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What Causes Seizures After Having Anti-rabies Vaccination?
Question: Timeline and Current Symptoms 21/06/2015
Took a booster shot of anti-rabies (Rabipur 2 shots) after playing with a pet dog (the dog did not attack or bite me but there was a cut with some bleeding). Last shot was on 26th April.
Nine days later, on 5th May, just after midnight, I had a tonic-clonic convulsion just after falling asleep. Before going to sleep I smelt burning rubber and even asked my wife if she smelt it too(she didn’t). Acc to my wife, 10-15-30 mins later(not sure as I have no memory of the event), I was at the foot of my daughter’s bed and was convulsing. My wife tells me that there was some (but not a lot) saliva coming out of my mouth. There was no urination. After regaining consciousness I realized that I had bit my tongue in the front not the side. (1st neuro found it atypical..he said it is generally on the side). Also, I had a very bad headache in my crown (neuro called it postictal headache) which went away after 4-5 days. I have no personal or family history of seizures (febrile or epileptic)
I had venous brain MRI done the next morning which was normal. In the evening I had a lot of bloodwork and an EEG done and both were normal. Neuro said that Rabipur could lead to ADEM but since MRI was clear that didn’t seem to be the case. He asked me to start with KEPPRA 750 mg and continue on it for 3 yrs.
I went for a second opinion to the neuro who conducted my EEG. He said that since I had no family history and no prior seizures, I should wait for a second episode before actually starting the medicine. He asked me to rest and avoid driving for 3 months. So I decided to wait.
The very next day following the seizure, I started experiencing humming/buzzing sound and slight giddiness whenever I would get up. I also noticed that this would happen whenever I would get up after lying down any time of the day. The humming+giddiness would go away in a minute. In a few days, this humming then got louder and was accompanied by a throbbing sensation in my ear (like pressure going up and down) and giddiness. After a week, the throbbing went away on its own but the humming has since become permanent.
I went to my ENT when the humming and giddiness started and he diagnosed it as Tinnitus. He also did an Audiometry test which showed mild hearing loss, especially in the right ear. The ENT said that Tinnitus + giddiness could be either because of an infection, or because of DAMAGE TO THE CRANIAL NERVE or idiopathic. I am currently on Vertin 16mg and a folic acid supplement which has reduced the giddiness somewhat but has had no effect on the Tinnitus which has become permanent.
Around 8-10 days after the seizure (about 17-19 days after the vaccine), I started to have extreme back pain out of nowhere. The neuro asked me to get an X-ray of the dorsal spine which was normal. I did a 5 day course of tramadol when the back pain went away but it came back in full force after I finished the course. It too has become permanent (it varies in intensity from day to day).
10 days after the seizure, I also started having pins and needles sensations in my legs. Initially, I would experience only this when I was sitting. I also started having muscle twitches randomly a few times a day. One fine day (not very sure when), I woke up to find my left hand fully asleep. Since then the tingling/pins and needles/numbness increased a lot. I also started getting A LOT muscle twitching all over my body.
In the last 1-2 weeks, the numbness/tingling in my hands and legs has increased a lot. I also get shooting pains in my hand/leg that come and go away. Whenever, I pick something up, my hands start to pain immediately. Climbing stairs (only 2-3 stories) leads to a lot of leg cramping, discomfort and shooting pain. The rigidity in my hands causes difficulty in typing (for example) and makes it very difficult for me to lift anything for an extended period of time. I have also rarely experienced tingling on the right side of my forehead. I also wake up with a lot of numbness in my hands everyday. In the last 2 days, I have noticed a lot of numbness in my right leg and it moves in an “irregular” fashion when I walk.
Since then, I have tried to find whether the vaccine had anything to do with the seizure and the symptoms that I have suddenly started experiencing. I scoured the VAERS database which records adverse events after vaccine use in the United States. These are reported by public health authorities and physicians. I found 63 cases of tonic clonic seizures in adults (25-44) who had no history of epilepsy or seizures and had their first seizure 0-20 days following RABIPUR. The number of first time convulsions after ALL Rabies vaccines was over 300. Some of those 63 cases also listed tingling in the arms and legs and muscle twitching as symptoms.
