title: Clinical and epidemiological characteristics of subacute sclerosing panencephalitis in Bulgaria during the past 25 years (1978-2002).
abstract: The aims of the present study are to establish the subacute sclerosing panencephalitis (SSPE) incidence in Bulgaria for the 25-year period 1978-2002; to analyze the SSPE incidence prior to, and in the period of, routine measles immunization; and, to analyze the clinical characteristics of SSPE. SSPE was diagnosed in a total of 40 children; 28 of were diagnosed between 1978 and 1984, and 12 between 1995 and 2002. Thirty-eight cases (95%) were non-immunized and have had an early measles infection (mean age 16 months). The SSPE onset occurred primarily between 8 and 11 years of age (52.5%) with a mean latent period of about 7 years after the measles infection. After the 10-year disease-free period (1985-1994), the SSPE incidence increased between 1995 and 2002 because of the 1991-1992 measles epidemic. During the period 1995-2002 children with earlier measles infection and earlier SSPE onset predominated, compared to the period 1978-1984. The initial clinical manifestations included intellectual deterioration in 35%, extrapyramidal hyperkinesias in 29%, epileptic seizures in 15%, hemiparesis in 10%, and visual disturbances in 10% of the cases. Nine children (22.5%) demonstrated an atypical onset. A rapidly progressive course was observed in 4 children (10%) and a chronic progressive course with pseudoremissions over 2 years-in 8 cases (20%). Our analysis of the SSPE incidence in Bulgaria for the 25-year period (1978-2002) supports the importance of early measles infection as a crucial risk factor for this persistent neuroinfection. Moreover, it confirms the role of routine measles immunization in SSPE prevention.
authors.affiliation: Clinic of Child Neurology, 'St Naum' University Hospital of Neurology and Psychiatry, 1, Luben Roussev Street, 1113 Sofia, Bulgaria. tchamov@bulinfo.net
authors.forename: Veneta S
authors.initials: VS
authors.lastname: Bojinova
authors.forename: Petia S
authors.initials: PS
authors.lastname: Dimova
authors.forename: Liliana D
authors.initials: LD
authors.lastname: Belopitova
authors.forename: Assen S
authors.initials: AS
authors.lastname: Mihailov
authors.forename: Nina L
authors.initials: NL
authors.lastname: Gatcheva
authors.forename: Zaphira G
authors.initials: ZG
authors.lastname: Mihneva
authors.forename: Maria T
authors.initials: MT
authors.lastname: Hristova
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D017668:Age of Onset; D002031:Bulgaria / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008457:Measles / Q000453:epidemiology; D008458:Measles Vaccine; D012189:Retrospective Studies; D013344:Subacute Sclerosing Panencephalitis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*
chemical_list: D008458:Measles Vaccine