unimmunized and immunization status could not be confirmed in three other children. CONCLUSION This case series highlights the threats posed by measles infection in children with cancer who are immunosuppressed because of the underlying disease and ongoing chemotherapy. Loss of herd immunity because of declining measles immunization rates secondary to vaccine hesitancy and COVID-19 lockdown pose a greater risk of measles infection and its complications for patients with deficient immune systems.

Global Immunization Crisis Amid the COVID-19 Pandemic: Implications for Pediatric Oncology

“…In the article that accompanies this editorial, Sharma et al 29 presented findings from an analysis of 18 children with leukemia, each exhibiting symptoms of ataxia, myoclonic jerks, and focal seizures. Although this outbreak was eventually identified as measles inclusion-body encephalitis, only four of these children had a documented history of the typical measles-like rash.…”

“…The identification of the clustering of patients with these symptoms and the rigorous investigation into the causative factors conducted by Sharma et al 29 are commendable. A detailed epidemiologic outbreak investigation was performed, with focused serologic and molecular confirmation of the measles infection once it was suspected.…”