I have also found literally hundreds of cases of tingling, cramping and muscle twitching 2-3 weeks after vaccine use (mostly flu but also tetanus and rabies). most of these cases settled down after 6-18 months but some were eventually diagnosed as CIDP etc. While reactions after vaccines are very rare and most doctors (including the ones I went to) laugh when you mention the vaccine. The reality is that vaccine reactions do happen and when they happen they often result in autoimmunity and nerve damage. They are noticed more in the West because they have mandatory and repetitive vaccination for adults which is not the case in XXXXXXX
My Neuro agrees that I had some sort of autoimmune/hyper immune reaction to the vaccine. He also told me that muscle twitching is a common feature of motor neuron disease but he also clarified that it doesn’t mean that I have it and he wants me to wait and see what happens. However this has scared me a lot. I have also read that tingling, muscle weakness and muscle twitching can be due to CIDP. My family doctor feels I have developed peripheral neuropathy as part of the vaccine reaction and it will take a few months to a year to go away.
Took a booster shot of anti-rabies (Rabipur 2 shots) after playing with a pet dog (the dog did not attack or bite me but there was a cut with some bleeding). Last shot was on 26th April.
Nine days later, on 5th May, just after midnight, I had a tonic-clonic convulsion just after falling asleep. Before going to sleep I smelt burning rubber and even asked my wife if she smelt it too(she didn’t). Acc to my wife, 10-15-30 mins later(not sure as I have no memory of the event), I was at the foot of my daughter’s bed and was convulsing. My wife tells me that there was some (but not a lot) saliva coming out of my mouth. There was no urination. After regaining consciousness I realized that I had bit my tongue in the front not the side. (1st neuro found it atypical..he said it is generally on the side). Also, I had a very bad headache in my crown (neuro called it postictal headache) which went away after 4-5 days. I have no personal or family history of seizures (febrile or epileptic)
I had venous brain MRI done the next morning which was normal. In the evening I had a lot of bloodwork and an EEG done and both were normal. Neuro said that Rabipur could lead to ADEM but since MRI was clear that didn’t seem to be the case. He asked me to start with KEPPRA 750 mg and continue on it for 3 yrs.
I went for a second opinion to the neuro who conducted my EEG. He said that since I had no family history and no prior seizures, I should wait for a second episode before actually starting the medicine. He asked me to rest and avoid driving for 3 months. So I decided to wait.
The very next day following the seizure, I started experiencing humming/buzzing sound and slight giddiness whenever I would get up. I also noticed that this would happen whenever I would get up after lying down any time of the day. The humming+giddiness would go away in a minute. In a few days, this humming then got louder and was accompanied by a throbbing sensation in my ear (like pressure going up and down) and giddiness. After a week, the throbbing went away on its own but the humming has since become permanent.
I went to my ENT when the humming and giddiness started and he diagnosed it as Tinnitus. He also did an Audiometry test which showed mild hearing loss, especially in the right ear. The ENT said that Tinnitus + giddiness could be either because of an infection, or because of DAMAGE TO THE CRANIAL NERVE or idiopathic. I am currently on Vertin 16mg and a folic acid supplement which has reduced the giddiness somewhat but has had no effect on the Tinnitus which has become permanent.
Around 8-10 days after the seizure (about 17-19 days after the vaccine), I started to have extreme back pain out of nowhere. The neuro asked me to get an X-ray of the dorsal spine which was normal. I did a 5 day course of tramadol when the back pain went away but it came back in full force after I finished the course. It too has become permanent (it varies in intensity from day to day).
10 days after the seizure, I also started having pins and needles sensations in my legs. Initially, I would experience only this when I was sitting. I also started having muscle twitches randomly a few times a day. One fine day (not very sure when), I woke up to find my left hand fully asleep. Since then the tingling/pins and needles/numbness increased a lot. I also started getting A LOT muscle twitching all over my body.
