HPV and Seizures: Another Reason to Vaccinate?

Epilepsy Notes

Andrew N. Wilner, MD


September 23, 2013

Two Reports: HPV and Focal Cortical Dysplasia

Two amazing research papers concerning the human papillomavirus (HPV) have recently appeared in distantly related medical journals. The first article was published in the Journal of Infectious Diseases[1] by researchers at the Centers for Disease Control and Prevention. The second article stemmed from research at Shriners Hospitals Pediatric Research Center and was published in the Annals of Neurology.[2] The intimate relationship of these 2 independent reports is crucial to neurologists and epileptologists, yet it has largely passed under the radar of the mainstream and medical news.[3]

Success of HPV Vaccination

Markowitz and colleagues[1] report a clinical success story. The 2006 recommendation of the Advisory Committee on Immunization Practices for routine immunization with HPV vaccine for females aged 11 or 12, with catch-up vaccination for those aged 13-26 years,[4] has led to a significant reduction in vaccine-type HPV prevalence: from 11.5% in 2003-2006 to 5.1% in 2007-2010 in females aged 14-19 years -- an impressive 56% decline. Although 3 vaccine doses are recommended, even 1 dose afforded 82% effectiveness.

Genital infection with HPV is the most common sexually transmitted disease in the United States.[4] Although many HPV infections are asymptomatic, HPV infection can cause genital warts and anogenital cancers. A primary motivation of this vaccination campaign has been to prevent persistent HPV infection that increases the risk for cervical cancer.

A Viral Cause for Cortical Dysplasia

Chen and colleagues[2] reported the presence of HPV16 oncoprotein E6 in 50/50 (100%) of focal cortical dysplasia type IIB (FCDIIB) surgical specimens from children with intractable epilepsy. None of the 36 control brain specimens had similar findings, including those with temporal lobe epilepsy or tuberous sclerosis. To test the hypothesis that the E6 oncoprotein was related to FCDIIB, the researchers transfected E6 into fetal mouse brains, which resulted in a focal cortical malformation with enhanced mTORC1 signaling. Enhanced mTORC1 signaling is associated with other brain disorders, such as tuberous sclerosis complex, hemimegalencephaly, and ganglioglioma. This is the first report to document that HPV can infect the brain. Until now, cortical dysplasia has been considered a sporadic birth defect of unknown cause.


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