Dylon Finley v. HHS - MMR, epilepsy and subsequent speech impediment (2003)

On July 10, 2000, petitioners Chandria and Lonnie Finley filed a petition for compensation under the National Vaccine Injury Compensation Act on behalf of their son, Dylon Finley. They alleged that the measles-mumps-rubella (MMR) vaccine administered on July 11, 1997, when Dylon was fifteen months old, caused his epilepsy and subsequent speech impediment.

Petitioners claimed Dylon suffered an encephalopathy, a condition listed in the Vaccine Injury Table, as a result of the vaccine. The government contended that the medical records did not support the petitioners' claim.

An evidentiary hearing was held on October 5, 2001. Petitioners presented testimony from Dylon's family physician, Dr.

Michael T. Rendler, and his treating pediatric neurologist, Dr.

Brian E. Grabert.

The government presented testimony from Dr. Russell Snyder, a pediatric neurologist.

Dylon had no prior history of seizures or family history of seizures. Nine days after receiving the MMR vaccine, on July 20, 1997, Dylon experienced his first seizure, a generalized tonic-clonic episode lasting approximately three minutes, accompanied by a low-grade fever.

He later developed a rash and lymphadenopathy. Dr.

Ashakiran Sunku, a pediatric neurologist, attributed these symptoms to post-measles syndrome. An EEG performed the day after the seizure was essentially normal.

Dylon's mother reported increased aggression and problems with fine and gross motor skills after the vaccination. Dylon had a second seizure on June 26, 1998, accompanied by a rash and a rectal temperature of 102.6°F.

A third seizure occurred on February 11, 1999, lasting thirty-four minutes and not accompanied by fever. Further afebrile seizures followed in April and May 1999.

On May 11, 1999, Dr. Brian E.

Grabert diagnosed Dylon with primary generalized epilepsy. Dylon's neurological exam that day was normal.

He began taking Depakote in August 1999 and has been seizure-free since. On January 27, 2000, Dylon was diagnosed with a moderate phonological delay.

In total, Dylon had thirteen seizures and some speech problems. Dr.

Rendler and Dr. Silviano L.

Arguello noted in 2000 that they considered the seizure disorder secondary to the MMR vaccine. Dr.

Grabert testified that the MMR vaccine triggered Dylon's first seizure and, in his opinion, also triggered his epilepsy. He stated that Dylon must have an underlying encephalopathy because his first two seizures were triggered by low fevers, indicating a low seizure threshold.

However, Dr. Grabert conceded that most pediatric neurologists do not believe febrile seizures cause future epilepsy, that epidemiological data does not associate febrile seizures with epilepsy, that Dylon's epilepsy appeared to be of genetic origin and was "primary generalized," and that the MMR was at most a "possible" cause.

He also testified that Dylon would have developed epilepsy even if he had never received the MMR and attributed the third seizure to strobe lights. Dr.

Snyder testified that while the MMR caused the first seizure by inducing fever, all subsequent seizures and the epilepsy itself were the product of an underlying brain disorder of probable genetic origin, not a sequela of the vaccine-induced first seizure. Dr.

Snyder stated that Dylon's speech disorder was caused by the same brain disorder. He agreed that Dylon would have had epilepsy even without the MMR.

Dr. Russell Weibel, author of a medical article relied upon by petitioners, submitted a statement that Dylon did not fit the definition of encephalopathy used in his study.

The Special Master denied compensation, finding that the MMR-induced first seizure had no residua lasting more than six months and that the underlying brain disorder, not the vaccine, caused the epilepsy and speech impediment. The Special Master found Dr.

Snyder's testimony more credible and concluded that petitioners failed to prove a prima facie case that Dylon's MMR injury lasted more than six months and caused his current condition. The Special Master noted that Dylon's epilepsy was generalized and not symptomatic, indicating no brain insult.

The Special Master also found that Dr. Grabert's opinion that the MMR "possibly" caused the epilepsy was insufficient and that his concession that Dylon would have had epilepsy without the MMR undermined the claim.

The Special Master found Dr. Rendler lacked expertise in pediatric neurology.

The Special Master concluded that the MMR caused only the first seizure, which had no residua, and that an underlying brain disorder caused Dylon's epilepsy and speech deficit. On review, the Court of Federal Claims affirmed the Special Master's decision, holding that the Special Master's reliance on Dr.

Snyder over Dr. Grabert was not arbitrary or capricious, particularly given Dr.

Grabert's concessions. The court found that the Special Master properly considered Dylon's predisposition to epilepsy and that the petitioners failed to meet their burden of proving causation by a preponderance of the evidence.

The petition was denied.