In the last 1-2 weeks, the numbness/tingling in my hands and legs has increased a lot. I also get shooting pains in my hand/leg that come and go away. Whenever, I pick something up, my hands start to pain immediately. Climbing stairs (only 2-3 stories) leads to a lot of leg cramping, discomfort and shooting pain. The rigidity in my hands causes difficulty in typing (for example) and makes it very difficult for me to lift anything for an extended period of time. I have also rarely experienced tingling on the right side of my forehead. I also wake up with a lot of numbness in my hands everyday. In the last 2 days, I have noticed a lot of numbness in my right leg and it moves in an “irregular” fashion when I walk.
Since then, I have tried to find whether the vaccine had anything to do with the seizure and the symptoms that I have suddenly started experiencing. I scoured the VAERS database which records adverse events after vaccine use in the United States. These are reported by public health authorities and physicians. I found 63 cases of tonic clonic seizures in adults (25-44) who had no history of epilepsy or seizures and had their first seizure 0-20 days following RABIPUR. The number of first time convulsions after ALL Rabies vaccines was over 300. Some of those 63 cases also listed tingling in the arms and legs and muscle twitching as symptoms.
I have also found literally hundreds of cases of tingling, cramping and muscle twitching 2-3 weeks after vaccine use (mostly flu but also tetanus and rabies). most of these cases settled down after 6-18 months but some were eventually diagnosed as CIDP etc. While reactions after vaccines are very rare and most doctors (including the ones I went to) laugh when you mention the vaccine. The reality is that vaccine reactions do happen and when they happen they often result in autoimmunity and nerve damage. They are noticed more in the West because they have mandatory and repetitive vaccination for adults which is not the case in XXXXXXX
My Neuro agrees that I had some sort of autoimmune/hyper immune reaction to the vaccine. He also told me that muscle twitching is a common feature of motor neuron disease but he also clarified that it doesn’t mean that I have it and he wants me to wait and see what happens. However this has scared me a lot. I have also read that tingling, muscle weakness and muscle twitching can be due to CIDP. My family doctor feels I have developed peripheral neuropathy as part of the vaccine reaction and it will take a few months to a year to go away.
Brief Answer:
Possibly related to vaccine reaction.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted the detailed description of your symptoms, in chronological order and the fact that you received anti-rabies vaccine. I appreciate your detailed description and your research/insights into your illness.
In my opinion, I agree that your neurological symptoms are possibly related to the anti-rabies vaccine. They are often due to an enhanced/abnormal immune response to the vaccine.
Symptoms suggest involvement of various parts of central and peripheral nervous systems- seizures/headache (brain), tinnitus (auditory nerve), tingling and numbness (peripheral nerves). This could be given a name of acute disseminated encephalomyelitis (ADEM), however, MRI is often abnormal in ADEM. I agree MRI of spine has not been done yet.
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is unlikley, as we need at least three months of symptoms to diagnose CIDP, and brain is not involved (seizures do not occur) in CIDP.
Similarly, motor neuron disease (MND) is unlikely, as seizures, tingling, numbness, tinnitus, etc are not seen in MND.
So, in summary, the most likely diagnosis in your case is post-vaccinial ADEM.
Further work up should include MRI of spine, repeat MRI of brain (as initial MRI may be normal in some patients), nerve conduction studies and lumbar puncture.
Treatment wise, you should receive a course of methylprednisolone injections.
I hope it helps.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Possibly related to vaccine reaction.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted the detailed description of your symptoms, in chronological order and the fact that you received anti-rabies vaccine. I appreciate your detailed description and your research/insights into your illness.
In my opinion, I agree that your neurological symptoms are possibly related to the anti-rabies vaccine. They are often due to an enhanced/abnormal immune response to the vaccine.
