Myoclonus　is brief, involuntary twitching of a　muscle　or group of muscles, may be mistaken as tics and has been described with SSPE [1]. Tics are characterized by abrupt, repetitive movements, commonly preceded by premonitory sensation of an urge and can be suppressed with effort [2]. Tourette syndrome is most frequent cause of tics, others are insults to the brain; particularly the basal ganglia, infection, stroke, head trauma, certain toxins, drugs and various sporadic, genetic, neurodegenerative disorders [2]. Differential diagnosis of childhood cognitive deterioration and movement disorders like Wilsons disease, childhood systemic lupus erythematosus, hypoparathyroidism, Hallervorden Spatz disease and progressive myoclonic epilepsy were excluded due to lack of clinical, laboratory and imaging findings.

Previously reported atypical features of SSPE include isolated psychiatric manifestations, poorly controlled seizures, stroke like onset, hemiparesis, acute encephalopathy, cerebellar ataxia, visual disturbances, symptoms suggestive of intracranial space occupying lesion and parkinsonism like features [3-5]. While this association may be coincidental, but the possibility of tics as a result of insult to the brain due to SSPE should be kept in mind.

Acknowledgment: Dr Kaberi Basu, Professor, Department of Pediatrics for helping to diagnose and manage the case.

1. Bonthius DJ, 　Stanek N,　Grose C. Subacute sclerosing panencephalitis, a measles complication, in an internationally adopted child. Emerging Infectious Dis. 2000;6:377-81.

2. Mejia NI, Jankovic J. Secondary tics and tourettism. Rev Bras Psiquiatr. 2005;27:11-7.

3. Sarkar N, Gulati S, Dar L, Broor S, Kalra V. Diagnostic dilemmas in fulminant subacutesclerosingpanencephalitis (SSPE). Indian J Pediatr. 2004;71:365-7.

4. Dimova P, Bojinova V. Sub acute sclerosinpanen-cephalitis with atypical onset: clinical computed tomography and magnetic resonance imaging correlations. J Child Neurol. 2000;15:258-60.