Symptoms suggest involvement of various parts of central and peripheral nervous systems- seizures/headache (brain), tinnitus (auditory nerve), tingling and numbness (peripheral nerves). This could be given a name of acute disseminated encephalomyelitis (ADEM), however, MRI is often abnormal in ADEM. I agree MRI of spine has not been done yet.
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is unlikley, as we need at least three months of symptoms to diagnose CIDP, and brain is not involved (seizures do not occur) in CIDP.
Similarly, motor neuron disease (MND) is unlikely, as seizures, tingling, numbness, tinnitus, etc are not seen in MND.
So, in summary, the most likely diagnosis in your case is post-vaccinial ADEM.
Further work up should include MRI of spine, repeat MRI of brain (as initial MRI may be normal in some patients), nerve conduction studies and lumbar puncture.
Treatment wise, you should receive a course of methylprednisolone injections.
I hope it helps.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sir, thanks for your prompt reply and sorry for the length of my post but I had to include everything as clearly as possible.
The current neuros that I go to say that you cannot get ADEM 6-7 weeks post vaccination. Pls advise.
Also I have read that both gbs cidp and other pns autoimmune conditions can rarely have cns involvement. Is this possible in my case. Also is the same possible with mnd?
In any case should I repeat my brain MRI with the spinal MRI?
The current neuros that I go to say that you cannot get ADEM 6-7 weeks post vaccination. Pls advise.
Also I have read that both gbs cidp and other pns autoimmune conditions can rarely have cns involvement. Is this possible in my case. Also is the same possible with mnd?
In any case should I repeat my brain MRI with the spinal MRI?
Brief Answer:
ADEM is the most likely.
Detailed Answer:
Thank you for getting back.
I would not get into what others said! (They are entitled to their opinions).
Among the possible diagnoses, ADEM is the most likely, and it can occur in the time frame mentioned by you.
Seizures do not occur in GBS, CIDP, etc, as only PNS can be involved in them (brain can never get involved in a PNS disease). If it does, then, the term changes to ADEM. (GBS+seizures= ADEM)
Yes, you should get MRI brain and spine (with contrast) done
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
ADEM is the most likely.
Detailed Answer:
Thank you for getting back.
I would not get into what others said! (They are entitled to their opinions).
Among the possible diagnoses, ADEM is the most likely, and it can occur in the time frame mentioned by you.
Seizures do not occur in GBS, CIDP, etc, as only PNS can be involved in them (brain can never get involved in a PNS disease). If it does, then, the term changes to ADEM. (GBS+seizures= ADEM)
Yes, you should get MRI brain and spine (with contrast) done
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sir I called up the bombay hospital EMG/NCS center. They want the following
1. A doctor's note
2. which limbs to be tested (2 or 4)
3. possible diagnosis (so that they can setup the test accordingly).
Also, I have no idea which EMG/NCS centre in XXXXXXX has the latest equipment. Sir, If you know anything about this...pls let me know and I will go there.
While i will get both the MRI's done ...is the contrast MRI required... I have read that there is a small chance of reactions with the contrast XXXXXXX that is injected and I am currently extremely wary of any such thing happening as you would understand...pls let me know.
Lastly, if the seizure was related to an autoimmune condition...is it more likely that it was a one-off episode and I will not develop chronic epilepsy?
1. A doctor's note
2. which limbs to be tested (2 or 4)
3. possible diagnosis (so that they can setup the test accordingly).
Also, I have no idea which EMG/NCS centre in XXXXXXX has the latest equipment. Sir, If you know anything about this...pls let me know and I will go there.
While i will get both the MRI's done ...is the contrast MRI required... I have read that there is a small chance of reactions with the contrast XXXXXXX that is injected and I am currently extremely wary of any such thing happening as you would understand...pls let me know.
Lastly, if the seizure was related to an autoimmune condition...is it more likely that it was a one-off episode and I will not develop chronic epilepsy?
Brief Answer:
My replies are below:
Detailed Answer:
Thank you for getting back.
1. Nerve conduction studies of all four limbs are required to exclude a diagnosis of peripheral neuropathy/radiculoneuropathy. It can be done at any good Neurology facility.
2. You can go for non-contrast MRI of brain and spine first. If any abnormality is found, then, the contrast injection may be given.
3. Possibly, the seizure would be one-off phenomenon, and the chances of it becoming chronic epilepsy is remote.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
My replies are below:
Detailed Answer:
Thank you for getting back.
1. Nerve conduction studies of all four limbs are required to exclude a diagnosis of peripheral neuropathy/radiculoneuropathy. It can be done at any good Neurology facility.
2. You can go for non-contrast MRI of brain and spine first. If any abnormality is found, then, the contrast injection may be given.
3. Possibly, the seizure would be one-off phenomenon, and the chances of it becoming chronic epilepsy is remote.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Sir,
Brain MRI was normal
Spine screening MRI was normal
cervical spine normal,
dorsal spine = posterior bulge of D7-D8, D8-D9 and D9-D10 discs however not causing significant cord compression (no obvious signal abnormality seen in the cervical cord)
Lumbar spine = posterior bulge of the L5-S1 disc indenting the thecal sac
Conclusion : No significant abnormality is detected in the brain parenchyma
No obvious signal abnormality is seen within the spinal cord.
Sir, I have quoted from the MRI report.
Also, The NCS/EMG was normal
No doctor is ready to give me a note for a spinal tap..
Pls let me know what I should do next.
Also...do my symptoms (weakness in hands and legs, back pain, twitching, tingling) sound like a developing or sub-acute form of Transverse Myelitis???
Pls let me know what you think. Neuro here told me that TM would show up on the spinal MRI...but my query is can the symptoms preceede the spinal lesion/abnormality?
In any case sir, pls let me know what you think and what I should do next
Regards
Brain MRI was normal
Spine screening MRI was normal
cervical spine normal,
dorsal spine = posterior bulge of D7-D8, D8-D9 and D9-D10 discs however not causing significant cord compression (no obvious signal abnormality seen in the cervical cord)
Lumbar spine = posterior bulge of the L5-S1 disc indenting the thecal sac
Conclusion : No significant abnormality is detected in the brain parenchyma
No obvious signal abnormality is seen within the spinal cord.
Sir, I have quoted from the MRI report.
Also, The NCS/EMG was normal
No doctor is ready to give me a note for a spinal tap..
Pls let me know what I should do next.
Also...do my symptoms (weakness in hands and legs, back pain, twitching, tingling) sound like a developing or sub-acute form of Transverse Myelitis???
Pls let me know what you think. Neuro here told me that TM would show up on the spinal MRI...but my query is can the symptoms preceede the spinal lesion/abnormality?
In any case sir, pls let me know what you think and what I should do next
Regards
Brief Answer:
You should go for symptomatic treatment.
Detailed Answer:
Thank you for getting back.
I am glad to note that the MRIs of brain and spine, as well as NCS are within normal limits and there is no evidence of transverse myelitis or ADEM.
Transverse myelitis is an acute illness and the maximum severity is reached within a day to a few days. So, in your case, it is highly unlikely.
We can wait for the spinal tap.
At this stage, I would feel that no further investigations are ready. We should follow your clinical symptoms and investigate only if symptoms worsen.
You can take symptomatic treatment.
In any case, post-vaccinial reactions are one-time (monophasic) illness, and we expect slow recovery over time, rather than progression or worsening in future.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
You should go for symptomatic treatment.
Detailed Answer:
Thank you for getting back.
I am glad to note that the MRIs of brain and spine, as well as NCS are within normal limits and there is no evidence of transverse myelitis or ADEM.
Transverse myelitis is an acute illness and the maximum severity is reached within a day to a few days. So, in your case, it is highly unlikely.
We can wait for the spinal tap.
At this stage, I would feel that no further investigations are ready. We should follow your clinical symptoms and investigate only if symptoms worsen.
You can take symptomatic treatment.
In any case, post-vaccinial reactions are one-time (monophasic) illness, and we expect slow recovery over time, rather than progression or worsening in future.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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